As the 2024 election enters its final weeks, the direction of policies affecting the health of millions of Americans is at stake.

The next president and Congress will have the authority to: mark In major health care programs such as Medicare and Medicaid, which cover approximately 150 million Americans. They will be able to direct resources on how the United States is combating the drug overdose crisis and how the country is preparing for the next epidemic.

A. latest survey It found that two-thirds of Americans say more attention should be paid to health care in the presidential campaign, and there are many important health policy options the next president will face in his first year. Here are the candidates’ opinions on three issues:

1. What is the future of Medicare drug price negotiations?

The Biden-Harris Administration scored a historic victory by giving Medicare the authority to directly negotiate prices for some of the most expensive prescription drugs. The first 10 prices federal health officials are negotiating would go into effect in 2026, saving patients and Medicare together $7.5 billion.

Some top Congressional Republicans want: repeal this powerArgues that the decline in drug manufacturer’s profits will decrease their encouragement to develop the next blockbuster treatment. Several pharmaceutical companies have also sued the federal government, claiming Medicare’s negotiating powers are unconstitutional.

Trump has not said whether he supports repealing the law or whether he will continue to defend it in court. Stacie Dusetzina, professor of health policy at Vanderbilt University Medical Center, says Medicare’s new authority is still vulnerable.

“Once you provide better benefits to Medicare beneficiaries, it’s really hard to take them away,” Dusetzina said. “But I don’t think anyone will miss out on them (if they are repealed) since the negotiated prices won’t come into force until 2026.”

Harris said on the campaign trail that she wants Medicare to: “speed up the pace Negotiating prices for more drugs to drop faster.” Experts believe this will likely mean either negotiating prices for more drugs or starting negotiations earlier in a drug’s lifecycle. Both moves would require congressional approval.

Harris’ campaign says she would put any additional savings toward new policy proposals like expanding Medicare home health care coverage. But a recent report from the Congressional Budget Office estimates that: Additional funds from such an effort would be minimal.

It’s also unclear whether Harris’ plan will slow the pipeline for new drugs, Dusetzina said.

“I think it pays to be a little cautious about how much you expand and expand right away,” he said. “I want to see what this means in terms of drug development. What does this mean in terms of patient access?”

Trump did not say how his administration would conduct the negotiations. Health experts say the Trump administration will have limited ability to undermine the law if it remains in effect because the rules direct Medicare which drugs it chooses to negotiate and set the minimum rebates the government must receive.

2. Should Congress expand the Affordable Care Act’s increased subsidies?

For people who buy their own health insurance through the ACA marketplaces, the federal government covers a portion of the monthly health insurance premiums most people pay. Under the original law, lawmakers limited that aid to people making 400% of the federal poverty level; today this about $125,000 for a family of four.

Democrats in Congress eliminated the income cap and increased the size of subsidies in 2021. Consumers’ share of premiums is almost I cut it in halfAccording to the impartial health research organization KFF. Number of people enrolled in ACA coverage increased since subsidy increase almost doubled To more than 21 million people.

These enhanced subsidies will expire at the end of 2025. KFF estimates monthly premiums for people with subsidized ACA plans will end at the end of 2025. couple In many states, the Congressional Budget Office estimates that enrollment under the ACA will decline by 100 percent 7 or 8 million people. (CBO estimates that about half of these people will get coverage through work.)

Vice President Harris said she wants to make these subsidies permanent and that would give Washington about 335 billion dollars in the coming period ten years. Former President Trump did not state a position, but A lotRepublicansto contain Trump’s former officialsHe argues that aid should end.

Many Republicans point out: report The report, published this year by the conservative Paragon Health Institute, found that as many as 5 million people were misreporting their income, potentially trying to defraud the government and trying to qualify for $0 premium health plans. According to Paragon, this activity costs taxpayers up to $26 billion.

Other health policy experts say there is a less nefarious explanation. Cynthia Cox, vice president of KFF, said it can be very difficult to estimate their annual earnings, especially for people working in low-wage jobs. What looks shady on paper may in reality be a guess gone wrong.

“It could depend on how much tips you make, how many vehicles you own, or how many shifts you work,” Cox said. “That’s where I think there’s an important nuance to consider, like is this really fraud or not?”

Cox added that there are provisions in the law that force people to pay back all or part of the subsidies if their predictions are wrong.

Michael Cannon, director of health policy at the libertarian Cato Institute, accuses the subsidies of encouraging another form of fraud by insurance brokers. Federal health officials took 275,000 complaints About brokers signing up for Obamacare coverage this year without their consent. Brokers earn a commission for each person they sign up for coverage, and consumers who don’t have to pay monthly premiums may be less likely to notice a change in their insurance.

“If more enrollees had to pay at least a small amount to sign up for these plans, that would curb a lot of this unscrupulous behavior by brokers,” Cannon said.

federal authorities 850 brokers suspendedrecommended new rules to take action against unscrupulous broker behavior and resolve almost all complaints.

3. Will medication abortion continue?

Almost two thirds 50 percent of abortions in the United States are now medication abortions and typically involve a regimen of two pills (mifepristone and misoprostol). In June, the U.S. Supreme Court rejected an attempt by anti-abortion advocates to expand access to and the Food and Drug Administration’s longstanding approval of mifepristone. But depending on the election, new leaders at the FDA could move to restrict (or further expand) access to medication abortion.

Under the Biden-Harris administration, the FDA allowed doctors to prescribe mifepristone to any patient via telehealth, rather than requiring patients to go to a healthcare provider in person. Telehealth prescriptions now enabled 1 in 5 abortions In the US, Harris has made protecting and expanding abortion access a centerpiece of her campaign.

Trump has rolled over. In some cases the former president said: no restrictions in access and others would be open to federal restrictions. Project 2025, conservative administration plan written by former Trump officials and other close advisers, calls for FDA withdraw approval of mifepristone.

“I think a lot of people don’t know that we can trust what he says because they keep saying different things,” said Ederlina Co, a law professor at Pacific University.

If the Trump administration had restricted or cut off access to mifepristone, people could still have medication abortions using the other pill. misoprostol. Misoprostol is safe and effective when used alone, but may have more side effects.

Uncertainty regarding Trump’s health policy

Harris’s stance on these three issues is clear. He supports expanding ACA-backed subsidies. He supports drug abortion and wants to pump the fuse in Medicare drug negotiations.

It’s harder to predict what will happen to health policy under a second Trump administration because Trump has not taken public positions on many important issues.

“The language used when former President Trump describes his plans is often so general that it is difficult to understand,” KFF’s Cox said.

For example, until recently, one of Trump’s clearest positions on prescription drug prices was the “most favored nation” policy he introduced late in his first term. This would force drug manufacturers to sell certain drugs to Medicare at rates paid by other countries.

Trump’s campaign in the last few weeks said Policy And Statistics that the former president will not revive the policy in a second term.

Ben Ippolito, a health economist at the conservative American Enterprise Institute, said that beyond that now-repealed policy, it’s “a little bit harder to predict” how Trump will handle health care.

This story comes from the health policy news organization Tradeoffs. Ryan Levi is a reporter/producer for the show that featured a version of this story. first appeared. You can listen here:

Copyright 2024