Harris Defends ACA While Trump Calls for "Much Better" Health Plan During Debate

Health care emerged as a pivotal topic at last night’s presidential debate as moderator Linsey Davis questioned former President Donald Trump and Vice President Kamala Harris on their differing visions for the future of the Affordable Care Act (ACA), also known as Obamacare.

The candidates discussed what their future plans for the Affordable Care Act would entail if elected as the next president of the United States.

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During his presidency, Trump's policies regarding the ACA included attempts to repeal it, deprioritizing the individual mandate penalty, reducing cost-sharing subsidies, cutting funding for ACA outreach, and expanding short-term plans that did not comply with ACA standards.¹ These actions contributed to rising premiums and increased federal spending on subsidies, according to KFF.

As part of the Biden-Harris administration, Harris has supported efforts to strengthen the ACA by enacting the American Rescue Plan Act, addressing the "family glitch," reversing Trump-era expansions of short-term plans, and achieving record-high enrollment in ACA Marketplace plans. These provisions were extended through 2025 by the Inflation Reduction Act (IRA). As a result of the act, last month CMS announced new drug prices for Medicare resulting in significant discounts for various drugs.² Last year, the cost of insulin was capped at $35 for almost 4 million seniors with Medicare.³

Last night, the candidates discussed what their future plans for the ACA would entail if elected as the next president of the United States.

Trump Said He Saved the ACA Instead of “Letting it Rot”

Davis broached the topic of health policy by asking if Trump currently had a specific plan to improve or replace the ACA and acknowledged his long-standing vow to repeal and replace it.⁴

“You now say you’ll keep Obamacare quote, 'unless we can do something much better.' Last month, you said quote, 'we're working on it,'” Davis said to Trump. “So tonight, 9 years after you first started running, do you have a plan, and can you tell us what it is?”

Trump responded by criticizing the ACA, saying, “Obamacare was lousy health care—always was. It's not very good today.” He reiterated that his administration had considered different approaches to replace it but claimed that Democratic opposition had blocked any changes, to which Harris later stated that while he was president, Trump attempted to “get rid” of the ACA 60 times.

He expressed that he was compelled to "save" the ACA and make it "as good as it can be," even though he believed it would never reach the level of a great health care plan due to its cost.

“I had a choice to make when I was president: do I save it and make it as good as it can be—never going to be great—or do I let it rot? I felt I had an obligation, even though, politically, it would have been good to just let it rot and let it go away,” Trump said.

If his team finds a better, less expensive option, Trump said he would pursue it. When pressed by Davis for a simple yes or no on whether he currently had a concrete plan, Trump acknowledged that he only had "concepts of a plan" and is currently “looking at different plans.” However, he did not provide specific details about a replacement plan, saying only that the public would hear more "in the not-too-distant future."

Harris: Strengthen the Affordable Care Act

Shifting to Harris, Davis asked her to clarify her evolving stance on health care reform. She pointed out that in 2017, Harris supported Sen Bernie Sanders' (I, Vermont) proposal to eliminate private insurance in favor of a government-run health care system, but 2 years later, she proposed a plan that included a private insurance option.

Harris responded by emphasizing her support for private health care options over the past 4 years as vice president while also advocating for the maintenance and expansion of the ACA. She emphasized the importance of preserving the ACA by recalling the efforts to repeal it during Trump's presidency, noting that Trump attempted to dismantle the ACA 60 times.

“I was a senator at the time when I will never forget the early morning hours when it was up for a vote in the United States Senate…” Harris said. “The late great John McCain, I will never forget that night, walked onto the Senate floor and said, ‘No, you don't. No, you don't. No, you don't get rid of the Affordable Care Act. You have no plan.’”⁵

Harris also highlighted key achievements made under the Biden administration to strengthen the ACA. She pointed out that, for the first time, the administration has negotiated drug prices on behalf of Americans and capped the cost of insulin at $35 per month. Additionally, the administration has limited the annual cost of prescription medication for seniors to $2000.

“When I am president, we will do that for all people, understanding that the value I bring to this is that access to health care should be a right and not just a privilege of those who can afford it, and the plan has to be to strengthen the Affordable Care Act, not get rid of it,” Harris concluded.

Before moving on to the next question, Trump responded by claiming that Harris does not want to improve private medical insurance for people. He argued that she wants everybody to be on government insurance, which would result in long waiting times for necessary medical procedures. Trump also reiterated the need for a better alternative to Obamacare, stating that it could be achieved at a lower cost.

The Future of US Health Policy

The debate highlighted the stark contrast between the candidates' visions for the future of health care in America. Trump emphasized his dissatisfaction with the ACA, his past efforts to repeal it, and his current intention to replace it with a plan he claims would be more affordable, though without providing specific details. In contrast, Kamala Harris reinforced her commitment to preserving and expanding the ACA, by building on the efforts of the Biden-Harris administration's achievements in lowering prescription drug costs, fixing flaws in the health care system, and broadening access to care.

As the election approaches, health care remains a critical issue, with each candidate presenting fundamentally different approaches to addressing the needs of Americans.

References

1. Compare the candidates on health care policy. KFF. Updated September 10, 2024. Accessed September 11, 2024. https://www.kff.org/compare-2024-candidates-health-care-policy/

2. McCormick B. Reaction mixed after CMS unveils negotiated Medicare drug prices. AJMC^®. August 19, 2024. Accessed September 11, 2024. https://www.ajmc.com/view/reaction-mixed-after-cms-unveils-negotiated-medicare-drug-prices

3. Fact sheet: President Biden's cap on the cost of insulin could benefit millions of Americans in all 50 states. News release. The White House. March 2, 2024. Accessed September 11, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2023/03/02/fact-sheet-president-bidens-cap-on-the-cost-of-insulin-could-benefit-millions-of-americans-in-all-50-states/

4. Joszt L. Without votes for BCRA, McConnell calls for repeal and delay of ACA. AJMC. July 18, 2017. Accessed September 11, 2024. https://www.ajmc.com/view/without-votes-for-bcra-mcconnell-calls-for-repeal-and-delay-of-aca

5. Joszt L. Senate rejects skinny repeal; 3 Republicans vote no. AJMC. July 28, 2017. Accessed September 11, 2024. https://www.ajmc.com/view/senate-rejects-skinny-repeal-3-republicans-vote-no