Harris vs Trump: What it means for US healthcare at a glance

With another election cycle nearing I wanted to pull together a short piece on the stances and likely impact of the two main tickets on offer (sorry RFK Jr). This isn’t my political opinion, but a summary of what the two parties have said, done, or stated they will do and my best guess at the likely consequences of it to American’s. I’m also not a prophet so this may all end up being nonsense. Finally, for those less familiar with American politics, it's worth noting that whilst both candidates have ambitions, without control of all the necessary branches of government in the current constitutional set up, or absent bipartisan cooperation, the ability to enact legislation will be limited.?

Harris / Walz

The impact of a Harris term is most simply summarized as probably more of the same.?

• VP Harris has taken a tough stance in the past to block mega mergers of health plans such as the $54 Billion Anthem - Cigna merger so that provider pricing could not be cut. She will likely continue to pursue anti-competitive practices in the market.?

• It is also likely that VP Harris will continue to have a less fiduciarily friendly relationship with the large health insurers with continued headwinds with regards to Medicare.?

• VP Harris has previously backed the Medicare For All single payer movement. She has been less vocal about this in recent years and there has been no mention of it on the ticket. It will likely not be a significant policy stance. Instead it is more likely she will continue to support and push for legislation that strengthens and improves the Affordable Care Act and Federal Medicaid subsidies.?

• VP Harris has backed stricter drug pricing such as aligning US prices with those in other markets. We should expect this to continue with medications coming more into line with other developed nations.

• The strongest healthcare policy stance is likely to be regarding reproductive rights. VP Harris has a track record of advocating for expanded Medicaid coverage for new and expectant mothers and better data collection around adverse maternal outcomes and associated inequity. The overturning of Roe vs Wade and putting into place protections on a women’s rights to choose is looking to be the biggest healthcare policy push for the VP and her running mate in the run up to November. Success here should stabilize maternal and child health outcomes in areas that are influenceable.

Trump / Vance

The impact of another Trump term is harder to predict as policy stances tend to evolve in real time, there are consistencies in the messaging however.?

• Trump has stated he still wishes to repeal the Affordable Care Act. The biggest danger of this will be the possible removal of the pre-existing conditions clause. Without knowing what it will be replaced with the impact can only be quantified in terms of what would happen absent it. In that scenario fewer people will have access to or the ability to get coverage.?

• Trump wishes to put tougher caps on federal government Medicaid spending through a variety of mechanisms including work requirements and block grants. Whilst Medicaid will continue to be a state by state situation, the national impact will be to reduce access and coverage, reduce the sustainability of services provided by the state and likely pass the cost onto other actors or the individual to become uninsured.?

• Trump will continue to push for lower prescription drug pricing after efforts such as the most favored nation model in his previous term. Progress was made here and this will likely be an area for bipartisan cooperation.?

• Trump has been clear that he believes in competition and free market principles. Expect a friendlier approach to the big health plans than the current administration and more reimbursement for their services especially in the Medicare market.?

• Trump has been vocal about framing the repeal of Roe vs Wade as a victory and wanting to enshrine limiting abortion access into law. This may be political grandstanding with a more moderate position in actuality, but assuming not, this in combination with decreased Medicaid spending will likely lead to worse Maternal and Child outcomes.
• Project 2025 proposes Medicare Advantage for all as the default for all newly eligible Medicare beneficiaries and whilst explicit endorsement of Project 2025? has not occurred, it is not a stretch that Trump may adopt this policy position.?