The dust has settled on both national political conventions, and the presidential election is just around the corner. Now is the perfect moment to dive into the health policy positions of Vice President Kamala Harris and former President Donald Trump. Understanding their stances could be crucial for you and your employees.

Affordable Care Act (ACA)

The ACA dramatically changed the way Americans and small businesses get health insurance. It mandates Essential Health Benefits like preventive care, prescription drugs, emergency services, and hospitalization, among others. It includes protections for people with pre-existing health conditions. The ACA made health insurance available to more people and lowered the cost for many small business employees.

President Trump attempted to repeal and replace the ACA. Congressional Budget office analysts say his actions could have boosted uninsured Americans to 51 million. The administration discontinued cost-sharing subsidies, leading to increased premiums for Marketplace participants. Funding for outreach was cut. Both contributed to lower ACA Marketplace enrollment in 2017, 2018, 2019, and 2020.

The Trump administration proposed ACA changes that would have weakened pre-existing condition protections. Critics note short-term plans often do not cover pre-existing health conditions – or do so at a higher cost. The California legislature passed a prohibition on the sale of short-term health plans effective in 2019.

In campaigning for the 2024 election, President Trump has called to “never give up” on the repeal of the ACA. He says he will deliver a “much better” program at “far less money,” but he has not yet provided details.

Vice President Harris advocated for the American Rescue Plan Act (ARPA), which expanded the eligibility rules and ACA Marketplace cost-sharing subsidies. The temporary subsidies expire in 2025.

The ACA “family glitch” was amended by the Biden administration. Those with unaffordable employer-sponsored health care can qualify for ACA subsidies. The White House also announced a 2024 plan to curb the sale of non-ACA-compliant short-term health plans. Enrollment in ACA Marketplace plans is currently at an all-time high of more than 21.4 million.

Prescription Drug Prices

The Trump administration created a voluntary model allowing Medicare Part D plans to offer insulin at a monthly cost of $35 (from 2021 to 2023). It developed a program allowing the import of prescription drugs from Canada where prices are lower than in the U.S. President Trump also proposed eliminating drug rebates in Medicare Part D; however, implementation was delayed. His proposal to require drug manufacturers to disclose pricing in their TV advertising was also blocked.

Vice President Harris cast the tie-breaking vote in the U.S. Senate for the Inflation Reduction Act. The IRA enables the U.S. government to negotiate the price for some Medicare-covered medications. It also mandates rebates if drug prices rise more than inflation. It limits insulin costs to $35 for Medicare Part B and Part D plan participants, while boosting assistance for low-income Medicare beneficiaries.

Abortion and Contraception

President Trump has taken credit for overturning Roe v. Wade by appointing three anti-choice justices to the U.S. Supreme Court. He says he would consider a national 15- or 16-week ban on abortion. Recently he has expressed support for leaving the matter to individual states. In an August interview with CBS News, he said he would not use the 1873 Comstock Act to ban mail delivery of mifepristone. It is a medication that blocks a hormone needed for a pregnancy to continue. Some conservatives and anti-abortion activists have attacked this stance as nonsensical. President Trump took action to prohibit Planned Parenthood from receiving federal Title X funds. He issued a regulation allowing employers to claim a religious or moral exemption from the ACA’s contraception coverage requirement.

The leading voice for the Biden White House on reproductive rights, Vice President Harris supports a federal law to restore Roe v. Wade. She is the only vice president or president to visit a Planned Parenthood clinic while in office. While in the U.S. Senate, Harris co-sponsored the Women’s Health Protection Act. It would have blocked states from imposing restrictive policies to limit abortion access. She strongly supports the ongoing availability of mifepristone and the ACA’s contraception coverage mandate.

Health Care Costs and Cancellation of Medical Debt

President Trump signed the No Surprises Act. This bipartisan legislation protects patients from unexpected medical bills from out-of-network care. He also issued an order requiring hospitals to post negotiated charges online. He supported efforts to repeal and replace the ACA with what he said would be a less expensive option. No plan details were ever shared. Legislative efforts by the GOP also fell short.

The Biden-Harris administration has proposed cancelling medical debt for millions of Americans. It also announced a proposal to remove medical debt from the credit reports of 15 million Americans. It is encouraging local and state government actions to reduce the burden of medical debt.

In implementing the No Surprises Act, the Biden-Harris administration proposed expanding protections to include ground ambulance providers. As noted, the Inflation Reduction Act passed in 2022 empowers Medicare to negotiate prescription drug prices starting in 2026. The estimated cost savings on the 10 selected drugs for the first year could top $1 billion. Negotiated discounts range from 38% to 79% off list prices.

Exercise Your Right to Vote

The goal of this column was to offer a clear presentation of President Trump’s and Vice President Harris’s perspectives on health issues. For more details, check out their websites and the KFF website.

Keep the following information in mind when it comes to voting in the November 5, 2024, election:

• The last day to register to vote for the November 5, 2024, General Election is October 21, 2024.
• All California active registered voters will receive a vote-by-mail ballot for the November 5, 2024, General Election.
• County elections offices will begin mailing ballots by October 7, 2024.
• Ballot drop-off locations open on October 8, 2024.
• Vote-by-mail ballots can be returned by mail, at a drop-off location, or your county election office. You can look up your county’s election offices on the Secretary of State’s website.
• Vote centers open for early in-person voting in all Voter’s Choice Act counties beginning on October 26, 2024.
• Vote-by-mail ballots must be postmarked on or before Election Day and received by November 12, 2024.

Maximizing Your Health Insurance Dollars

If you offer employee health insurance, or are considering it for the first time, talking with an insurance broker can help. Your broker will compare plans and discuss the benefits of CaliforniaChoice.

 

Editor’s Note: For a complete analysis of health care policy views and actions by former President Trump and current Vice President Harris, visit the KFF website.