Public Health on the Ballot: Health Coverage
A look at where the presidential candidates stand on issues surrounding health care coverage, past and present.
Read Time: 3 minutes
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In 2023, the average person in the U.S. spent over $13,000 on health care expenses, accounting for 18% of the country’s GDP. As we continue to spend more than other wealthy countries on health care, the U.S. fails to see better health outcomes. Costs are out of control, and many American voters are looking for a President who will address this economic health crisis.
The 2024 presidential nominees each have histories of enacting policy for public and private health insurance. Battles over the Affordable Care Act (ACA), drug price negotiations, and more have brought this topic into the spotlight again as we move towards election day in November.
The following graphic compares the prominent health care coverage policies of the Trump-Pence and Biden-Harris administrations, as well as the plans for the Trump-Vance and Harris-Walz administrations if elected.
Past Administrations
Biden-Harris (2021-2025)
- Public Insurance: Supported incentivizing Medicaid expansion as outlined originally in the ACA, though Harris previously supported a universal care model in the 2019 primaries.
- Affordable Care Act: Expanded eligibility for ACA subsidies with the American Rescue Plan Act:
- Allowed Americans to enroll in the marketplace if they earned up to 600% of the FPL, leading to a 20% increase in eligible buyers.
- Extended Marketplace eligibility to DACA recipients, extending coverage to 100,000 Dreamers.
- Health Care Services and Drug Prices: Advocated for lower costs and bill transparency from private drug companies and health care providers:
- Harris cast the tie-breaking vote in favor of Biden’s Inflation Reduction Act (IRA) to lower Medicare prescription drug costs
- Began implementing the No Surprises Act in 2021 to limit surprise medical billing
Trump-Pence (2017-2021)
- Public Insurance: Worked to minimize public insurance programs and restrict eligibility:
- Approved waivers with work requirements to be eligible for Medicaid.
- Supported limiting Medicaid eligibility and benefits to reduce spending by $1 trillion over 10 years.
- Increased Medicare premiums for high-income beneficiaries.
- Affordable Care Act: Attempted to repeal and replace the ACA in 2017, which would have left 51 million Americans uninsured.
- Removed the ACA individual mandate.
- Health Care Services and Drug Prices: Proposed an out-of-pocket cap on drugs under Medicare Part D.
Future Administrations
Harris-Walz
- Public Insurance: Supports accelerating the negotiation of Medicare drug prices.
- Affordable Care Act: Supports expansion of the existing provisions of the ACA.
- Hopes to further expand ACA subsidies through legislation like the Inflation Reduction Act.
- Health Care Services and Drug Prices: Advocates for government intervention to lower costs, including:
- Capping out-of-pocket drug cost at $2,000 per year and insulin copays at $35 per month for everyone.
- Cancelling medical debt.
- As CA Attorney General, Harris prosecuted insurance companies and Big Pharma to lower prices, and hopes to see further prosecution to lower prices.
Trump-Vance
- Public Insurance: Promises to “always protect Medicare, Social Security, and patients with pre-existing conditions,” but has no specific policy proposed.
- Affordable Care Act: Plans to repeal and replace the ACA with no specific alternative proposed.
- Health Care Services and Drug Prices: Hopes to lower prices through market solutions:
- Claims to end surprise medical billing with no specific policy proposed.
- Supports a Most Favored Nation model, which compares international drug prices and removes incentives to use higher-cost drugs under Medicare Part B.
