The 2024 Presidential Election: Implications for Health Care Policy

The 2024 presidential election is poised to have significant implications for the future of health care policy in the US. With the potential for a Trump 2.0 administration or a Harris presidency, industry stakeholders are closely monitoring the candidates' positions and the possible scenarios that could unfold.

The 2024 presidential election is poised to have significant implications for the future of health care policy in the United States. | Image credit: tiero - stock.adobe.com

At AMCP Nexus 2024, experts discussed key health care issues at stake, the feasibility of proposed policy changes, and the role of executive actions and regulatory measures in shaping the health care landscape, whether Vice President Kamala Harris, a Democrat, or former President Donald Trump, a Republican, becomes president-elect next month.

Election Overview and Initial Thoughts

Close polling numbers and the potential for last-minute “October surprises” could sway the election outcome this year, panelists agreed.

“This is not a popularity contest,” said Andrew McKechnie, partner, Tiber Creek. “This is a strategic way to get the 270 electoral votes. In the history of elections, we have seen 5 times where a candidate has won the popular vote but lost the electoral vote. So, it does happen, and it could happen again, but where the campaigns are focused on is not winning the national vote, not winning the Congress votes, but the electoral votes; that’s going to come down to 7 states.”

McKechnie also explained the historical significance of the "blue wall" states of Michigan, Wisconsin, and Pennsylvania, noting that winning these 3 states has traditionally been a reliable path to victory for Democrats. However, he also highlighted the shifting dynamics, with Harris' nomination potentially opening new opportunities for the Democratic ticket in states like North Carolina and Georgia.

Demographic and geographic differences within key battleground states include the importance of urban and suburban areas in Pennsylvania, the role of unions in Michigan, and the potential impact of recent natural disasters in North Carolina.

Demographic and Gender Gaps in Voting

A key focus of the discussion centered around the demographic and gender-based voting patterns that could shape the election's outcome. Significant gaps have been observed between college-educated and non–college-educated voters, as well as the 26% gender gap, with women favoring Harris and men leaning toward Trump. The importance of voter turnout was emphasized, with the expectation of historically high participation levels, building on the record-breaking turnout seen in 2020. The potential impact of young people and Latino voters was also explored, as the campaigns work to mobilize these crucial voting blocs.

“I do think ultimately, in this election we can look at polls, we can look at fundraising, we can look at policy positions, [but] it will come down to turnout,” said McKechnie.

Key Issues and Candidate Stances

The discussion then shifted to the key issues that matter most to voters, including the economy, immigration, and health care. McKechnie outlined the perceived strengths of each candidate on these fronts, noting that Trump is viewed as stronger on immigration, while Harris is seen as more favorable on health care and reproductive rights. Key health care topics in the presidential election include reproductive health, the future of the Affordable Care Act (ACA), reducing prescription drug costs, health care consolidation and cost impacts on consumers, and a Medicare home health benefit.²

Congressional Races and Senate Outlook

The congressional landscape is seen as a toss-up, with both parties fighting for narrow majorities in the House and Senate. The House of Representatives is narrowly controlled by Republicans and the Senate is divided 50-50. The key Senate races to watch are in states including Montana, Wisconsin, Pennsylvania, and Nevada. Democrats see potential pickup opportunities in Texas and Nebraska, but maintaining their Senate majority will be challenging as they have more seats to defend. On the House side, the focus is on districts in New York and California where President Joe Biden won in 2020 but Republicans flipped the seat in 2022.

Election Outcomes on Health Policy

The election outcome will have significant implications for health care policy. In a Republican sweep, where the GOP controls both the White House and Congress, a renewed push to repeal or significantly modify the ACA could happen. This could include efforts to reduce subsidies, allow more flexibility around preexisting conditions, and potentially introduce Medicaid reforms.

Conversely, a Democratic victory, with a Harris administration and Democratic control of Congress, would likely focus on protecting and expanding the ACA, increasing drug pricing negotiation powers, and exploring initiatives like a Medicare benefit for community-based services.

Legislative and regulatory matters will be key drivers of health care policy, regardless of the election outcomes. These concerns include the expiration of the debt ceiling, the Trump tax cuts, and the enhanced ACA subsidies. Additionally, the extension of telehealth flexibilities enacted during COVID-19 will be a focus, as well as potential reforms to pharmacy benefit manager (PBM) regulation and policies around hospital outpatient department reimbursement.

The panelists also highlighted the importance of patent reforms and restrictions on prior authorization in Medicare Advantage plans as other regulatory issues that may see attention.

“There’s been this interesting development in the Medicare Advantage space, where clearly it used to be a very popular program among Republicans, Democrats have had their issues with it; those lines have blurred a little bit, mostly over Medicare Advantage plans’ use of prior authorization,” said Timothy Molino, consultant, Tiber Creek Group.

Under a Trump 2.0 administration, there could be a continued focus on drug pricing reforms, such as international reference pricing and PBM transparency, as well as potential Medicaid reforms. However, Molino noted that Trump's previous efforts to repeal the ACA were ultimately unsuccessful.

Executive Actions and Regulatory Impact

Lastly, the discussion highlighted the potential for executive actions and regulatory impact to shape health care policy, even in the absence of legislative changes. The executive branch has significant power through agencies like CMS, FDA, and HHS to influence policy outcomes. For example, a Republican-led administration could take actions on drug pricing, such as tariffs, or make changes to Medicaid financing and the ACA through regulatory channels. Similarly, a Democratic administration led by Harris could leverage the regulatory process to expand drug price negotiation authorities, despite potential challenges in passing such legislation through Congress.

“I think for Congress, [there’s] going to be a lot of these deadlines, but that will drive a lot of the agenda, [such as] lower any unforeseen events [like] COVID-19 or something like that,” said Molino. “A lot of it is going to be very hard, but it has to get done.”

References

1. Andel M, McKechnie A, Molino T. The 2024 election and its impact on health policy. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, NV.

2. Caffrey M. 5 hot health care topics in the presidential election. AJMC. October 18, 2024. Accessed October 18, 2024. https://www.ajmc.com/view/5-hot-health-care-topics-in-the-presidential-election