Healthcare in the U.S. costs far more and generates worse outcomes for Americans than almost every other developed nation.
This is due to the U.S.’s go-it-alone approach that prioritizes private industry over public access. Obama’s Affordable Care Act has partly addressed the problem, providing access to insurance to 45 million Americans and raising the percentage of insured citizens to its highest-ever mark.
While President, Donald Trump actively sought to repeal the Affordable Care Act, and though his efforts were unsuccessful, he made changes that weakened its protections and made insurance through its programs more costly. As a candidate in 2024, Trump has said he will never give up on repealing the ACA, suggesting that he has “concepts” for a plan that would provide ”much better healthcare” without providing any details or specifics as to how, for example, he would protect coverage for Americans with pre-existing health conditions – a key benefit of the ACA.
In a second Trump term, with such a conservative Supreme Court in place thanks to his three Supreme Court picks, all bets for survival of the ACA would be off, and other Biden/Harris achievements on healthcare – like $35 insulin payments for seniors – would be put at risk.
Harris
Through its successful implementation of the American Rescue Plan and the Inflation Reduction Act, the Biden-Harris administration expanded the benefits of the Affordable Care Ac through 2025. The administration also restored outreach and enrollment assistance programs that Donald Trump had cut.
As a result, a record-high number of Americans now have access to healthcare through the ACA, including the security of knowing that coverage cannot be denied or taken away due to pre-existing medical conditions. Kamala Harris proposes to build on this foundation by making these expanded provisions permanent.
As vice President, Kamala Harris cast the tiebreaking vote in the U.S. Senate for the Inflation Reduction Act, which enables negotiation of some Medicare-covered drugs, caps out-of-pocket drug spending, and limits insulin costs to $35/month for Medicare beneficiaries. Harris proposes to accelerate the Medicare drug price negotiation program and extend the $35 out-of-pocket insulin cap to all Americans. She pledges to secure the Medicare Trust Fund by ensuring that big corporations and wealthy Americans pay their fair share in taxes.
The Biden-Harris administration has sought to expand access to Medicare and issued comprehensive regulations and guidance to make it easier and simpler to enroll. Kamala Harris, in particular, championed efforts to encourage states to adopt a postpartum Medicaid coverage extension, focused on health risks associated with having a baby.
Trump
While making promises to “always protect Medicare,” Donald Trump as president enacted, and as a candidate continues to propose, tax reductions that would speed up how quickly the Medicare funding supply goes broke. Trump also wants to eliminate the provisions in the Inflation Reduction Act that enable the government to negotiate prices for some Medicare-covered drugs, including insulin.
When asked recently by AARP what he would do to protect Medicare and ensure older Americans have access to affordable health care, Trump’s response was that “we need to make our country successful again” and that he wants to incentivize older Americans to remain in the workforce longer so that they can maintain their employer-based insurance coverage.
Donald Trump has consistently sought to limit the reach of Medicaid, which supports the provision of healthcare to lower-income families and individuals, by cutting funding and making the program more difficult to access.
Trump’s clearest healthcare legacy is his stewardship of the U.S. response to COVID-19, which was a catastrophic failure. While promoting unproven, dangerous treatments like drinking bleach, Trump’s delays in treating the pandemic seriously led to an estimated 180,000 unnecessary American deaths.
While the COVID-19 vaccine program was developed during his presidency, Trump has consistently questioned the science behind a number of important public health programs. Trump believes that public health policy affecting Americans should be implemented on a state-by-state basis, which would result in dramatically different approaches to the management of diseases that do not respect political boundaries, and has said that he probably would disband the White House Office of Pandemic Preparedness and Response Policy, which was established by Congress in 2023 to help America prepare and protect itself against future pandemics.
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