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D.C. Diagnosis: A health care policy voter guide

by · STAT

With rare exception, early voting has started everywhere in the United States in the lead-up to election day on Nov. 5. We’re providing an extra newsletter as a refresher on the stakes for health care as you head to the polls. We’re also offering a 40% discount off a year subscription to STAT+.

What if Harris wins?

The Affordable Care Act and Inflation Reduction Act, both laws passed solely by Democrats, form the foundation of Vice President Harris’s health care platform. She plans to lean heavily on both to maintain high insurance coverage levels and keep insurance affordable.

Her advocacy for reproductive health services and focus on maternal mortality also set her apart, even among Democrats. 

However, she has added policy planks to that platform throughout her short presidential campaign. Her first new proposal was to cancel billions of dollars in medical debt, which could be a boon for hospitals. 

Harris proposed to expand Medicare price negotiation to fund new home care, vision, and hearing benefits in Medicare.

She also wants to extend drug pricing reforms beyond Medicare, to people who get health insurance through work.

Drugmakers are not the only target of drug pricing reform. She also wants to go after drug middlemen, which would benefit drugmakers.

Who to know in a Harris administration 

STAT put together a list of 10 people who have helped shape Harris’ positions and could continue to be influential if she wins the election. 

Some of Harris’ important relationships go back several years. She has known Sen. Laphonza Butler (D-Calif.) since before Harris became California attorney general, when Butler led a home care workers union. Others, such as billionaire business mogul Mark Cuban, have arrived on the scene much more recently.

What if Trump wins? 

Former President Trump is more difficult than Harris to predict. During the debate against Harris, he said he has a “concept of a plan” for replacing the Affordable Care Act. After a couple of attempts at clarifying that statement by running mate JD Vance, Trump said he’d probably keep the ACA. 

Trump seems to be building a health care platform that is based on fighting chronic illness in ways that eschew insurance and conventional medical treatments. 

Some of the GOP’s most divisive policies against immigrants and people who are transgender have been incorporated into Trump’s health care platform. 

However, abortion is an area in which he has tried to be less divisive by softening his stance on a national abortion ban – though he still boasts that he shaped the Supreme Court that overthrew federal abortion protections. Trump also dropped his most aggressive attack on the drug industry when he backed off his proposal to slash prescription drug prices by linking them to prices abroad. However, House Speaker Mike Johnson (R-La. ) said Tuesday that the House GOP has a plan for “massive reform” of the ACA, if Trump wins.

Who to watch in Trumpworld

Trump’s interest in chronic illness has created an opening for Robert F. Kennedy Jr. and a coterie of like-minded people to get close to Trump. They’re pushing a vague health care agenda that they call “Make America Healthy Again.”

Trump has promised to give the vaccine skeptic a role in his administration, much to the concern of industry. Trump hasn’t said what that position would be, but at his Madison Square Garden rally on Sunday in New York, he said he’s going to let Kennedy “go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on medicines.”

There are also several people from his previous administration who could return for a second.

What to expect of Congress

Congress could have a big hand in shaping health policy after the election, as many of Trump and Harris’ proposals would require the cooperation of lawmakers. And yet, lots of other policies that Congress is expected to deal with during the lame duck session and next year don’t rise to the level of being part of either candidate’s health care platforms.

Some also don’t depend on either party being in control. For example, anti-China sentiment is pervasive in both parties and could propel Congress to pass legislation aimed at hurting China’s biotech industry. Conversely, both parties support letting Medicare continue to cover telehealth services.

But the fight next year over expanded Affordable Care Act premium subsidies and Trump’s 2017 tax cuts, both of which expire at the end of 2025, will depend on who controls Congress and the White House.

What’s happening in the states

Residents in more than a dozen states are voting on health care issues that include abortion, psychedelics, long-term care, and medically assisted suicide.

Abortion features prominently among ballot measures. Ten states have abortion initiatives on the ballot, the most since the Supreme Court overturned Roe v. Wade in 2022. 

A handful of states with health care ballot initiatives also have key Senate races that could determine which party controls that chamber. Among the most interesting is Montana, where voters might approve a measure to protect abortion access while choosing anti-abortion Republican candidate Tim Sheehy over the Democratic incumbent Jon Tester.

California has an interesting combination of seemingly unrelated ballot measures. After controversial long-time AIDS activist Michael Weinstein got a rent-control measure on the ballot, apartment builders launched a ballot initiative that would undercut a drug discount program that is a key revenue generator for Weinstein’s AIDS clinics.

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