How Presidential Candidates’ Healthcare Proposals May Affect Your Practice

The 2020 presidential election will have a major impact on health policy, as well as on many other issues. With early voting already in full swing, understanding the key differences between each candidates’ health policy proposals is important when making a decision that’s right for you, your patients, and your practice.

We briefly explore below what each candidate has described as their top priorities and provide links to resources that explore their positions in greater depth.

What the Candidates Are Saying? 

At a high-level, both President Donald Trump and Vice President Joe Biden’s campaigns focus on two similar issues: the price of and access to healthcare. While the campaigns are focusing on broadly similar themes, each candidate has a different proposal for achieving these goals and prioritizes them differently. The two campaigns also provide vastly different levels of detail about their proposed agendas.

Donald Trump

President Trump’s campaign has provided fairly minimal detail on his website about his healthcare agenda for a second term. Instead, the campaign website links to a “Promises Kept” website, which describes some healthcare accomplishments from Mr. Trump’s first term.

In terms of future healthcare priorities, Mr. Trump’s campaign did issue a press release in late August describing his overall second-term agenda, which included a very short (40 words in seven bullet points) healthcare section. This release is the clearest indication we have of Mr. Trump’s proposed second term healthcare agenda:

1. Cut Prescription Drug Prices
2. Put Patients and Doctors Back in Charge of our Healthcare System
3. Lower Healthcare Insurance Premiums
4. End Surprise Billing
5. Cover All Pre-Existing Conditions
6. Protect Social Security and Medicare
7. Protect Our Veterans and Provide World-Class Healthcare and Services

Since late July, Mr. Trump also has signed various Executive Orders related to healthcare. While these Executive Orders have been viewed by many health policy observers as more style than substance, they have covered many of the same issues described by the second term agenda press release, indicating these issues will be an ongoing focus in a potential Trump administration second term.

Notably, on July 24, Mr. Trump announced four Executive Orders meant to help reduce the price of prescription drugs. These orders covered issues ranging from reducing insulin costs to drug importation to eliminating rebates to pharmacy benefit managers to using international reference pricing. And on September 24, Mr. Trump signed an Executive Order titled “An America-First Healthcare Plan,” which reiterated support for the general goals of providing more choice, lower costs, and better care; ensuring access to affordable health insurance to people with pre-existing conditions; ending surprise billing for unforeseeable out-of-pocket expenses; and improving the quality of care provided to veterans.

Mr. Trump also signed an Executive Order on July 24 focused on improving healthcare for Americans living in rural communities through efforts to expand telehealth access in rural areas, develop a new payment model for rural providers, improve physical communications healthcare infrastructure, and report on policy initiatives to increase rural access. These efforts to improve rural healthcare are likely to continue in a second term for the Trump administration.

Joe Biden

In contrast to the Trump campaign’s minimalist approach, Vice President Biden’s campaign has released a fairly detailed description of his main healthcare agenda. The overarching principle animating Mr. Biden’s healthcare agenda is that he will protect and expand on the Affordable Care Act (ACA), and his campaign describes four main ways in which he will do so.

• Access to Affordable Health Insurance: Mr. Biden proposes allowing individuals to purchase a public health insurance option like Medicare. He also supports increasing tax credits for the purchase of health insurance and providing premium-free access to the public health insurance option for people who would have been eligible for Medicaid if their states had implemented Medicaid expansion.
• Making Healthcare Less Expensive and Complex: Mr. Biden also proposes to ban surprise billing when a patient does not have control over which provider the patient sees and to use antitrust enforcement to prevent market concentration that is increasing healthcare costs.
• Lower Prescription Drug Prices: Mr. Biden has put forward a variety of proposals to lower drug prices, including permitting Medicare to negotiate prices with drug companies, limiting the launch price that Medicare will pay for certain drugs that do not have competition, limiting price increases to the general inflation rate as a condition of participation in the Medicare program, and allowing importation of prescription drugs from other countries.
• Healthcare as a Right, Not a Privilege: Mr. Biden proposes to expand access to contraception and protect the constitutional right to an abortion. Specific policies include working to codify Roe v. Wade, restoring federal funding for Planned Parenthood, and permitting U.S. funds to be provided to international aid organizations that offer information on abortion services. Mr. Biden also proposes to reduce maternal mortality rates; defend healthcare protections related to gender, gender identity, or sexual orientation; and expand access to (and achieve parity for) mental health care services.

Mr. Biden’s campaign also has released separate plans for many other related healthcare issues, including the opioid crisis, healthcare for Americans in rural areas, how his plans will benefit communities of color, veterans’ healthcare, and COVID-19. Similar to the detail provided for Mr. Biden’s main healthcare agenda, each of these plans includes a number of detailed proposals for consideration.

Final Thoughts

We may need to wait until a week or more after November 3 to know the outcome of the Presidential election due to the unprecedented number of people using mail-in ballots, but the ultimate winner will have the potential to profoundly impact health policy. However, the ability of the new President to do so will be strongly influenced by the results of the elections for the House of Representatives and the Senate, as the partisan make-up of Congress will place boundaries on the type of healthcare legislation that can become law.

The winner of the election also likely will need to spend significant time focusing on the ongoing response to the COVID-19 pandemic, leaving less time available for attempting to implement other healthcare proposals.

Lurking in the background is the Supreme Court argument on the constitutionality of the ACA scheduled to be held on November 10. If the Supreme Court declares the ACA unconstitutional, then whoever wins the election could see their healthcare agenda radically upended.

We will be keeping a close eye on these developments, and we will make sure to keep you informed of any important changes that may impact physicians and physician practices.

If you have specific questions about the presidential election or other healthcare policy topics, please email me directly at sam.cohen@curi.com.