Ken Perez: An assessment of the health policies of Kamala Harris and Donald Trump

Given the competitiveness of the 2024 presidential election, tremendous attention has been paid to seven so-called “battleground” states. But there also are key battleground issues, and among them, healthcare stands out as one of the public’s top areas of concern. Moreover, this critical policy battleground became more intriguing with the unprecedented passing of the baton in July from President Joe Biden to Vice President Kamala Harris to be the Democratic Party’s nominee, and the as yet only brief policy statements of former President and Republican Party presidential candidate Donald Trump.

A shift in policy position by Democratic Party candidate Kamala Harris

The Harris campaign has two tasks when it comes to healthcare policy.

First, Harris must distance herself from her previous advocacy of Medicare for All, which she supported as a co-sponsor of Bernie Sanders’ Medicare for All legislation in September 2017 while she was a U.S. senator. At a January 2019 CNN town hall, she seemed to fully support the concept, arguing that insurers are motivated by profit, impose paperwork on patients and delay care.

Harris then concluded, “Let’s eliminate all of that. Let’s move on.”

Ian Sams, her adviser and spokesperson at the time, said to CNN, “Medicare for All is the plan that she believes will solve the problem and get all Americans covered. Period.”^a

However, in the summer of 2019, Harris released her own healthcare plan, one that diverged from Sanders’ bill. Harris’ proposal would have expanded the existing Medicare system, including the popular insurance option called Medicare Advantage, and it called for a 10-year transition period, significantly longer than the four-year transition period proposed by Sanders. Because Harris’ plan retained a role for private insurance companies within the healthcare system, Sanders told CNN, “I like Kamala. She’s a friend of mine, but her plan is not Medicare for All.”

In early August of this year, Harris’ team said that she no longer supports Medicare for All, although the Trump campaign has attacked Harris over her past support for a single-payer, government-run healthcare system.

The Harris campaign’s second task is to align with and expand the healthcare policies of Biden. The 2024 Democratic Party Platform, released on Aug.18, provides a lengthy articulation of Biden’s agenda. Clearly written prior to his withdrawal from the race, it refers to “President Biden’s lowering costs agenda” and “President Biden’s plan.”^b

The platform’s 1,500-word section on healthcare emphasizes the Democrats’ commitment to defend the Affordable Care Act (ACA) and expand Medicaid. It also advocates for amplifying the Inflation Reduction Act’s prescription drug mandates, including:

• Medicare “negotiation” of prescription drug prices, adding at least 50 drugs a year to the 10 already negotiated for 2026
• Extension to all Americans the $2,000 per year cap on out-of-pocket prescription drug costs that exists for Medicare beneficiaries starting in 2025
• A $35 per month insulin cap for all everyone, not just Medicare beneficiaries
• Expansion of rebates to private insurers, not just Medicare, for drug price increases greater than inflation

The platform is highly critical of the private sector, reserving its harshest language for Big Pharma, accusing the drugmakers of price gouging and stating, in part, “Big Pharma has ripped off Americans for years.”

In addition, the Harris campaign has emphasized abortion rights, and on Aug. 19, in line with Biden’s 2025 Budget for Fiscal Year 2025, Harris proposed raising the corporate tax rate to 28%, up from the current 21%, an unwelcome change for for-profit hospitals and health systems. (In contrast, Trump has proposed reducing the corporate tax rate to 20%.)

Scaled back messages from Republican Party candidate Donald Trump

Throughout his term as president, Trump railed against the ACA and pushed Congress to pass legislation to repeal the law. However, his view of the ACA has evolved. In November 2023, he wished the Republicans in Congress had terminated or repealed it. One month later, he promised to come up with an alternative to the ACA. And then in March, he said he wasn’t running to terminate the ACA, but somehow make it better and less costly. 

Trump’s most recent health policy stances were reflected in “Better Health Care Choices at Lower Costs,” a 151-word section on Trump’s campaign website that has since been taken down, and a brief, 46-word paragraph titled “Affordable Healthcare” in the 2024 GOP Platform, which clearly echoes Trump’s voice.^c Notably, neither mentioned the ACA.

In the former, Trump advocated for cessation of all COVID mandates, restoration of medical freedom (i.e., protecting health workers who refuse to take part in procedures on religious or moral grounds), ending surprise medical billing, increasing fairness through price transparency, reducing the cost of prescription drugs and health insurance premiums and protecting Medicare, Social Security and patients with pre-existing conditions.

Most of these are not controversial, and the Harris campaign would agree that a number of them are valid goals. However, Trump does not spell out how he would go about  reducing the cost of prescription drugs and health insurance premiums.  

The “Affordable Healthcare” section of the 2024 GOP Platform provides a hint. After leading with “Healthcare and prescription drug costs are out of control,” it states, “Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options.” These are the watchwords of a market-based approach.

Conclusion

Harris and Trump agree on one thing:  the goal of improving the affordability of healthcare. But they disagree sharply on how to pursue that goal. Both of them are seeking to distance themselves from certain elements in their pasts — Harris from her prior support of Medicare for All, and Trump from his fierce opposition to the ACA. They are saying what they think voters want to hear, with political expediency taking precedence over economic reality. In the final analysis, they are offering voters strikingly different visions for the nation’s healthcare system.

  

---

Footnotes

a. Krieg, G., and Luhby, T., “Kamala Harris’ complicated history with Medicare for All becomes a Trump campaign attack line,” CNN, Aug. 14, 2024.
b. Democratic National Committee, “ Democratic Party Platform,” accessed Aug. 20, 2024.
c. The American Presidency Project, “2024 GOP Platform: Make America Great Again!” July 8, 2024.