Updated September 26, 2024

Healthcare systems faced an unprecedented surge of hospitalizations, during the COVID-19 pandemic. Both the toll and stress of the pandemic have contributed to the erosion of public confidence in American healthcare. More than a third of Americans believe that their healthcare system is below average worldwide while around half of U.S. adults state that they have trouble affording high medical costs. 

In terms of policy, 53% of Americans say it is the responsibility of the federal government to make sure all Americans have healthcare coverage, though this has declined from 60% in September 2018.

Republicans and Democrats are sharply divided on this though — 81% of Democrats believe it is the responsibility of the federal government, while 77% of Republicans believe the federal government does not have this responsibility. Americans are also divided over how health insurance should be provided. 27% of Americans support a single national program, whereas 24% believe it should be provided through a mix of private and public programs. Those who say the government is not responsible for healthcare mostly want to keep Medicare and Medicaid, with only 6% wanting no government involvement at all. 

Subissues:

• Affordable Care Act
  • Individual Mandate
• Medicare
  • Medicare for All
• Prescription Drugs
  • Junk Fees
• Gender Transition Treatments

The Candidates on the Affordable Care Act 

Note: The Patient Protection and Affordable Care Act is the long-form name of the act. 

Kamala Harris (D): Supports the Affordable Care Act. 

Vice President Kamala Harris has expressed support for “expanding and strengthening the Affordable Care Act,” backing away from support for “Medicare for All.” 

Harris criticized former President Donald Trump, at a rally in September, for lacking specificity on the matter. She claimed, at a rally in August, “If Donald Trump gets the chance, he will end the Affordable Care Act and take us back to a time when insurance companies had the power to deny people with pre-existing conditions.” In response to the claim, Trump’s campaign pointed to plans of reformation over termination. 

Donald Trump (R): Has expressed various stances on the Affordable Care Act.

Though former President Donald Trump once supported a repeal of the Affordable Care Act, during his presidency, he shifted to rebranding or revamping it. He signed a 2017 GOP-backed tax law that removed the individual mandate, but kept most of the bill intact. He also signed an executive order to cover Americans with pre-existing conditions and expanded health reimbursement arrangements, setting aside money for people to spend on health insurance. He stated, in 2023, that he would look for “alternatives” to the Affordable Care Act, reviving his past promise to repeal it; however, his campaign, in August, pointed to reformation plans. 

Cornel West (Ind.): Advocates expanding beyond the Affordable Care Act.

Cornel West wants to nationalize healthcare, although his platform remains unspecified. West recently stated, “I want all working people to have healthcare,” reaffirming his intention to go beyond the Affordable Care Act.

Chase Oliver (Lib.): Supports reform of government healthcare regulation.

Oliver advocates for limiting government healthcare regulation to promote individual choice, increase access, and reduce healthcare costs; therefore, he plans to reform healthcare regulation, which includes various changes to provisions of the ACA. Oliver has encouraged development of market alternatives to employer-provided insurance. He cited the Direct Primary Care (DPC) model as an alternative that he supports. DPC allows primary care physicians to offer care directly to their patients, without insurance company involvement, in exchange for a membership fee. Additionally, Oliver states he would urge congress to remove limits on Health Savings Accounts. 

The Candidates on Medicare

Kamala Harris (D): Supports Medicare but backed away from “Medicare for All.”

Vice President Kamala Harris enthusiastically advocated for “Medicare for All” leading up to President Joe Biden’s election in 2020. In reference to the act, she said, “It is inhumane to make people go through a system where they cannot literally receive the benefit of what medical science can offer because some insurance company has decided it doesn’t meet their bottom line in terms of their profit motivation,” at a rally in 2019. Harris also co-sponsored Sen. Bernie Sanders’ (I-VT) Medicare for All Act in 2017. 

Harris raised her hand in favor of potentially eliminating private healthcare insurance, in 2019, but later backed away from support. Harris has since shifted to support for the Affordable Care Act and governing private health insurance plans. 

The vice president backed the Inflation Reduction Act of 2022, which President Joe Biden signed in 2022, allowing the Secretary of Health and Human Services (HHS) to negotiate with drug companies to set prices for 10 prescription drugs covered under Medicare drug coverage (Part D) (starting in 2026) and Part B (which covers outpatient care, preventive services and medical equipment) (starting in 2028). The Inflation Reduction Act also capped the monthly cost of insulin at $35 for people covered by Medicare. It established an annual out-of-pocket costs cap for people with Medicare Part D, which will drop to $2,000 in 2025 and be indexed each year. The act also established that drug companies must pay rebates to Medicare if they increase their prices for certain drugs at a pace greater than inflation. 

The Biden-Harris Administration directed the Centers for Medicare & Medicaid Services to increase transparency for Medicare Advantage. It also introduced a rule to increase competition among insurance companies, prevent “predatory marketing” of Medicare Advantage plans, and mandate that Medicare Advantage insurance companies conduct annual health equity analyses. 

The administration cut 2025 base payments to Medicare Advantage plans by an average of 0.16%, which health insurers said may cause them to cut benefits. It also redesigned the Trump administration’s Direct Contracting Model for Medicare as the ACO Realizing Equity, Access, and Community Health Model.

Donald Trump (R): Against Medicare for All but supports an expansion.

Former President Donald Trump spoke of plans to cut entitlements, during his 2020 presidential campaign. However, as Republicans and Democrats debated about the debt ceiling in 2023, Trump addressed his party, “under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security.” Trump said in May 2024 that he “will never do anything that will jeopardize or hurt Social Security or Medicare” if elected. 

Trump said he is against “Medicare for All” because it would reduce citizens’ ability to choose their health insurance and monopolize other plans.

Trump signed an executive order in 2019 that was intended to strengthen Medicare Advantage. The executive order directed the Department of Health and Human Services to increase plan options and affordability and improve the enrollment procedures. It also included proposals to encourage seniors to use telehealth services, support wellness services and prevent waste, fraud and abuse in Medicare. The Trump administration promoted privatized health insurance by working to make Medicare Advantage plans more attractive to enrollees. 

The Trump administration implemented the Global and Professional Direct Contracting Model. The program gave providers a fixed budget to provide care for traditional Medicare patients instead of paying providers for every visit or lab test. The budget was intended to incentivize doctors and hospitals to provide higher quality of care to keep people healthy and avoid further treatment and medical costs. The Centers for Medicare & Medicaid Services reported that this model, continued under the Biden administration, saved $371.5 million in Medicare costs in 2022. 

The Trump administration added about 2,100 Medicare advantage plan options, and Medicare Advantage premiums decreased by about 34% during Trump’s presidency. Trump signed an executive order that increased Medicare funding for rural hospitals and aimed to improve rural healthcare.

The Trump administration proposed reducing the federal government’s Medicare payments to decrease debt and equalize payments, while also saying coverage would not be affected.

During Trump’s presidency, the date for Medicare Hospital Insurance trust fund solvency decreased by three years to 2026. 

Trump “will always protect Medicare, Social Security, and patients with pre-existing conditions” if elected, according to his 2024 campaign website.

Cornel West (Ind.): Supports free healthcare for all.

West stated that he hopes to “Go beyond Medicare for All towards true health justice” according to his campaign website, but he has not specified his healthcare policy or plans. West said that “healthcare is a human right,” and he proposed “Habeas Corpus Healthcare, free healthcare for any and all residents of the United States” on his campaign website.

Chase Oliver (Lib.): Against the government negotiating Medicare drug prices.

Chase Oliver said he believes that the federal government should not be allowed to negotiate drug prices for Medicare because “the government should not interfere with the free market.” Oliver also stated that the federal government should not increase funding of health care for low income individuals, but rather, "deregulate healthcare to lower costs and increase access."

Oliver has lobbied against both a single-payer program and government regulation of the prices of life-saving drugs.

The Candidates on Prescription Drugs

Kamala Harris (D): Supports lowering the cost of prescription drugs. 

Vice President Kamala Harris supports access to healthcare, including prescription drugs, as a human right. In August, she released a statement on the matter:

“Every American should be able to access the health care they need no matter their income or wealth… During the two years since President Biden signed [the Inflation Reduction Act of 2022] into law, we have cut prescription drug costs [and] capped the cost of insulin at $35 a month… Today, we are building on our work to lower costs and increase access to affordable prescription drugs by announcing that the Biden-Harris Administration has reached agreements with all participating manufacturers to lower prices for the first 10 drugs selected for the Medicare price negotiation program… Additional prescription drugs will be selected each year as part of our Medicare drug price negotiation program.”

Political contributions from pharmaceutical companies reportedly favor the Democratic ticket; however, the vice president declared in the August statement that she “held Big Pharma accountable for their deceptive and illegal practices.” 

The Biden-Harris Administration released a statement in March, claiming that its actions would eliminate over $20B in annual junk fees. 

Donald Trump (R): Advocates for lowering prescription drug prices.

Former President Donald Trump signed executive orders to decrease prescription drug prices by: outlawing deals between pharmacy benefit managers and drug companies to ensure that patients benefit from pharmacy discounts; and securing the lowest price available among other countries for Medicare Part B prescription drugs through the Most Favored Nation proposal. These executive orders were blocked by courts, and the Centers for Medicare & Medicaid Services rescinded the Most Favored Nation proposal.

However, Trump’s executive order to allow importing prescription drugs from Canada and other countries that have lower prices for the same medications still stands. 

Trump tried to implement a rule that drug companies had to disclose the price of medication in television ads, but it was struck down by a federal judge.

He also pledged, in 2017, to cut down FDA regulations on drug developments to allow drugs to be approved faster and increase competitiveness and allow generic drugs to enter the market.

Trump would “further reduce the cost of prescription drugs and health insurance premiums” if elected, according to his 2024 campaign website.

Cornel West (Ind.): Proposes nationalizing the pharmaceutical industry.

Cornel West’s website states that he hopes to nationalize the pharmaceutical industry to control prescription drug prices. 

Chase Oliver: Advocates for government action to reform the pharmaceutical industry.

Chase Oliver vowed, if elected, he would end “evergreen patents”, when drug companies slightly change existing drugs and patent them as new drugs, according to his campaign website. Oliver said these create artificial product monopolies that keep prescription drug prices high. Oliver also expresses desire to reduce the regulatory burden on the pharmaceutical industry so that prescription drugs can be brought to market by a greater number of small firms. 

The Candidates on Gender Transition Treatments 

Kamala Harris (D): Supports gender transition treatments, including for minors.

As attorney general in 2015, Vice President Kamala Harris, “pushed the California Department of Corrections and Rehabilitation to provide gender transition surgery to state inmates.” 

She wrote in a 2019 response to the American Civil Liberties Union (ACLU), “Transition treatment is a medical necessity, and I will direct all federal agencies responsible for providing essential medical care to deliver transition treatment.”

A 2022 White House statement from the Biden-Harris Administration stressed the following: 

• “Reinforcing federal protections for transgender kids”
• “Expanding trainings to support transgender and nonbinary students in schools”
• “Confirming the positive impact of gender affirming care on youth mental health”
• “Providing resources on the importance of gender affirming care for children and adolescents.”

Donald Trump (R): Against "the promotion" of gender transition treatments.

Former President Donald Trump is against “the promotion” of gender transitioning for people of all ages. In 2020, the Trump administration amended Section 1557 of the Affordable Care Act, which prohibits federally funded healthcare providers from discriminating based on race, color, national origin, age, disability, or sex. The amendment considers sex discrimination prohibition as applicable to the male and female genders. This was a change from the previous 2016 Obama-era interpretation of Section 1557 which defined gender based on an individual’s interpretation of their gender identity and included healthcare discrimination protections for transgender individuals. The Biden administration has since restored Section 1557 to the 2016 interpretation, including updates to the Obama-era provision. 

Cornel West (Ind.): Supports gender transition treatments, including for minors.

Cornel West expresses, on his campaign website, that he hopes to remove transgender discrimination from healthcare policies and establish a "Health Bill of Rights for Disabled People."

Chase Oliver (Lib.): Supports parents making decisions about gender transition treatments for minors.

Chase Oliver asserts that adults should have (in most instances) “bodily autonomy” to make their own healthcare decisions in consultation with their doctors, free from government involvement. He recently clarified his stance on gender transition treatments, saying that he supports “parents making decisions for their kids” and children being advocates for their parents. Oliver continued, stating that he does not support “trans-ing” kids; instead, he advocates for parents to have authority to make decisions under the guidance of a physician. He does not support government or insurance mandates requiring physicians to provide gender transition treatments.

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This blog was originally written by Harry Ding, Content Intern (Center bias). It was updated by Kai Lincke, Content Intern (Lean Left bias); Olivia Geno, News and Bias Assistant (Lean Right bias); Malayna J. Bizier, News Analyst and Social Media Editor; and Krystal Woodworth, Growth Specialist and Executive Assistant (Center bias). It was reviewed and edited by Henry A. Brechter, Editor-in-Chief (Center bias); Malayna J. Bizier, News Analyst and Social Media Editor (Right bias); Johnathon Held, News and Bias Analyst (Lean Right bias); and Joseph Ratliff, Content Designer and News Editor (Lean Left bias).

Editor's Note: A previous version of this guide used the phrase "gender-affirming care." This was an error. Read about why AllSides avoids using that phrase.