With Labor Day in the rearview mirror and Congress’ summer recess wrapping up, the end of the year is in plain sight — and before we know it, the nation will be in the midst of the 2024 presidential election.
In what is expected to be a highly contentious race, voters are worried about a litany of topics ranging from the economy to foreign policy, but healthcare always ranks near the top. This is especially true as the nation emerges from the worst of the three-year COVID-19 pandemic.
With all that said, healthcare — aside from abortion — wasn’t the hottest topic at the most recent GOP candidate presidential debate. Still, issues like prescription drug pricing, mental health access and the ongoing fentanyl crisis remain top-of-mind as candidates get closer to the election.
While the frontrunners are President Joe Biden and former President Donald Trump, there are currently seventeen people in total running for president (13 people among Republicans, three Democrats and one third-party candidate).
Here’s where the candidates stand on the most significant healthcare issues.
Abortion
Ever since the overturning of Roe v. Wade last year, abortion has remained a polarizing healthcare item on both sides of the aisle.
In this election cycle, the Democratic Party has largely unified around efforts to restore aspects of Roe in the form of reproductive rights protections, while conservative candidates have argued over whether they would sign a federal abortion ban into law.
At the Republican debate in Milwaukee in August, former South Carolina Governor Nikki Haley argued that a federal ban wouldn’t have enough support in Congress to pass — while former Vice President Mike Pence vowed that he would sign an abortion ban if elected.
“A 15-week [abortion] ban is an idea whose time has come,” Pence said, arguing that such a ban was “supported by 70% of the American people.”
Other GOP candidates have wavered on support for a federal ban as well as how many weeks would be included in it.
Florida Governor Ron DeSantis signed a six-week abortion ban bill into law this year, but has said he would leave it to individual states to determine abortion restrictions rather than instate a federal ban if he were president
Former Roivant Sciences CEO Vivek Ramaswamy has indicated doesn’t support a federal abortion ban — but does support state bans. “The federal government should stay out of it,” Ramaswamy said, according to the Associated Press.
Despite describing himself as “the most pro-life president in American history,” meanwhile, Trump has historically avoided specifying his stance on a federal ban.
“No Republican has worked harder to avoid the issue than the former president,” the Associated Press noted.
Trump did, however, recently criticize DeSantis’ six week abortion ban in Florida as being “too harsh” — suggesting he may steer away from the idea of a federal ban as well.
As for Biden, he has said he would veto a federal abortion ban if lawmakers attempt to pass one.
Since Roe v. Wade was overturned, the Biden administration has also pledged its commitment to protecting abortion access — as well as access to contraceptives.
In a statement this June, the White House noted that “the only way to ensure women in every state have access to abortion is for Congress to pass a law restoring the protections of Roe v. Wade.”
The other two Democratic candidates, Marianne Williamson and Robert F. Kennedy, Jr., have stated they are pro-choice, though Kennedy waffled on his stance at a campaign event in Iowa last month.
Drug prices
Congress passed the Inflation Reduction Act (IRA) last year, which included historic drug pricing reform provisions and remains a major issue among lawmakers and presidential candidates.
Unlike abortion, however, drug pricing regulation is an area that has recently seen a decent amount of bipartisan support in Congress – particularly when it comes to pharmacy benefit manager (PBM) reform.
Biden has already made drug pricing a major aspect of his campaign. He’s recently touted the provisions in the IRA that cap the cost of insulin at $35 and reduce out-of-pocket Part B drug costs — aiming to garner up support with the new policies. The administration’s recent announcement of the first 10 drugs that will fall under Medicare negotiations also bolsters Biden’s approach to the drug pricing issue according to political observers.
“Biden’s push on drug prices is a political master stroke,” wrote Jeet Heer in The Nation. “The policy will also help shore up Biden’s support among exactly those voters… crucial to Biden’s re-election (young people who are to the left of Biden on economic issues and feel he hasn’t done enough to fulfill his promises).”
On the other side of the aisle, Republican candidates are seeking to differentiate themselves from Democrats on Medicare’s new negotiating power, with some GOP operatives arguing conservatives should side with pharma on this one.
Joe Grogan, a Republican strategist, told Politico that Republican candidates should attack Democrats over the Medicare negotiations, arguing that the program is “killing clinical programs” and “fundamentally restricting the amount of treatments.”
Generally speaking, though, most Republican candidates haven’t procured a comprehensive drug pricing plan.
DeSantis did sign a Florida bill in May that seeks to boost transparency among PBMs for prescription drug costs, though he hasn’t stated how he would address drug pricing if president.
Trump, however, has been more vocal about the issue, echoing a stance he held during his presidency — that the U.S. shouldn’t pay any more for drugs than other countries in the world.
He has argued that he would reinstate an executive order that would require Medicare Part B and D to pay the same price for drugs as other countries — a program that the pharma industry has vehemently opposed.
Fentanyl crisis
While the skyrocketing trajectory of opioid overdose rates has flattened a bit since 2021, fentanyl is becoming an increasingly worse threat, according to data from the Centers for Disease Control and Prevention.
In 2021, there was a four-fold increase from five years ago in the number of fentanyl drug overdose deaths, to some 70,000 people. Now, fentanyl makes up the majority of all overdose deaths.
It’s not surprising, then, that presidential candidates have sparred over how to address the crisis.
Since taking office, Biden has supported a harm reduction approach in his drug control strategy, including expanding access to naloxone, drug test strips and syringe service programs.
Republican candidates, on the other hand, are taking a more “war on drugs” approach — with many vowing to use force to stem fentanyl drug dealing — instead of implementing drug addiction treatment programs.
DeSantis, for example, has said he would be open to employing “lethal force” via the U.S. military to stop drug cartels in Mexico and Trump has said he believes drug dealers should face the death sentence.
Interestingly enough, Ramaswamy’s stance doesn’t quite fit into the status quo for his party. While he has said he would employ the military to “annihilate the Mexican drug cartels if necessary,” he has also broken with the GOP party and said he doesn’t consider himself a “‘war on drugs’ person.”
Additionally, he has said that he supports decriminalization of certain drugs like psychedelics as a possible solution for stemming fentanyl overdoses.
“I’m eyes wide open and willing to be bold in crossing boundaries we haven’t yet crossed,” he said, according to Fox News. “[D]ecriminalization… is an important part of the long run solution here.”
ACA/Obamacare
While Republicans have largely given up on their goal of repealing the Affordable Care Act (ACA), a replacement healthcare agenda hasn’t materialized and GOP candidates haven’t been too outspoken about healthcare outside of abortion.
Still, Republican think tanks have been crafting together ideas that would push healthcare in a more conservative direction.
Some experts at Stanford’s Hoover Institution, for example, recently outlined a free-market healthcare alternative called “Choices for All” that they hope could serve as a replacement for the ACA.
“[I]t feels a little bit like there’s a void in thinking and ideas, and so what we’ve tried to do with concepts in this plan, is to fill in some of that,” plan author Lanhee Chen told Axios.
It’s unclear whether “Choices for All” or other GOP-led efforts will take the helm during next year’s campaign; and it’s safe to say that for now, the ACA will likely remain untouched.
Larry Levitt, executive vice president for health policy at Kaiser Family Foundation, noted in a July JAMA Forum article that “in fact, this may be the first presidential election since 2008 when health reform and the ACA — or repeal of the ACA — are not front and center.”
