The 2024 presidential election is weeks away, and healthcare is expected to be a key issue for voters as they head to the ballot box.
The overall cost of healthcare remains a major problem. Healthcare expenditures grew 4.1% in 2022, reaching $4.5 trillion and accounting for 17.3% of US GDP.
The ballooning costs highlight the crux of the US healthcare conundrum: The US spends more on healthcare than any other developed country in the world — an estimated $13,493 per person. Yet it falls behind in overall healthcare performance, access and affordability, administrative efficiency, equity, and health outcomes, according to the Commonwealth Fund.
“The cost of healthcare is always a pocketbook 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 elevated healthcare issues. While Trump's proposals have been light on details, he has focused on healthcare costs by pledging to tackle insurance premiums, improve price transparency, and reduce surprise bills.
Read more: What the 2024 campaign means for your wallet: The Yahoo Finance guide to the presidential election
Harris, meanwhile, has promised to extend the enhanced 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 rundown of some of the healthcare issues facing Americans, which make them relevant to the presidential race, and each campaign's stances when relevant.
Medical debt
An estimated 20 million Americans collectively owe $220 billion in medical debt, according to the Peterson-KFF Health System Tracker.
In June, the Consumer Financial Protection Bureau announced that it would erase medical debt from credit reports using funding from the American Rescue Plan.
Harris has said in her economic plan that her administration would “work with states to help them enter into agreements with hospitals and other health providers to relieve medical debt for more Americans, and help create plans to prevent debt accumulation in the future.”
Trump has not laid out a plan for tackling the issue.
KFF found that among insured adults with medical debt, 35% indicated they did not fill a prescription for medicine due to cost within the last 12 months (compared to 7% of insured adults without medical debt), while 41% didn’t go to a doctor or clinic for a medical problem due to cost (compared with 9% without medical debt).
Wendell Potter, former Cigna executive 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 laudable, to have 91%-92% of Americans covered," Potter said. "You still have millions who don’t have coverage, but the vast majority of people who have 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 of money a consumer pays for covered healthcare services before insurance kicks in — the average annual deductible is $1,787. Family deductibles, meanwhile, range from $1,548 to $4,991, depending on the plan structure.
While in office, Trump signed an executive order that required hospitals to disclose prices 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 survey from the Commonwealth Fund found that 55% of respondents between the ages of 19 and 64 reported not challenging a bill for a service that they thought should have been free or covered by their health insurance.
According to Potter, it’s “baked into the system to take a long time” because insurers know that consumers will often give up or their physicians have so many other prior authorizations that they won’t focus on any one patient.
“It’s gotten more difficult for physicians to practice and treat their patients ... because of the interference in various ways by insurance companies,” he said.
The Affordable Care Act
Trump has vowed to repeal the Affordable Care Act (ACA), commonly known as Obamacare, and replace it with something else. However, during his previous term in office, he and Republicans spearheaded multiple failed attempts to do so.
Harris, meanwhile, has pledged to permanently expand the enhanced subsidies granted through the ACA, which the Centers for Medicare & Medicaid Services stated have saved most consumers at least $800 annually on premiums.
Gideon Lukens, senior fellow and director of research for the Center on Budget and Policy Priorities, told Yahoo Finance that a surge in marketplace enrollment since 2020 is likely due to these "affordability improvements."
Lukens said policymakers "need to be aware" that extending these tax credits is something that "needs to happen as soon as possible" to prevent premium spikes.
“I think the urgency for extending the enhanced premium tax credits is something that not everybody 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 states on whether to adopt the ACA's expansion, creating a "coverage gap" in the 10 states that still haven't expanded Medicaid. That translates to roughly 2 million individuals without healthcare 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 on a national level is 8.2%, or roughly 27.1 million people, as of Q1 '24. When broken down by racial/ethnic group, the 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 coverage gains from the enhanced premium tax credits increased coverage overall, but they’ve also reduced disparities and inequities," Lukens said.
Abortion
Another issue that Shafer, the Boston University professor, said is “top of mind” for many voters is reproductive health.
“Vice President Harris wants to restore Roe through legislation, while former President Trump failed to commit to vetoing a national abortion ban in their first decade,” he said.
Harris is a staunch supporter of abortion rights, particularly 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. And when Congress passes a bill to restore reproductive freedom nationwide, she will sign it."
During his term as president, the Trump administration made several moves to limit access to abortion, including cutting federal funding from health centers that refer patients for abortions. Trump also appointed three Supreme Court justices who all voted in favor of overturning Roe v. Wade, a decision that he celebrated and even takes credit for.
As a candidate this time around, Trump has attempted to strike a different tone on abortion. When a Florida ban on abortions after six weeks of pregnancy took effect 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 seek to limit access.
Earlier this year, he posted a video on his Truth Social platform stating, "My view is now that we have abortion where everybody wanted it from a legal standpoint, the states will determine by vote or legislation, or perhaps both, and whatever they decide must be the law of the land. In this case, the law of the state. At the end of the day, this is all about the will of the people. You must follow your heart or in many cases, your religion or your faith. Do what's right for your family and do what's right for yourself."
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Adriana Belmonte is a reporter and editor covering politics and healthcare policy for Yahoo Finance. You can follow her on X @adrianambells and reach her at [email protected].