Potential Harris and Trump Health Policy Agendas

Date: 10.02.24

The 2024 presidential election campaigns have not focused on health policy (except for reproductive health care) and the two major candidates have made few policy speeches. Nonetheless, Manatt Health has assembled this infographic that compares the candidates’ positions, to the extent it can be discerned from their past actions and statements, and those of their allies.

Candidate policy positions have been divided into the nine topics below. To expand the table, click the relevant header to view the specific policy proposals for each candidate.

Medicaid

Policy	Kamala Harris¹	Donald Trump²
Expanding Medicaid	✓ Encourage adoption of ACA expansion for adults Support a new federal initiative to provide coverage for low-income adults in states that don’t take up ACA expansion	X Support state flexibility to limit the scope of the Medicaid program, including via eligibility restrictions (e.g., payment of premiums as a condition of eligibility) Overhaul Medicaid program funding by instituting block grants and per-capita caps Reduce federal funding for certain categories of Medicaid enrollees (e.g., expansion adults) Support state flexibility to limit certain benefits (e.g., a Non-Emergency Medical Transportation benefit)
Requiring Work or Community Engagement as a Condition of Enrollment	X Oppose conditioning Medicaid eligibility on meeting work requirements	✓ Allow and potentially encourage states to condition Medicaid eligibility on meeting work or community engagement requirements
Covering Health-Related Social Needs (HRSN)	✓ Support states in expanding coverage of HRSN services for eligible Medicaid enrollees	✓ Consider curtailing of some previously approved HRSN service authority and funding

Prescription Drug Pricing

Policy	Kamala Harris¹	Donald Trump²
Importing Drugs from Other Countries	✓ Allow the importation of some drugs
Using International Reference Pricing	✓ Establish an independent review board to recommend reasonable prices for new drugs	✓ Support an International Pricing Index Model for Medicare Part B
Limiting Drug Price Increases	✓ Continue restricting price increases relative to the inflation rate in Medicare, extend to commercial market	✓ Limit price increases in exchange for lower cost-sharing in Part D; require Medicare rebates for increases above inflation
Capping Insulin Out-of-Pocket (OOP) Costs	✓ Expand the $35 monthly OOP cap on the price of insulin beyond Medicare	? A July 2020 executive order signed by President Trump established a temporary, voluntary program to allow Medicare Part D prescription drug plans to cap monthly OOP insulin copay costs at $35 or less
Redesigning Medicare Part D	✓ Expand IRA redesign of Medicare Part D by capping cost-sharing for generics at $2	✓ Expand access to affordable prescription drugs
Reducing OOP Drug Costs	✓ Extend $2000 OOP cap on prescription drug costs from Medicare to all payers	X Republicans have opposed extending this OOP cap, saying that Medicare Advantage and Part D plans are already increasing premiums to compensate for the additional costs borne by the plans
Negotiating Drug Prices	✓ Continue drug price negotiation in Medicare, potentially expand to the commercial market; expand number of drugs negotiated to at least 50 drugs per year	? President Trump previously voiced support for Medicare negotiation of drug prices but cited a proposal to allow the HHS Secretary to negotiate drug prices as the reason he would veto a House bill⁴
Enhancing Transparency of PBM Practices	✓ Both candidates support reining in practices of PBMs viewed as “anticompetitive” in order to enhance savings for consumers and patients
Leveraging State Prescription Drug Affordability Boards (PDABs) to Control Prescription Drug Costs	✓ Support states seeking to establish upper payment limits for certain prescription drugs, as a complement to Medicare drug price negotiation	? The first state PDAB was not established until after the first Trump term
Addressing Drug Shortages	✓ Enhance Food and Drug Administration's (FDA) capabilities to prepare for and respond to drug shortages; improve supply chain resilience	̶

Reproductive Health

Policy	Kamala Harris¹	Donald Trump²
Guaranteeing Abortion Access	✓ Protect abortion access nationwide (including medication abortion), restore protections guaranteed by Roe v. Wade Ensure access to emergency medical care	X Defer to states on abortion regulation following the Supreme Court’s decision to overturn Roe v. Wade
Addressing Maternal and Infant Health	✓ Reduce maternal mortality and improve maternal and child health Increase investments in maternal health and the Maternal and Child Health Block Grant Support mothers and policies that advance prenatal care Address racial, ethnic and geographic disparities	✓ Reduce maternal mortality and improve maternal and child health Increase investments in maternal health and the Maternal and Child Health Block Grant Support mothers and policies that advance prenatal care
Accessing Family Planning Services	✓ Increase financial support for Title X family planning program Support access to contraception, in vitro fertilization, and other family planning services	X Restrict the use of Title X family planning funds. Reinstate the gag rule for Title X ✓ Support access to IVF

Innovation

Policy	Kamala Harris¹	Donald Trump²
Working with China	✓ Protect U.S. supply chain, data, and intellectual property from countries of concern Cooperate to block fentanyl imports into the U.S.	X Support revoking China’s most favored nation status, seek to phase out imports of essential goods and stop China from buying American real estate and industries
Enhancing Biosimilar Competition	✓ Improve access to high-quality, affordable biosimilars to increase competition
Covering Breakthrough Drugs and Devices	✓ Streamline reviews for breakthrough drugs and devices, establish breakthrough designation programs	✓ Accelerate review and approval of drugs and devices; support new technology add-on payments for new technology and breakthrough devices
Supporting Development of Rare Disease Products	✓ Accelerate development of rare disease products; continue investments in research for rare cancers via Cancer Moonshot	✓ Accelerate development of orphan drugs and rare disease treatments⁵
Supporting Medical Research at Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and FDA	✓ Preserve the authority of CDC, NIH, FDA and related agencies Expand support for ARPA-H	X Limit the authority of CDC, NIH, and FDA, particularly in the wake of COVID-19
Encouraging the Use of Artificial Intelligence (AI) in Health Care	✓ Harness the power of AI and machine learning to advance health care research and practice Promote responsible use of AI in health care, including by implementing guardrails to limit bias	✓ Leverage AI to improve health analytical functions and enhance efforts to reduce improper payments and prevent fraud

Behavioral Health⁶

Policy

Kamala Harris¹

Donald Trump²

Improving the Behavioral Health Workforce

✓
Increase investments in 988 hotline to support rollout and uptake

Expand the behavioral health workforce via investments in workforce development programs

Support expansion of school-based services to improve youth mental and behavioral health

✓
Support funding for existing Behavioral Health Workforce Development Programs⁷

Enhancing Biosimilar Competition

✓
Expand access to opioid treatment, opioid overdose reversal drugs

Crack down on fentanyl trafficking

Affordable Care Act

Policy	Kamala Harris¹	Donald Trump²
Extending Enhancements to APTCs to Purchase Marketplace Coverage	✓ Support extension of enhanced APTCs beyond the 2025 expiration date	X Oppose extending enhanced APTCs beyond 2025⁸
Leveraging Section 1332 State Innovation Waivers	✓ Allow waiver flexibility to pursue universal access to affordable coverage and other administration priorities	✓ Allow waiver flexibility to advance policies consistent with administration priorities
Encouraging Alternatives to ACA Marketplace Coverage	X Support enhancing access to the Marketplace (through maintaining deeper premiums subsidies (APTCs)) and oppose alternative sources of coverage (like short-term limited duration insurance (STLDI)) that are not subject to Marketplace consumer protections	✓ Encourage use of alternative avenues for coverage, including STLDI, association health plans and Health Savings Accounts

Medicare

Policy

Kamala Harris¹

Donald Trump²

Expanding Medicare Benefits

✓
Expand traditional Medicare benefits to cover dental, vision and hearing services

✓
Encourage enrollment in Medicare Advantage (MA) plans that offer benefits beyond traditional Medicare

Regulating MA

✓
Strengthen program integrity by addressing excess payments to agents and brokers and cracking down on plan marketing tactics

Limit utilization management policies

✓
Address improper payments while limiting MA plan regulation

Health Equity and Non-Discrimination

Policy	Kamala Harris¹	Donald Trump²
Accessing Gender Affirming Care	✓ Strengthen protections for transgender and gender non-conforming individuals; support access to gender-affirming care for minors Defend Section 1557 rule defining protections against discrimination on the basis of gender identity and sexual orientation	X Oppose taxpayer funding for gender affirming medical care; support restrictions on access to gender affirming care for minors Rescind and replace Section 1557 rule defining protections against discrimination on the basis of gender identity (and sexual orientation)
Improving Racial and Gender Health Disparities	✓ Continue the “whole-of-government” equity agenda Prioritize improving health outcomes for women, people with disabilities and LGBTQIA+ Americans by addressing health equity Improve collection of race, ethnicity, sexual orientation and gender identity data	X Support removing gender identity and sexual orientation from Section 1557 regulation Renew Executive Order 13950 characterizing systemic racism as a “divisive concept”⁹
Enhancing Access to Health Care for Non-Citizens	✓ Support state efforts to create affordable coverage options for non-citizens including by maintaining Deferred Action for Childhood Arrivals (DACA) Encourage state creativity in affordable health coverage programs for noncitizens (e.g., Marketplace-based strategies, Basic Health Program-like programs)	X “Seal the border, and stop the migrant invasion” is the first plank of the GOP 2024 platform Support termination of the DACA program and revoke section 1332 waivers that allow additional non-citizens to enroll in Marketplace coverage Protect Medicare solvency by keeping “illegal immigrants [from] the rolls of Medicare”

Provider and Health Care Access

Policy	Kamala Harris¹	Donald Trump²
Improving Rural Health	✓ Address rural health disparities, particularly related to maternal and behavioral health care Invest in community health centers, programs that attract providers to practice in rural areas Improve telehealth access Invest in mobile health clinics	✓ Expand access to broadband and telemedicine services Modify payments to Rural Health Clinics¹⁰ Remove requirements on rural hospitals to address trends in hospital closures Maintain funding for Rural Health Outreach grants
Ensuring Access to Telemedicine	✓ Expand access to telemedicine services
Addressing Health Care Consolidation and the Role of Private Equity in the Health Sector	✓ Support FTC/DOJ’s ongoing efforts to address consolidation in health care and crack down on anticompetitive behavior	✓ Scrutinize role of private equity and provider consolidation Increase choice and promote transparency and competition
Protecting Consumers from Medical Debt	✓ Support policies that protect patients from aggressive debt collection practices and ease the burden of medical debt (e.g., push to exclude medical debt from credit scores)	̶
Encouraging Price Transparency	✓ Promote price transparency among health plans and providers Eliminate surprise medical bills

Legislation is required for most of the major health care reforms proposed by Harris and Trump. Therefore, the makeup of Congress will impact how much of the President’s agenda is actually enacted into law.

Key:

✓ represents policies supported by the candidate in campaign and other written materials.

̶ ̶ represents policies not included in campaign platform statements or that the candidate is likely to oppose.

X represents policies actively opposed by the candidate.

? represents policies that are not included in campaign platform statements but where the candidate’s past statements or actions contradict the party’s historical stance on an issue.

Where candidates both pledge action on an issue, but the proposed actions vary significantly, a short description is captured under the check mark. Candidate positions that are materially the same are indicated in purple.

_{¹ In this infographic, Vice President Harris’ positions are based on campaign statements as well as executive activity during the Biden-Harris Administration which is largely expected to continue.}

_{² In this infographic, President Trump’s positions are based on campaign statements as well as executive activity during his first term that is expected to continue.}

_{³ While President Trump has not weighed in on using Medicaid to address HRSN, the Heritage Foundation’s Project 2025 chapter on HHS notes that CMS’s overhaul of current waiver processes should “include adding Section 1115 waiver requirements in some cases (such as imposing work requirements for able-bodied adults) while rescinding requirements in others (such as non-health care benefits and services related to climate change).” (Emphasis added.)}

_{⁴ H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, see Statement of Administration policy on H.R. 3 here.}

_{⁵ The Trump fiscal year (FY) 2021 budget proposed decreasing NIH funding by more than $2 billion.}

_{⁶ In this context, “Behavioral Health” refers to both mental health services and SUD services.}

_{⁷ The Trump Administration’s FY 21 HHS budget request proposed level funding for the Health Resources and Services Administration’s Behavioral Health Workforce Development Programs.}

_{⁸ A recent CBO report published in response to an inquiry from several House Republican leaders on the budgetary effects of the enhanced APTCs estimated that making these APTCs permanent would increase the budget deficit by an estimated $335 billion over the next ten years.}

_{⁹ Executive Order 13950, “Combating Race and Sex Stereotyping,” September 22, 2020. This executive order defines a “divisive concept” as: “concepts that (1) one race or sex is inherently superior to another race or sex; (2) the United States is fundamentally racist or sexist; (3) an individual, by virtue of his or her race or sex, is inherently racist, sexist, or oppressive, whether consciously or unconsciously; (4) an individual should be discriminated against or receive adverse treatment solely or partly because of his or her race or sex; (5) members of one race or sex cannot and should not attempt to treat others without respect to race or sex; (6) an individual's moral character is necessarily determined by his or her race or sex; (7) an individual, by virtue of his or her race or sex, bears responsibility for actions committed in the past by other members of the same race or sex; (8) any individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of his or her race or sex; or (9) meritocracy or traits such as a hard work ethic are racist or sexist, or were created by a particular race to oppress another race.”}

_{¹⁰ Note that the President’s proposed budget included a $1.8 billion cut to Medicare payments to Rural Health Clinics over ten years.}

Resource List

Medicaid

Prescription Drug Pricing

Reproductive Health

Innovation

Behavioral Health6

Affordable Care Act

Medicare

Health Equity and Non-Discrimination

Provider and Health Care Access

Behavioral Health⁶