The Buzz This Week
Tuesday was the first presidential debate between Vice President Kamala Harris and former President Donald Trump. The two key healthcare issues discussed during the debate were abortion and reform of the Affordable Care Act (ACA). Overall, healthcare received limited airtime.
Abortion saw the lengthiest dialogue of any healthcare topic. In recent weeks, Trump has shifted his stance on state-specific abortion policies and evaded questions about a national abortion ban. Trump had previously stated that a 6-week ban, like the one in Florida where Trump is a registered voter, was too restrictive. But he now says he will vote against his state’s proposition extending abortion protections.
Tuesday night, Trump noted that he believes abortion should remain a decision at the state level and cited Ohio and Kansas as examples of voters choosing to protect abortion rights. However, when asked to confirm his vice-presidential candidate JD Vance’s statement that Trump would veto a national abortion ban, he replied that he “didn’t discuss it with JD.”
Harris reiterated that she would reinstate national abortion protection through legislation and highlighted that most Americans feel healthcare decisions should not be made by the government. A recent Pew Research Center survey found 63% of Americans feel abortion should be legal in all or most cases. Harris also shared stories of women who have not been able to receive reproductive healthcare as a result of the Dobbs decision.
The other key healthcare topic in the debate involved healthcare coverage through the ACA and private insurance options. Harris noted that despite her backing of Medicare for All in her 2020 presidential run, she now supports private insurance coverage. She also stated she would expand the ACA. She touted the Biden administration’s achievements on Medicare drug pricing negotiations and capping the cost of insulin.
Trump expressed his continued disapproval of the ACA, specifically the cost. But when asked about details for what he would replace the ACA with, he stated that he “has concepts of a plan.” Trump’s platform for this election does not mention repealing the ACA. He did note if a less expensive public option came across his desk, he would sign it.
Why It Matters
Tuesday may have been the only opportunity for voters to hear the candidates debate each other. A second meeting has not yet been scheduled, though Vice President Harris has indicated she would like a second debate in October.
Without a second debate, voters would need to rely on party platforms, speeches, and interviews to understand the nominees’ positions on other key healthcare topics. According to a recent Kaiser Family Foundation (KFF) poll, economy and inflation are the issues most voters say are their top concern (38%), followed by threats to democracy (22%), and immigration (12%). The next four issues all relate to healthcare or public health. Of respondents, 7% said abortion was their top concern, 7% said Medicare and Social Security, 5% said healthcare costs, and 3% said gun policy, making up 22% of those surveyed.
In July, Chartis previously covered where the candidates may fall on key healthcare issues. We have since reviewed both parties’ platforms for healthcare-specific policies. Below are the positions noted in the party platforms on the four key healthcare issues KFF identified as top voter priorities, as well as issues that each party has specifically addressed.
The Republican platform is relatively sparse on healthcare policy but does make note of a few key healthcare topics:
- Abortion and women’s health. The platform notes it will leave reproductive protection decisions to the states. It also notes it will support policies that advance prenatal care, access to birth control, and access to IVF, though this varies from what other party leaders have expressed in recent months.
- Seniors and Medicare. The platform states that Republicans will protect Medicare and support a focus on chronic disease management as well as flexibility and choice in benefit design.
- Healthcare affordability. The party expresses a desire to make healthcare more affordable through increased transparency, competition, and prescription drug options.
- Gun control. While the GOP platform does not mention gun control, it does list the right to keep and bear arms as one of the 20 promises the party hopes to accomplish.
- Opioid epidemic. The GOP notes little about treatment and harm reduction. Instead, the platform suggests a naval embargo to prevent fentanyl from entering the US. Trump has also suggested the death penalty for convicted traffickers.
The Democratic platform provides a greater level of detail on its policy intentions related to healthcare and more specifically notes a number of healthcare topics the party plans to address:
- Abortion and women’s health. The Democratic party aims to protect access to reproductive care, reduce maternal mortality, increase funding for women’s health research, strengthen access to contraception, protect IVF, pass a national 12-week paid leave program for mothers, and strengthen the Violence Against Women Act.
- Seniors and Medicare. Like the GOP, the Democratic party also vows to protect Medicare. The platform also notes they intend to expand traditional Medicare coverage to include dental, vision, and hearing services.
- Healthcare affordability. The platform states the party will continue the health insurance premium tax cut and make it permanent, continue negotiations of prescription drug prices, and continue Medicaid expansion. The platform also states it will invest in mobile, community, and rural health clinics to provide greater access to care in communities in need and ease the burden of medical debt.
- Gun control. The Democratic party seeks to pass universal background checks with increased funding to complete checks, ban assault weapons and high-capacity magazines, require safe storage of all guns, end gun industry immunity, pass national red flag laws, and fund gun violence research across the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH).
- Opioid epidemic. The platform notes the party will invest in treatment, life-saving medication, and recovery support services.
- Health disparities. Democrats aim to address social drivers of health that lead to inequities, invest in a diverse workforce to support pregnant and postpartum women, and address the disproportionate impact of infectious diseases on people of color.
- LGBTQIA+ health. The platform states the party will expand mental health and suicide prevention services for the LQBTQIA+ population, ban conversion therapy, and provide training for healthcare workers.
- Mental health. The Democrats aim to strengthen mental health parity requirements, close insurance loopholes, and expand Medicare coverage for mental health.
- Climate change. The platform suggests they will consider and try to improve the health impacts of pollution and climate change on all communities.
Former President Trump and Vice President Harris will continue to speak on their intended policies over the coming 2 months through interviews, campaign rallies, and potentially a second debate. While platforms are published, nuances in the goals for their respective administrations may continue to evolve.
Additionally, the ability of each party to carry out its stated platform is dependent not only on which party wins the presidential election but also the outcome of congressional elections. The House and Senate outcomes will be crucial to shaping the first 2 years of either administration, during which the opportunity for legislation is typically the greatest.
Many healthcare decisions are determined at the state level rather than the federal level. States oversee the distribution of state healthcare resources, including Medicaid administration, regulation of health insurance plans not underwritten by employers, and currently reproductive freedoms. In the coming months, Chartis will provide additional coverage on state propositions, gubernatorial races, and key congressional elections impacting healthcare.
RELATED LINKS
Kaiser Family Foundation:
KFF Health Tracking Poll September 2024: Harris v. Trump on Key Health Care Issues
Forbes:
Trump Admits He Has No Answer To Obamacare, But ‘Concepts Of A Plan’
STAT News:
Trump struggles to find an abortion answeR
Fierce Healthcare:
Harris and Trump square off on abortion, Obamacare in first debate
Editorial advisor: Roger Ray, MD, Chief Physician Executive.
