With the South Carolina Republican primary results in over the weekend, it seems a Biden-Trump re-match is inevitable. Given the legacies associated with Presidencies of the two and the healthcare platforms espoused by their political parties, the landscape for healthcare politics seems clear:
Healthcare Issue | Biden Policy | Trump Policy |
Access to Abortion | ‘It’s a basic right for women protected by the Federal Government’ | ‘It’s up to the states and should be safe and rare. A 16-week ban should be the national standard.’ |
Ageism | ‘President Biden is alert and capable. It’s a non-issue.’ | ‘President Biden is senile and unlikely to finish a second term is elected. President Trump is active and prepared.’ |
Access to IVF Treatments | ‘It’s a basic right and should be universally accessible in every state and protected’ | ‘It’s a complex issue that should be considered in every state.’ |
Affordability | ‘The system is unaffordable because it’s dominated by profit-focused corporations. It needs increased regulation including price controls.’ | ‘The system is unaffordable to some because it’s overly regulated and lacks competition and price transparency.’ |
Access to Health Insurance Coverage | ‘It’s necessary for access to needed services & should be universally accessible and affordable.’ | ‘It’s a personal choice. Government should play a limited role.’ |
Public health | ‘Underfunded and increasingly important.’ | ‘Fragmented and suboptimal. States should take the lead.’ |
Drug prices | ‘Drug companies take advantage of the system to keep prices high. Price controls are necessary to lower costs.’ | ‘Drug prices are too high. Allowing importation and increased price transparency are keys to reducing costs.’ |
Medicare | ‘It’s foundational to seniors’ wellbeing & should be protected. But demand is growing requiring modernization (aka the value agenda) and additional revenues (taxes + appropriations).’ | ‘It’s foundational to senior health & in need of modernization thru privatization. Waste and fraud are problematic to its future.’ |
Medicaid | ‘Medicaid Managed Care is its future with increased enrollment and standardization of eligibility & benefits across states.’ | ‘Medicaid is a state program allowing modernization & innovation. The federal role should be subordinate to the states.’ |
Competition | ‘The federal government (FTC, DOJ) should enhance protections against vertical and horizontal consolidation that reduce choices and increase prices in every sector of healthcare.’ | ‘Current anti-trust and consumer protections are adequate to address consolidation in healthcare.’ |
Price Transparency | ‘Necessary and essential to protect consumers. Needs expansion.’ | ‘Necessary to drive competition in markets. Needs more attention.’ |
The Affordable Care Act | ‘A necessary foundation for health system modernization that appropriately balances public and private responsibilities. Fix and Repair’ | ‘An unnecessary government takeover of the health system that’s harmful and wasteful. Repeal and Replace.’ |
Role of federal government | ‘The federal government should enable equitable access and affordability. The private sector is focused more on profit than the public good.’ | ‘Market forces will drive better value. States should play a bigger role’ |
My take:
Polls indicate Campaign 2024 will be decided based on economic conditions in the fall 2024 as voters zero in on their choice. Per KFF’s latest poll, 74% of adults say an unexpected healthcare bill is their number-one financial concern—above their fears about food, energy and housing. So, if you’re handicapping healthcare in Campaign 2024, bet on its emergence as an economic issue, especially in the swing states (Michigan, Florida, North Carolina, Georgia and Arizona) where there are sharp health policy differences and the healthcare systems in these states are dominated by consolidated hospitals and national insurers.
- Three issues will be the primary focus of both campaigns: women’s health and access to abortion, affordability and competition. On women’s health, there are sharp differences; on affordability and competition, the distinctions between the campaigns will be less clear to voters. Both will opine support for policy changes without offering details on what, when and how.
- The Affordable Care Act will surface in rhetoric contrasting a ‘government run system’ to a ‘market driven system.’ In reality, both campaigns will favor changes to the ACA rather than repeal.
- Both campaigns will voice support for state leadership in resolving abortion, drug pricing and consolidation. State cost containment laws and actions taken by state attorneys general to limit hospital consolidation and private equity ownership will get support from both campaigns.
- Neither campaign will propose transformative policy changes: they’re too risky. integrating health & social services, capping total spending, reforms of drug patient laws, restricting tax exemptions for ‘not for profit’ hospitals, federalizing Medicaid, and others will not be on the table. There’s safety in promoting populist themes (price transparency, competition) and steering away from anything more.
As the primary season wears on (in Michigan tomorrow and 23 others on/before March 5), how the health system is positioned in the court of public opinion will come into focus.
Abortion rights will garner votes; affordability, price transparency, Medicare solvency and system consolidation will emerge as wedge issues alongside.
PS: Re: federal budgeting for key healthcare agencies, two deadlines are eminent: March 1 for funding for the FDA and the VA and March 8 for HHS funding.