Differing stands

As the United States heads to the polls on November 5, 2024, healthcare remains a flashpoint in the presidential race. With the country lagging behind other developed nations in healthcare quality, major issues like the Affordable Care Act (ACA), Medicaid, abortion rights and the skyrocketing costs of prescription drugs have become defining topics for candidates Kamala Harris and Donald Trump.

A report from private foundation Commonwealth Fund, published in September 2024, ranked the US last among 10 high-income nations in healthcare, citing the highest rates of avoidable deaths and an alarming number of premature fatalities.

As voters prepare to choose the next president, the Democratic and Republican nominees offer starkly different visions for the future of healthcare in the US.

Divergent visions for health reform

Democratic nominee and current US vice president Harris has centred her campaign on expanding and enhancing the ACA, colloquially known as “Obamacare.” Signed into law in 2010 by then-President Barack Obama, the ACA increased access to affordable health insurance, guaranteed coverage for pre-existing conditions and allowed young adults to stay on their parents’ plans until age 26.

Harris has promised to build on this legacy, advocating for increased subsidies to reduce out-of-pocket costs and expanding Medicaid in states that have yet to adopt it.

Meanwhile, former President Trump has continued his critical stance against the ACA. During the September 10, 2024 debate with Harris, he reiterated his desire to replace Obamacare, though he offered no detailed plan, just a ‘concept’ of one. “If we can come up with a plan that costs less and is better, I’d absolutely do it,” Trump stated.

His campaign, however, emphasised that repealing the ACA is not an immediate policy goal. Instead, Trump is focusing on what he describes as “healthcare transparency, competition and choice” to drive costs down. On the surface, a more affordable health-care law appears to be appealing to US citizens — health-care spending in the country is growing faster than the overall economy and Americans pay roughly twice as much for healthcare than any other country, according to the Commonwealth Fund.

Yet, Trump’s alignment with House Speaker Mike Johnson, who recently declared “No Obamacare” during a campaign event before backtracking on it, has fuelled speculation about the GOP’s long-term plans for health reform.

Abortion rights under fire

Abortion has also emerged as a deeply polarising issue. The 2022 Supreme Court ruling in Dobbs v Jackson, which overturned Roe v Wade, placed abortion rights into state legislators’ hands, igniting new legislation in 41 states restricting abortion access.

Trump, who appointed three justices who helped overturn Roe, has taken credit for the decision. He supported exceptions for cases involving rape, incest or maternal health and has opposed some of the harshest state laws. However, Trump has avoided taking a definitive stance on whether he would support a national abortion ban, leaving the future of federal abortion legislation uncertain.

If the former president wins the polls again, Trump could select two more Supreme Court justices, current President Joe Biden has warned.

Harris, in contrast, has vowed to protect abortion access at the federal level, arguing that healthcare rights should not vary by state. Her campaign has pledged to codify protections once guaranteed by Roe, making access to abortion a cornerstone of her healthcare platform. Codifying Roe v Wade would mean passing a law that affirms a pregnant person’s right to an abortion without undue interference.

The most effective way to codify Roe v Wade would be for Congress to pass a law, such as the Women’s Health Protection Act, that would be binding for all states. This act was passed in the House on September 2021 as ‘H R 12’, but it is considered unlikely to pass in the Senate

After the 2022 overturning of Roe v. Wade, abortion rights activists slammed former President Obama and the Democratic Party for not codifying Roe into law when they held a supermajority in Congress from 2009 to 2011.

While campaigning in 2007, Obama had pledged to make codifying Roe a priority, yet in 2009 he stated it was not “the highest legislative priority.” Obama and his supporters later argued that there were not enough pro-choice votes in Congress to pass the Freedom of Choice Act. This issue may come up again as Harris takes a stance on protecting abortion rights in the current presidential race.

Medicaid and prescription drug prices

The candidates’ healthcare plans also address Medicaid and prescription drug prices — two issues central to Americans facing high medical expenses. Harris aims to expand Medicaid eligibility, especially in states that resisted expansion under the ACA and supports measures to cap out-of-pocket costs for prescription drugs.

Trump has pointed to market-based solutions to make prescription drugs more affordable and previously attempted to limit drug prices during his presidency.

With the nation’s health outcomes under intense scrutiny, the healthcare crisis has escalated into one of the most critical debates of the 2024 election. As the Commonwealth Fund’s findings cast a stark light on the country’s healthcare deficiencies, voters will soon decide which candidate’s vision aligns with their expectations for affordable, accessible and comprehensive healthcare.

The writer is Senior Sub Editor for Down To Earth web. Views expressed are personal