[Editor’s Note: Phone2Action is writing a series of posts showing what is at stake in November’s election in different industries and policy areas. See the inaugural post for an overview, as well as posts on energy policy and criminal justice reform.]
While response to the pandemic is America’s most pressing public health crisis, dominating the national conversation in Washington and on the presidential campaign trail, it is not the only healthcare issue that hangs on the election.
There are a slew of other policy decisions that could spin in dramatically different directions depending on the outcome in November. Republicans and Democrats have long held vastly different visions for the future of American healthcare, and those visions are even more relevant now that millions are losing health insurance due to Covid-19-related job cuts.
The party that controls the White House and Congress will have a major say over policies that govern the cost of prescription medications, the fate of the Affordable Care Act, the future of Medicare and Medicaid and many other issues. Here are some of the major items hanging in the balance.
No organization has all the answers. But we can all keep asking the right questions. Join our “Navigating Uncertainty in the 2020 Election” Webinar to learn how your organization can succeed in the months ahead
Obamacare and Medicare For All
Trump and Republican leaders have spent years trying to eliminate the Affordable Care Act in the courts, through legislation and with regulatory changes. Meanwhile, Democrats have begun an earnest discussion over Medicare For All that is seeing increased support in the Democratic base.
Killing Obamacare and extending Medicare to all Americans are good rallying points for political activists on both ends of the spectrum. Realistically, however, implementing those visions is more complicated, and it is highly questionable if either vision could come to fruition any time soon. That said, the outcome of the election could move the ball on either issue.
If Joe Biden wins and Democrats make gains in Congress, expect a big debate over expanding government-sponsored health insurance. A Democratic win will shift focus to expanding Medicaid and will likely revive the debate over Medicare For All. That proposal, the core of the single-payer healthcare vision that sees government guaranteeing health insurance for all Americans, has become a key plank in the progressive Democratic platform. Progressives want to move the system away from relying on employer-sponsored health insurance.
Many Republicans deride Medicare For All as socialism, and will push back aggressively on any such proposal. Medicaid expansion may encounter less resistance. Some Republican-led states, such as Oklahoma, have voted to expand Medicaid. In fact, 37 states and Washington DC have adopted Medicaid expansion, while 13 states have not.
Though massive job losses may soften the pressure in the Republican party to weaken Obamacare, President Trump still appears dedicated to ending it. The Department of Justice asked the Supreme Court in June to vacate the law, even as the pandemic swelled usage of the program in recent months.
Smart advocacy organizations with an interest in healthcare are keeping tabs on these policies because they know that, in some cases, changes will occur quickly after the election is over. Insurance companies, associations and nonprofits may well be mobilizing supporters to support or oppose policy changes by the end of the year.
Prescription Drug Pricing
Outrage over rising costs of prescription medicines has been a big political issue for both parties. In town halls before the pandemic, lawmakers were seeing prescription drug pricing as the top concern from their constituents. Trump, faced with polls showing that Democrats lead on healthcare, is trying to revive his own 2016 campaign promise to control the rising price of medicines, with the hope of regaining some of the populist firepower that excited his base in the last presidential election.
To address the issue, House Democrats passed a bill that would allow the federal government to negotiate lower prices for many prescription medications, force pharmaceutical companies to offer those prices to all consumers and cap out-of-pocket drug costs for Medicare beneficiaries. Trump has vowed to veto that bill, but if Biden wins, expect that measure to see renewed congressional action.
Senate Finance Committee Chairman Chuck Grassley, a Republican, has argued that the pandemic is an ideal time to have a debate in Washington about prescription drug prices, since the costs of potential Covid-19 medicines and treatments will be under scrutiny.
Since 2018, Trump has called for tying the price that Medicare pays for drugs administered by doctors to prices negotiated by foreign governments. But while he pushes for allowing for the negotiation of drug prices under Medicare, Republican lawmakers have joined with pharmaceutical companies in resisting the move.
Trump also recently signed a series of executive orders to address the high cost of prescription drugs, including a plan to tie the price that Medicare pays for some drugs to the lower price foreign countries pay. His orders also would require the government to “buy American” for certain essential drugs, which the administration says would address supply-chain issues caused by the pandemic.
But it remains to be seen how much real action will occur on this issue after the election, given that the White House is also working with pharmaceutical companies like Pfizer, AstraZeneca and Johnson & Johnson to quickly develop new medicines and vaccines for Covid-19.
Some analysts say Biden’s moderate positions reduce the likelihood of significant drug pricing changes even if he wins. However, he has formed a “task force” with his Democratic primary chief rival, Bernie Sanders, to look for ways to bring costs down.
Trump and Biden will not be the only voices on prescription drug costs. Advocacy organizations will also be raising their voices to influence policy, as they have in the past. Expect to see more digital grassroots engagement on this issue after the election, no matter who wins.
Of course, the primary healthcare issue will be how the next administration and Congress contain the COVID-19 pandemic, which is clearly on the rise after several states relaxed restrictions in an effort to realize an economic boost. It is likely that America will be managing the coronavirus for the foreseeable future, and the two presidential candidates will bring very different approaches.
The Trump administration has downplayed the health impacts of the virus, despite the high death toll (more than 185,000 Americans have died). It has called for less testing, required schools to reopen and generally made decisions that prioritize economics over public health. Trump famously declined to wear a mask in public for the first three months of the outbreak.
Biden is positioning himself as everything Trump is not, emphasizing public safety and a collective approach to managing the pandemic.
While Trump formally told the United Nations that America will leave the World Health Organization, Biden tweeted his support for WHO membership. “Americans are safer when America is engaged in strengthening global health. On my first day as President, I will rejoin the @WHO and restore our leadership on the world stage,” he wrote.
Subscribe for Updates
Get the latest civic engagement trends, best practices, and news, right in your inbox.