Marcelo Leal/Unsplash

Updated June 30, 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:

The Candidates on the Affordable Care Act 

Joe Biden (D): Supports the Affordable Care Act.

As president, Joe Biden strengthened the Affordable Care Act by increasing marketplace subsidies for health insurance. He also supports an individual mandate for Americans to obtain healthcare, meaning most people who do not sign up for health insurance would face a financial penalty.

Donald Trump (R): Opposes 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 has recently stated that he will look for “alternatives” to the Affordable Care Act, reviving his past promise to repeal it.

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

Joe Biden (D): Against Medicare for All but supports an expansion.

President Joe Biden said, during the 2020 Presidential Election, that he would veto a “Medicare for All” plan because of the cost of the plan but advocated to strengthen existing healthcare systems instead. Biden proposed a public option plan, an insurance program directed by the federal government and available to all U.S. citizens. This plan faded as his presidency progressed.

Biden said, during his 2020 campaign, that he hoped to decrease Medicare eligibility to as low as age 60, a proposal that he has since dropped. He also called for making vision, dental and hearing benefits standard in the original Medicare plan, and included provisions for this goal in his Build Back Better Plan. As negotiations progressed, and the plan evolved into the Inflation Reduction Act, these provisions were not included in the final version of the plan. 

Biden signed the Inflation Reduction Act of 2022 into law, which included actions to expand benefits and decrease prescription drug costs. The act allows 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). Biden has proposed increasing the number of drugs that the federal government can negotiate pricing for to at least 50 drugs each year.

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 administration also released a plan to allow people with Medicare Part D to pay out-of-pocket drug costs in monthly payments instead of paying in full when they pick up their medication. 

The Biden administration directed the Centers for Medicare & Medicaid Services to increase transparency for Medicare Advantage. Medicare Advantage bundles Part A, Part B and, typically, Part D from the original Medicare plan with an approved plan from an outside company to provide supplemental coverage for services like hearing, dental and vision. 

The Biden Administration 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 and help enrollees access the benefits included in their plans. 

Biden released a plan in 2023 to increase Medicare’s Hospital Insurance (HI) Trust Fund solvency by at least 25 years. The HI fund finances services associated with hospital stays, hospices, and skilled nursing facilities (Medicare Part A) and was projected to become insolvent by 2028. Biden included steps to increase HI solvency in his 2025 budget: raising the Medicare tax rate on income greater than $400,000 from 3.8 percent to 5 percent; closing loopholes in Medicare taxes; and directing revenue from the Medicare net investment income tax and savings from prescription drug price reform to the HI Trust Fund. 

The latest estimates project that the HI fund will remain solvent until 2036, following Biden’s actions on Medicare.

The Biden 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. 

Biden vowed to prevent Medicare cuts during his 2024 State of the Union address and has made healthcare costs and coverage one of the central issues of his 2024 campaign. 

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

Joe Biden (D): Advocates for lowering prescription drug prices.

President Joe Biden has advocated to cut the cost of prescription drugs, specifically insulin, lobbying to cap the cost at $35 per month. Biden called on Congress to expand the $2,000 out-of-pocket price cap on drugs in Medicare drug plans to all private insurance plans. He also encouraged Congress to expand the mandate that drug companies pay rebates if they increase prices at a rate greater than inflation from just Medicare drug sales to all commercial drug sales. 

Biden also called on Congress to implement a $2 cost-sharing limit for “high-value generic drugs” on all Medicare plans. 

Biden has criticized high drug prices in the U.S. compared to other countries and pressured drug companies to lower prices for prescription drugs and inhalers.

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 

Joe Biden (D): Supports, including for minors.

President Joe Biden reversed a Trump-era policy that limited “sex discrimination" protections at federally funded healthcare providers solely to biological sex. He also signed an executive order increasing access to gender transition treatments for minors.

Biden broadened the definition of sex discrimination under Section 1557 of the ACA. The amendment prohibits federally funded health providers and insurers from discriminating against gay and transgender patients; however, it preserves religious exemptions and clinical judgment, as it does not mandate the provision of any particular medical service.

Donald Trump (R): Against, including for minors.

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, 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.

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, Content Intern (Lean Right bias); 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 Assistant (Right bias); Johnathon Held, 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.

2024 Presidential Election, Republican Party, Democratic Party, Donald Trump, Joe Biden, Cornel West, Chase Oliver