In the final days of the campaign, stark disagreements between Vice President Kamala Harris and former President Donald Trump over the future of American health care are on display, particularly in stark warnings about abortion access, the specter of future cuts to Affordable Health Insurance. Take action and bold statements about empowering activists eager to change course and clean house.
Trump and his campaign have been vague about plans for health care policy, although current and former Trump advisers have released plans that go far beyond rolling back programs in place under the Biden administration to reforming public health agencies and allowing Trump quickly fire officials who disagree. .
Harris, on the other hand, has primarily advocated for positions to preserve and protect access to existing health care: on abortion, transgender health care, insurance coverage, and more.
Here are some of the biggest health policy changes that could depend on who wins the White House.
ACA Premiums
The election is likely to affect the cost of health insurance for millions of people who buy coverage on the Affordable Care Act marketplaces.
That’s because additional pandemic-era subsidies that reduce the cost of premiums will expire at the end of 2025 unless Congress and the next president act.
Harris has committed to making the enhanced subsidies permanent, while Trump has made no such commitment.
Letting them expire “would reduce fraud and waste,” said Brian Blase, a former Trump adviser and president of the Paragon Health Institute, a conservative policy research firm.
About 19.7 million people with ACA coverage benefit from a subsidy—92% of all enrollees. The expanded subsidies, initiated in 2021, helped increase ACA enrollment to a record level and reduce the uninsured rate to a record low.
They have also reduced premium payments by approximately 44%. Many do not pay any premium.
Without congressional action, nearly all ACA enrollees will see sharp increases in premium payments in 2026, according to KFF. The Urban Institute estimates that 4 million people could become uninsured.
Letting the subsidies lapse could cause a setback for Republicans in 2026, said Jonathan Oberlander, a health policy expert at the University of North Carolina School of Medicine: “Is it worth it politically?”
—Phil Galewitz
Abortion
When he was president, Trump promised (and delivered) Supreme Court justices who would vote to overturn the constitutional right to abortion. In the event of a second term, he promised to leave abortion policy in the hands of the states, although he would have significant room to maneuver to reduce access at the national level.
Harris has promised to restore protections from Roe v. Wadealthough doing so would require help from Congress. At the very least, a Harris presidency would largely preserve existing protections and prevent new federal restrictions.
Trump’s early actions would likely mirror those of many Republican presidents since the 1980s: defunding Planned Parenthood and the United Nations family planning agency and, more recently, allowing employers with religious or moral objections to contraception to refuse coverage through employment-sponsored health plans. .
But Trump could go much further and effectively ban abortion even in states where it is legal. For example, the FDA could reduce the availability of the abortion pill mifepristone or cancel its approval. This has been the subject of numerous lawsuits, including one before the Supreme Court that was recently revived.
Trump could also order the Justice Department to enforce the Comstock Act, an 1873 law that prohibits the mailing of “any article or thing designed, adapted, or intended to produce abortions, or for any indecent or immoral use.” This could apply not only to abortion pills, but also to supplies for abortion procedures.
—Julie Rovner
Drug prices
Both campaigns say they are committed to lowering drug prices. Trump has offered few details, although the America First Policy Institute, a think tank run by close Trump allies, has proposed policies that are considerably less aggressive than Harris’s proposals.
Harris has said she would expand negotiations on drug prices and limits on out-of-pocket drug spending allowed by the Inflation Reduction Act. He has also called for more transparency requirements for pharmacy benefit managers, or PBMs, the pharmaceutical industry’s power brokers.
The America First plan would reduce costs by reducing reimbursements to doctors for some expensive infused drugs, using trade policy to force other developed countries to raise what they pay for drugs and making more prescription drugs available without a prescription.
The plan does not mention bipartisan legislation being considered in both chambers of Congress that seeks to achieve lower drug prices through new transparency requirements for PBMs.
-Arthur Allen
Health of trans people
The presidential election could determine whether transgender Americans retain broad protections that ensure they have access to gender-affirming health care. Trump has said he would seek to ban hormone replacement therapy, gender reassignment surgery and other treatments for minors, and make the services more difficult for adults to receive.
In the final days of the campaign, Trump and his political action committees have leaned toward running divisive ads attacking Harris for past comments supporting access to care for transgender people who are incarcerated.
Backed by Republicans eager to stoke culture war social issues, Trump has pledged to repeal Biden policies that affect transgender health care, including rules that prohibit federally funded providers and insurers from discriminating based on gender identity reasons.
When some states passed laws opposing transgender rights, the Biden administration expanded coverage of gender-affirming care and increased research funding for the National Institutes of Health.
In a video on his campaign site, Trump promised to order federal agencies to “cease all programs that promote the concept of sex and gender transition at any age” and to prohibit government programs such as Medicare and Medicaid from paying for health care. that affirms gender.
Trump also said he would withdraw federal funding from hospitals that provide such care, create the right to sue doctors who perform gender-affirming procedures on children, and investigate whether the pharmaceutical industry and hospitals have “deliberately covered up horrible side effects to long term.” of transitional treatments.
Harris has remained silent about Trump’s campaign rhetoric targeting trans people. But he has said he will “follow the law” in giving transgender Americans the same right as others to access necessary health care.
—Daniel Chang
Health insurance
Although the word “Medicaid” was barely uttered during this year’s election campaign, the election will determine future benefits for its 80 million members, primarily low-income and disabled.
“The stakes are high,” UNC’s Oberlander said.
While Harris has described Medicaid as a key program to improving health, Trump has framed it as a failed welfare program that needs cuts.
Nearly half of Medicaid enrollees are children, and the program pays for about 40% of births nationwide.
The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, or $20,783, this year. All but 10 states, which are led by the Republican Party, have chosen to expand their program.
The Biden administration has focused heavily on efforts to protect and expand Medicaid to reduce the number of uninsured people.
The Trump administration, and GOP proposals since then, sought to reduce Medicaid spending by tightening eligibility standards, such as adding work requirements, and changing federal funding to a block grant, which would place a greater burden on states. .
—Phil Galewitz
Revolutionizing biomedical agencies
Trump said at an Oct. 27 rally in New York City that he would give anti-vaccine activist Robert F. Kennedy Jr. free rein to “go crazy” on health and food policies in a second term.
Even a Republican-controlled Senate would be unlikely to confirm Kennedy for any high government position. Regardless of whether he had a specific role, RFK Jr.’s influence could be powerful, said Georges Benjamin, executive director of the American Public Health Association.
Kennedy said Trump promised to give him “control” of public health, including appointing leaders of the NIH, the FDA and the Centers for Disease Control and Prevention. He has advocated for a doctor who made her name as a right-wing health guru, Casey Means, to head the FDA. This week, in a discussion on CNN during which he presented the debunked theory that vaccines cause autism, Trump transition team co-chair Howard Lutnick said Kennedy wanted data on vaccines “so he could say these things don’t happen.” are safe,” at which point “companies will withdraw the vaccines… from the market.”
Numerous Trump allies have urged disempowering public health agencies, stripping the CDC of much of its research and advocacy authority, while streamlining the NIH and adding congressional oversight over its grantmaking.
Project 2025, the Heritage Foundation blueprint disavowed by Trump but whose authors include many former Trump officials, says the pharmaceutical industry and other corporations have “captured” regulatory agencies: “We must close and lock the revolving door.” between agencies like the NIH, the CDC, and the FDA, and the industries they regulate, he says.
Kennedy recently posted on the social media platform
He warned FDA employees who are “part of the corrupt system” that they should “1. Keep your records and 2. Pack your bags.”
-Arthur Allen
