The 2024 presidential election is still weeks away and health care is expected to be a top issue for voters heading to the polls.
The overall cost of healthcare remains a major problem. Healthcare spending rose 4.1% to $4.5 trillion in 2022 and represented 17.3% of US GDP.
Rising costs highlight the core of America’s health care problem: The U.S. spends more on health care than any other developed country in the world – an estimated $13,493 per person. Yet, according to the Commonwealth Fund, it lags in overall health care performance, access and affordability, administrative efficiency, equity and health outcomes.
“The cost of health care is always a concern for Americans,” Paul Shafer, assistant professor at Boston University’s Department of Health Law, Policy, and Management, told Yahoo Finance.
In recent weeks, the campaigns of both Vice President Kamala Harris and former President Donald Trump have raised health care issues. While Trump’s proposals are light on details, he has focused on health care costs by promising to tackle insurance premiums, improve price transparency and reduce surprise bills.
Read more: What the 2024 campaign means for your wallet: Yahoo Finance’s guide to the presidential election
Harris, meanwhile, has pledged to expand increased subsidies in the Affordable Care Act marketplace, cap insulin costs for all Americans — not just Medicare recipients — cancel medical debt and expand Medicare to cover long-term care.
Here’s a look at some health care issues facing Americans, making them relevant to the presidential race, and the positions of each campaign, if relevant.
Medical debt
According to the Peterson-KFF Health System Tracker, an estimated 20 million Americans have a combined medical debt of $220 billion.
In June, the Consumer Financial Protection Bureau announced it would remove medical debt from credit reports using funding from the American Rescue Plan.
Harris said in her economic plan that her administration would “work with states to help them reach agreements with hospitals and other health care providers to alleviate medical debt for more Americans, and to help create plans to reduce the accumulation of debt in the future.”
Trump has not laid out a plan to address the problem.
The KFF found that among insured adults with medical debt, 35% reported that they had not filled a prescription for medicine in the past 12 months due to costs (compared to 7% of insured adults without medical debt), while 41% had not went to. a doctor or clinic for a medical problem because of the costs (compared to 9% without medical debt).
Wendell Potter, former director of Cigna and current president of the Center for Health and Democracy, noted that high out-of-pocket costs and other barriers make it difficult for people to get the care they need — even if they have insurance .
“It’s one thing, and commendable, to have 91% to 92% of Americans covered,” Potter said. “You still have millions who don’t have coverage, but the vast majority of people with medical debt have insurance.”
High out-of-pocket costs
In 2024, the average annual premium was $1,368 for single coverage and $6,296 for family coverage.
For workers with single coverage in a plan with an annual deductible – the amount a consumer pays for covered health care services before the insurance takes effect – the average annual deductible is $1,787. The deductible for families, meanwhile, ranges from $1,548 to $4,991, depending on plan structure.
While in office, Trump signed an executive order that required hospitals to make prices public in a consumer-friendly format and insurers to show people what they can expect to pay for out-of-pocket non-emergency services through an online tool.
In addition to high out-of-pocket costs, other insurance practices – such as prior authorization, which requires provider approval for certain prescriptions or services – can increase costs.
An August 2024 Commonwealth Fund survey found that 55% of respondents between the ages of 19 and 64 reported not having challenged a bill for a service they thought should have been free or covered by their health insurance.
According to Potter, it’s “baked into the system that it takes a long time” because insurers know consumers will often give up or their doctors have so many other prior authorizations that they won’t focus on one patient.
“It has become more difficult for doctors to practice and treat their patients… because of the interference in various ways by insurance companies,” he said.
The Affordable Care Act
Trump has promised to repeal the Affordable Care Act (ACA), commonly known as Obamacare, and replace it with something else. During his previous term, however, he and Republicans had led several failed attempts to do so.
Harris, meanwhile, has pledged to permanently expand the increased subsidies provided through the ACA, which the Centers for Medicare & Medicaid Services claims have saved most consumers at least $800 annually in premiums.
Gideon Lukens, senior fellow and research director at the Center on Budget and Policy Priorities, told Yahoo Finance that a surge in market enrollment since 2020 is likely due to these “improvements in affordability.”
Lukens said policymakers “need to be aware” that expanding these tax credits is something that “needs to happen as quickly as possible” to avoid premium spikes.
“I think the urgency for expanding the enhanced premium tax credits is something that not everyone is aware of,” he said.
Medicaid expansion
Medicaid expansion has been an ongoing issue since the implementation of the ACA.
In 2012, the Supreme Court ruled to leave decisions up to the states on whether to adopt the ACA expansion, creating a “coverage gap” in the ten states that still have not expanded Medicaid. That translates to about 2 million people without health care coverage.
A 2023 study published in Health Affairs found that states that adopted the Medicaid expansion were able to reduce uninsured rates and narrow racial and ethnic disparities in coverage.
The current uninsured rate nationally is 8.2%, or approximately 27.1 million people, as of the first quarter of 2024. When broken down by racial/ethnic group, uninsured rates vary widely: 26% of Hispanic/Latino -Americans, 9.8% of black Americans, 7.7% of white Americans and 5.1% of Asian Americans.
“Not only have the coverage gains from the improved premium tax credits increased coverage overall, but they have also reduced disparities and inequities,” Lukens said.
Abortion
Another topic that is “top of mind” for many voters, according to Shafer, a professor at Boston University, is reproductive health.
“Vice President Harris wants to restore Roe through legislation, while former President Trump failed to veto a national abortion ban in his first decade,” he said.
Harris is a staunch supporter of abortion rights, especially after the Roe v. Wade decision was overturned by the Supreme Court in 2022. Her campaign website states that as president she will “never allow a national abortion ban to become law.” passes a bill to restore reproductive freedom across the country, she will sign it.”
During his term as president, the Trump administration took several steps to restrict access to abortion, including cutting federal funding from health centers that refer patients for abortion. Trump also appointed three Supreme Court justices, all of whom voted to overturn Roe v. Wade, a decision he celebrated and even took credit for.
As a candidate this time, Trump has tried to strike a different tone on abortion. When a ban on abortions after six weeks of pregnancy went into effect in Florida earlier in 2024, Trump criticized the law — but also opposed a state ballot measure to codify abortion rights in the state. He has been vocal about his support for IVF, even as members of his own party try to restrict access.
Earlier this year, he posted a video on his Truth Social platform in which he stated, “My view is that we now have abortion where everyone wanted it from a legal standpoint, the states will determine through vote or legislation, or maybe both, and whatever they decide. It should be the law of the land. In this case it’s all about the will of the people. You have to follow your heart, or in many cases your religion or faith. Do what is right for your family and do what is right for yourself.”
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Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on X @adrianambells and reach her at adriana@yahoofinance.com.
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