The outcome of the U.S. presidential election on November 5, 2024 could have a profound effect on federal government policies affecting healthcare and public health in the coming years. This is because the U.S. political system has become so polarized in its outcomes that government health policies would be substantially different depending on which political party is in the majority. Over the years, the American political system has changed in such a way that elected officials pay more attention to the opinions of their own party members rather than to public opinion as a whole when it comes to policy decisions. This means that the health policies that will be adopted after these elections will likely reflect the political opinions of the party that will have the majority in Washington, with very marked differences and necessarily divisive choices.
<a href="http://www.world-today-news.com/donald-trump-whats-behind-the-us-presidents-baltimore-attack/" title="Donald Trump: What's behind the US President's Baltimore attack”>Kamala Harris and Donald Trump propose very different recipes on healthcare in their election programs. While health care reform may not be as central an issue in this election as it has been in the past, health care remains a major concern for voters.
Much of the debate on health issues during the election campaign focused on access to reproductive health care and the methods and timing of pregnancy termination. But the election will also have important implications for policies affecting health insurance coverage and access to care more generally in the United States. “For perhaps the first election campaign since 2004, controversies over health coverage policies had a relatively low profile,” they explain Sherry Glied (New York University) e Benjamin D. Sommers (Harvard T.H. Chan School of Public Health) in un editoriale pubblicato dal New England Journal of Medicinethe most prestigious medical journal in the world, which recently dedicated numerous articles to the topic: “Despite the absence of widely disseminated policy proposals, the precedents of the candidates and their parties offer strong signals of very different approaches to very important issues relating to markets, to Medicaid and to Medicare. The results of presidential and congressional elections and state elections could have profound effects on the coverage available to tens of millions of Americans.”
Let’s try to make a schematic comparison between Trump and Harris on some health policy issues (to see them all click here):
DONALD TRUMP
▪ Signed the bipartisan No Surprises Act, which protects patients from unexpected medical bills when they unknowingly receive care.
▪ Issued an executive order on price transparency, which led to a rule requiring hospitals to post negotiated rates for their services online, using the authority of the ACA.
▪ On his 2024 campaign website, he promises to continue his previous efforts regarding surprise medical bills, price transparency and prescription drug prices. He also promises to reduce health insurance premiums, but provides no details on how he plans to do so.
▪ The administration has challenged anticompetitive behavior, including healthcare mergers. He approved, with some conditions, the merger between CVS Health and Aetna, one of the largest healthcare mergers in history.
▪ Despite creating Operation Warp Speed, which successfully developed effective COVID-19 vaccines in record time, and initially promoting the vaccines, he has regularly questioned science and public health.
▪ Devolved most of the responsibility for the COVID-19 response to states, with the federal government acting as “mere support” and “provider of last resort.”
▪ Proposed significant budget cuts to the CDC and other federal public health programs.
▪ He said he would “probably” disband the White House Office of Pandemic Preparedness and Response Policy, established by Congress in 2023.
▪ Proposed requiring drug makers to disclose drug prices in television ads (blocked by court ruling).
▪ Pursues an “America First” approach to foreign policy, including on global health, prioritizing sovereignty and disengaging from multilateral agreements.
▪ Ended U.S. funding to the World Health Organization and began a process to withdraw U.S. membership in the organization.
▪ Chose not to join COVAX, the global initiative to distribute COVID-19 vaccines.
▪ Proposed to eliminate/significantly reduce funding for most US global health programs in several presidential budget requests; ended funding for the United Nations Family Planning Agency (UNFPA).
KAMALA HARRIS
▪ Proposes working with states to cancel medical debt for 15 million Americans.
▪ In 2021, the Biden-Harris administration began implementing the No Surprises Act, establishing processes to determine out-of-network bill payments and resolve payment disputes. The administration has also proposed extending surprise billing protections to ambulance providers.
▪ The administration has expanded Trump-era rules on price transparency to address challenges in implementing and enforcing the legislation.
▪ The administration supported the Inflation Reduction Act that authorizes Medicare to negotiate the prices of some drugs with pharmaceutical companies and increase subsidies for ACA marketplace plans.
▪ The administration issued an executive order to promote competition, issued updated merger guidance, and challenged anticompetitive behavior in the healthcare industry.
▪ The Biden-Harris Administration is committed to listening to science, public health advice and evidence-based guidance in responding to the COVID-19 pandemic.
▪ The administration has rolled out new federal COVID response policies, such as mask and vaccine mandates, expanded access to testing and vaccines, and a major effort to strengthen the nation’s public health workforce.
▪ The administration established a new White House Office of Pandemic Preparedness and Response Policy.
▪ The administration has begun a project to reorganize and modernize the CDC “to better share science and data to better serve and protect the American public.”
▪ The administration has proposed significant increases to the nation’s public health budget each year, including the fiscal year 2025 budget, which includes $20 billion in new mandatory funding for pandemic preparedness and response and $12 billion in dollars over ten years for a new adult vaccine program.
▪ The administration launched new initiatives to combat health misinformation and address health inequities.
▪ The administration established a voluntary model to increase access to cell and gene therapies for people with Medicaid.
▪ The Biden-Harris administration promotes international cooperation and alliances in foreign policy and global health.
▪ The administration reversed its decision to withdraw from the WHO and restored U.S. funding for the organization.
▪ The administration restored funding for UNFPA.
▪ The administration issued a national security memorandum and executive order that positioned global health as a “top national security priority.”
▪ The administration joined COVAX and committed to making the United States the largest donor of COVID-19 vaccines globally.
▪ The administration reestablished the NSC Directorate for Global Health Security and Biodefense.
▪ The administration supported WHO negotiations to develop a new agreement on pandemics and to revise the International Health Regulations.
“Although Harris and Trump have markedly different political orientations, whoever the next US president is will have a conservative Supreme Court and may lack a congressional majority,” they warn Marcella Alsan (Harvard Kennedy School, Cambridge) e Ruqaiijah Yearby (Ohio State University, Columbus) sempre sul NEJM. “Recent judicial decisions, such as the overturning of the Chevron doctrine, limit the power of the president and federal agencies to establish rules that safeguard the health of Americans. However, the president retains the power to appoint federal judges and agency directors and to define issues such as whether observed health inequities should be attributed primarily to systemic deficiencies, which require government intervention, or to personal choices, which require changing lifestyles.”
