The upcoming presidential election in November 2024 presents a pivotal moment for the future of healthcare in the United States. The contest between Kamala Harris and Donald Trump is not just a showdown between two political figures but also a referendum on profoundly different visions for American healthcare policy. Central to this debate is the fundamental question of equity: who should bear the risks and costs of healthcare—individuals, employers, states, or the federal government? This article delves into their contrasting approaches, highlighting how their policies could reshape the healthcare landscape and impact broader societal issues like social inequality, poverty, and systemic racism.
Kamala Harris’s Vision: Strengthening Federal Involvement
Kamala Harris has consistently advocated for expanding access to healthcare by enhancing the federal government’s role. As a staunch supporter of the Affordable Care Act (ACA), Harris has pushed for the continuation and enhancement of federal subsidies that have significantly reduced the number of uninsured Americans. Since the ACA’s inception fourteen years ago, the uninsured rate has fallen to a historic low of less than eight percent, largely due to these subsidies allowing millions to gain health insurance coverage. During the pandemic, the Biden administration introduced enhanced subsidies to ensure continuous coverage for many Americans. Harris is expected to support the extension of these subsidies beyond their 2025 expiration, arguing that such measures are crucial for maintaining healthcare security. By strengthening these federal protections, she aims to keep the uninsured rate low and provide a safety net for vulnerable populations.
Medicaid expansion is another cornerstone of Harris’s healthcare vision. The ACA expanded Medicaid to cover individuals earning up to 138 percent of the Federal Poverty Level. Harris plans to advocate for universal adoption of Medicaid expansion and eliminate restrictive waivers that impede access, ensuring a broader coverage base and more equitable healthcare access. This expansion remains vital as states refusing the ACA’s full Medicaid expansion leave many low-income residents without healthcare coverage. Harris’s strategy underscores her commitment to increasing federal intervention to ensure medical access for a wider swath of Americans, emphasizing coverage for those often left behind by the current system.
Donald Trump’s Vision: Reducing Federal Oversight
Donald Trump’s healthcare policy starkly contrasts with Harris’s, focusing on reducing federal involvement and increasing state discretion. Throughout his presidency, Trump criticized the ACA and sought to repeal it in 2017, advocating for a system that places more responsibility on individuals, employers, and states. His administration introduced short-term insurance plans as alternatives to the ACA marketplace plans, which allowed insurers to deny coverage based on preexisting conditions and adjust rates according to medical histories. Trump’s stance has also been reflected in the Republican Study Committee’s proposals. They suggest eliminating federal regulations on preexisting conditions and leaving such decisions to individual states. This approach aligns with the broader Republican ideology of minimizing federal oversight in healthcare, which they argue could lead to more locally tailored and cost-effective solutions.
Another significant aspect of Trump’s healthcare vision is his administration’s approval of waivers that permitted states to impose work requirements for Medicaid eligibility. These requirements, however, proved ineffective and costly, contributing little to expanding healthcare access. Trump’s approach emphasizes personal responsibility and reduced federal spending, but critics argue it undermines the core mission of expanding affordable healthcare coverage. By shifting more responsibilities to states and individuals, Trump’s policies aim to decentralize control but risk exacerbating inequities in the healthcare system. Critics contend that such measures could lead to a patchwork of healthcare standards that vary drastically from state to state, potentially leaving the most vulnerable populations without essential care.
The Impact of Policy Choices on Social Inequality
The diverging healthcare policies of Harris and Trump extend beyond coverage specifics to address broader social issues. The treatment of marginalized populations, such as low-income individuals and racial minorities, is a crucial litmus test for the effectiveness of healthcare policies. Harris’s vision includes robust federal intervention to mitigate systemic inequities and ensure that social determinants of health, like income and education, do not hinder access to quality care. Statistical evidence underscores the disparities in the U.S. healthcare system. Despite higher per capita healthcare spending, the United States lags in life expectancy compared to other wealthy nations. Racial discrepancies in maternal and infant mortality rates, for instance, are stark. A study in California revealed that babies born to the poorest Black mothers have nearly twice the mortality rate of those born to the poorest white mothers. Even babies born to the wealthiest Black mothers face higher mortality rates than those of the poorest white mothers. These disparities highlight the intersection of healthcare policy and systemic racism, areas where Harris aims to implement impactful changes.
These unsettling statistics illustrate how existing healthcare disparities are deeply rooted in systemic racism and economic inequality. Addressing these issues requires comprehensive policy changes that extend beyond healthcare to various sectors influencing health outcomes. Harris’s approach advocates for a more integrated system, focusing on creating a robust social safety net that addresses the multifaceted nature of healthcare inequity. Conversely, Trump’s policy focus on individual responsibility and minimal federal intervention raises concerns among experts about its sufficiency in addressing these broader issues. Critics argue that without substantial federal initiatives, existing inequalities are likely to persist or worsen, making the need for a more inclusive approach clear.
Real-World Implications: Stories from the Frontlines
The real-world impact of healthcare policies is vividly illustrated by an internist’s account of treating an indigent man in a San Francisco public hospital. The man chose hospice care over amputation for a bone infection due to fears of increased vulnerability to assault on the streets without his arm. His eventual death from sepsis underscores the dire consequences of social inequality manifesting as physical illness. The term “end-stage poverty” used by the internist poignantly describes the intersection of healthcare, poverty, and systemic failure. Such stories are critical for understanding how different policy approaches play out in reality. Harris’s focus on federal protections and expanded coverage aims to prevent such tragic outcomes by addressing the root causes of social inequality. In contrast, Trump’s vision of reduced federal oversight and increased responsibility on states and individuals risks perpetuating these inequalities, according to critics.
These personal accounts underscore the human cost of policy decisions, highlighting the dire stakes involved. Real-life examples provide a tangible perspective on the consequences of policy choices, emphasizing the need for a healthcare system that prioritizes equitable access and support for the most vulnerable. The competing visions presented by Harris and Trump represent fundamentally different approaches to handling these issues, reflecting broader ideological divides on the role of government and community responsibility in shaping healthcare outcomes. As voters consider the direction of U.S. healthcare policy in the upcoming election, the real stories of those affected by these decisions serve as potent reminders of what is at stake.
Future Trajectory: Continuity vs Reversal
The upcoming presidential election in November 2024 is a pivotal moment for the future of healthcare in the United States. This election, showcasing Kamala Harris and Donald Trump as the primary contenders, moves beyond being a mere duel between two prominent political figures. It essentially serves as a referendum on their starkly different visions for American healthcare policy. Central to this discourse is the critical question of equity: who should shoulder the risks and costs of healthcare—individuals, employers, states, or the federal government? The policies of Harris and Trump offer contrasting pathways that could drastically reshape the healthcare landscape and influence broader societal challenges such as social inequality, poverty, and systemic racism. This article explores these diverging approaches, examining their potential impacts on the nation’s healthcare system and on issues that deeply affect the fabric of American society.
