Kamala Harris has tailored her health policy away from Medicare for All, aligning it more closely with an expansion of the Affordable Care Act. Donald Trump said he has concepts of a healthcare plan. Nearly 80% of voters view healthcare as at least very important in the upcoming election, according to a recent Gallup poll.
What will the candidates propose for Medicare, Medicaid, abortion, and employer-based private insurance—and what crucial element are they overlooking?
Medicaid
Medicaid is the government’s joint federal and state safety-net insurance program. A Trump administration would likely aim for reduced Medicaid funding, stricter eligibility criteria, and potentially a repeal of the Affordable Care Act. This would mean fewer entitlements, lower enrollment, and reduced spending. A Harris administration would focus on expanding coverage, increasing access, and promoting equity. Traditional debates on taxation, entitlements, and costs remain divided along party lines
Is the $805 billion price tag justified?
Coverage does not equate to access. In my practice, I’m fortunate to care for patients irrespective of their financial capacity, but treating Medicaid patients is considerably more challenging. Their physician visits are often capped annually, they have fewer pre- and post-operative resources, and they face greater obstacles in obtaining imaging and medications. Managed care increases the administrative burden. Large registry data from Andrew Chan MD, a neurosurgeon on faculty at Columbia University, indicate that Medicaid patients experience worse outcomes following spine surgery. While Trump advocates for reduced funding, Harris promotes equity.
In Alabama, if Medicare pays a physician $1 for a procedure, Medicaid pays $0.72, while private insurance pays $1.43. This arithmetic complicates care delivery.
Deep dive here.
Private Insurance
In the United States, 57 percent of Americans under 65 get insurance through their employer.
This system, originating from WWII-era wage laws, has hindered real wage growth, as health insurance costs rise annually.
Trump’s intentions to repeal the ACA remain uncertain, as does his plan for a replacement. Harris has retreated from Medicare for All, a position she co-sponsored in 2020 alongside Bernie Sanders. She hasn’t needed to address the issue from the Left in this cycle, having skipped a primary election.
Enhanced subsidies in the ACA marketplace present a more pragmatic issue. In 2021, Democrats eliminated the previous income cap and increased the subsidy amount. These subsidies are set to expire in 2025. Harris advocates making them permanent, with a price tag of $335 billion, while Trump has largely remained silent, though many Republicans favor the program’s expiration.
Regardless of ACA views, it’s important to note health insurance is still more expensive now than ever before. There may be some bend to the cost curve, but the average cost of health insurance for a family of four was $23,968 in 2023. UnitedHealth Group’s 2023’s net earnings were $22.4 billion, up 11.2% from last year.
Deep Dive here.
Abortion
If you prefer more access to abortion, the vote is Harris. If you want the chance of laws being enacted at the state level to restrict abortion, the vote is Trump.
From a policy perspective, Harris advocates for a return to Roe v. Wade, a stance aligned with 60% of voters. Trump’s policy emphasizes making abortion a state-level issue. Trump’s opinion on the matter has fluctuated; he currently supports limits around 15-weeks, in line broader public sentiment on abortion itself. Harris’s previous record on abortion is more progressive and less in line with America. She supported the Reproductive FACT Act, which mandated that pregnancy centers inform clients about abortion services (overturned in 2018 on First Amendment grounds), and voted against measures to protect infants surviving abortion procedures and restrict post-20-week abortions. Only 22% of Americans support abortion in the third trimester.
Harris supports eliminating the filibuster to codify Roe, though this depends on Democrat control of Congress. Trump appears comfortable mostly delegating abortion laws to the states.
Deep dive here.
Medicare
Both Trump and Harris perpetuate illusions about Medicare. Trump claims to protect it, yet his budget proposals suggest otherwise. Harris’s plans for new entitlements, funded through increased taxes and alleged efficiencies, appear fiscally untenable. Medicare faces insolvency by 2036.
Harris is recently touting coverage for home health care with a price tag of $40 billion per year. Mia Ives-Rublee and Molly Weston-Williamson from the Center for American Progress Action state the addition this would revolutionize care in America; it would help families, communities and the economy. Michael Cannon from the Cato Institute frames it as an; “irresponsible proposal.” Something else will have to be cut or taxation significantly increased.
Some progress has been made in drug price negotiations. The Biden-Harris administration enabled Medicare to negotiate prices, with reductions expected by 2026, a long-blocked goal. Republicans worry this could stifle R&D. Trump has not clarified his stance.
Deep dive here.
What Are The Candidates Missing?
Healthcare spending has ballooned to levels that defy fiscal prudence, but healthcare dollars aren’t going to the people who provide it. Physician services make up just 14.5% of healthcare spending.
From 1975 to 2019, the number of physicians grew 150% while healthcare administrators grew by 3200%. Hospital executive salary jumped 93% over a decade with average pay gaps of 5:1 for hospital CEOs versus surgeons, 12:1 versus pediatricians, and 44:1 versus nurses.
The average gap in salary between a hospital CEO and surgeon is 5:1, pediatrician is 12:1, and nurse is 44:1.
Neither candidate addresses a return to the fundamental tenet of healthcare: the patient-physician relationship.
