(13) US Healthcare - Different Approaches of Trump and Harris

Importance of Healthcare Policy in Presidential Administrations:

This discussion aims to provide a comparative analysis of healthcare policies under the Trump and Biden administrations. Let’s explore their approaches, key policies, and impacts on coverage, costs, and public health. Through this analysis, we will understand the differences and implications of their healthcare strategies and the potential future direction of the U.S.Healthcare Policy.

Healthcare Under the Trump Administration:

Overview of Trump's Healthcare Agenda:

General Approach and Objectives

The Trump administration's Healthcare agenda focused on reducing federal involvement, promoting market-based solutions, and dismantling the ACA. The administration sought to increase state flexibility, reduce regulations, and foster competition in the healthcare market. Trump's policy aimed to lower costs and improve care quality by encouraging innovation and efficiency.

Key Policies and Actions

Attempt to Repeal and Replace the Affordable Care Act (ACA):

A central goal of the Trump administration was to repeal and replace the ACA. This effort culminated in the American Health Care Act (AHCA) of 2017, which aimed to dismantle significant ACA provisions. The AHCA proposed eliminating the individual mandate, reducing Medicaid expansion, and altering subsidies for private insurance. Despite passing the House, the bill failed in the Senate, maintaining the ACA's framework.

Executive Orders and Administrative Actions Affecting Healthcare:

Trump's administration used executive orders and administrative actions to alter the healthcare landscape. For instance, the administration expanded the availability of short-term, limited-duration insurance plans, which are less comprehensive but cheaper. It also allowed association health plans, enabling small businesses to band together to purchase insurance, bypassing some ACA regulations.

Impact on Coverage and Access:

Changes in Insurance Coverage and the Uninsured Rate:

Trump's policies led to increased numbers of uninsured Americans. The removal of the individual mandate penalty through the Tax Cuts and Jobs Act of 2017 and the promotion of short-term plans, which do not comply with ACA standards, contributed to a rise in the uninsured rate. According to the Census Bureau, the uninsured rate increased from 8.6% in 2016 to 9.2% in 2019.

Medicaid Work Requirements and Block Grants:

The Trump administration introduced Medicaid work requirements, mandating that beneficiaries work, volunteer, or train for jobs to receive benefits. This policy aimed to promote employment but resulted in coverage losses for those unable to meet the requirements. Additionally, the administration encouraged states to adopt Medicaid block grants, providing a fixed amount of federal funding for Medicaid, which could limit states' ability to respond to increased demand.

Short-term Health Plans and Association Health Plans:

The expansion of short-term health plans and association health plans provided cheaper alternatives to ACA-compliant plans but often lacked comprehensive coverage. These plans attracted healthier individuals, leading to higher premiums for ACA-compliant plans and destabilizing the insurance markets. Critics argued that these policies undermined the ACA's protections and left consumers exposed to higher out-of-pocket costs.

Healthcare Costs and Affordability - Prescription Drugs Initiatives

The Trump administration attempted to address high prescription drug prices through several initiatives, including promoting the importation of cheaper drugs from Canada and encouraging price transparency. Executive orders aimed to lower drug prices by tying the cost of certain medications to prices in other countries. However, these efforts faced significant opposition and limited implementation.

Hospital Price Transparency Rules:

In 2019, the Trump administration finalized rules requiring hospitals to disclose prices for services and procedures publicly. This policy aimed to increase transparency and competition, enabling consumers to make informed choices about their healthcare. Despite legal challenges from the hospital industry, these rules took effect in January 2021. 

Public Health and Pandemic Response - Handing of the COVID-19 Pandemic:

The Trump administration's handling of the COVID-19 pandemic was widely criticized for its delayed response, inconsistent messaging, and inadequate coordination with state and local governments. Despite initiating Operation Warp Speed, which accelerated vaccine development, the administration faced challenges in testing, contact tracing, and PPE distribution, contributing to the high infection and death rates.

Impact on Public Health Infrastructure and Response Capabilities:

The pandemic exposed weaknesses in the U.S. public health infrastructure, highlighting underfunding and fragmentation. The Trump administration's approach to the pandemic strained the healthcare system, leading to overburdened hospitals and healthcare workers. The lack of a coordinated national response and reliance on state-led efforts resulted in uneven outcomes and disparities in COVID-19 management.

Regulatory and Administrative Changes

Changes in Healthcare Regulations and Enforcement

The Trump administration rolled back numerous regulations, aiming to reduce the regulatory burden on healthcare providers and insurers. This included relaxing ACA requirements and promoting state flexibility in Medicaid. However, these changes often led to reduced consumer protections and increased variability in healthcare access and quality across states.

Impacts on Healthcare Providers and Insurance Markets:

The regulatory changes under Trump had mixed impacts on healthcare providers and insurance markets. While some providers benefited from reduced administrative burdens, others faced challenges due to increased uncompensated care from uninsured patients. Insurance markets experienced volatility, with premium increases and market exits in response to policy shifts.

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Healthcare Under the Biden-Harris Administration

Overview of Biden-Harris's Healthcare Agenda:

The Biden-Harris administration's Healthcare agenda is centered on expanding access to care, improving affordability, and addressing healthcare disparities. Unlike the Trump administration, which focused on reducing federal involvement, Biden-Harris aims to strengthen and build upon the Affordable Care Act (ACA). Their administration seeks to ensure that more Americans have access to comprehensive health insurance and to enhance the quality of healthcare services. Key objectives include increasing subsidies for insurance, expanding Medicaid, and implementing policies to reduce prescription drug prices.

Key Policies and Actions:

Strengthening and Expanding the ACA:

A cornerstone of Biden-Harris’s healthcare policy is the reinforcement and expansion of the ACA. This includes increasing subsidies to make insurance more affordable and extending the open enrollment period to allow more people to sign up for coverage. The administration also reversed several Trump-era policies that weakened the ACA, such as the expansion of short-term health plans that did not meet ACA standards.

American Rescue Plan's Healthcare Provisions:

The American Rescue Plan Act of 2021 included significant healthcare provisions aimed at expanding coverage and reducing costs. It temporarily increased subsidies for ACA marketplace plans, making premiums more affordable for millions of Americans. The plan also provided incentives for states to expand Medicaid by offering additional federal funding, and it extended postpartum Medicaid coverage for new mothers, aiming to reduce maternal mortality rates.

Public Health Initiatives and Increase in Funding:

The Biden-Harris administration has placed a strong emphasis on public health, with substantial funding increases for public health programs and infrastructure. This includes significant investments in the Centers for Disease Control and Prevention (CDC) to enhance disease surveillance and response capabilities. Additionally, Biden-Harris has prioritized mental health services and substance abuse treatment, recognizing the broader health impacts of the COVID-19 pandemic.

Impact on Coverage and Access -- Expansion of ACA Subsidies and Medicaid:

The Biden-Harris administration’s Policies have significantly expanded ACA subsidies, making Health Insurance more affordable for middle- and low-income individuals. According to the Department of Health and Human Services (HHS), the expanded subsidies under the American Rescue Plan have reduced premiums by an average of 40%. Additionally, the administration has encouraged states to expand Medicaid, resulting in millions of newly eligible individuals, gaining coverage.

Efforts to Reduce the Uninsured Rate:

Biden-Harris’s efforts have led to a notable reduction in the uninsured rate. The increased ACA subsidies and extended enrollment periods have contributed to a rise in marketplace enrollments. In 2021, the number of Americans without a Health Insurance dropped by 1.5 million, reversing the trend of the increasing uninsured rates seen during the Trump administration.

Addressing Healthcare Disparities and Inequities:

The Biden-Harris administration has taken steps to address longstanding healthcare disparities, particularly those affecting minority communities. Initiatives include funding for community health centers, efforts to increase maternal health, and policies aimed at reducing racial and ethnic disparities in healthcare access and quality. The administration’s focus on health equity aims to ensure that all Americans, regardless of background, have access to high-quality healthcare.

Healthcare Costs and Affordability:

Prescription Drug Price Reforms

One of Biden-Harris’s key initiatives is to lower prescription drug prices, a significant burden for many Americans. The administration supports allowing Medicare to negotiate drug prices directly with pharmaceutical companies, a policy projected to save billions in healthcare costs. Additionally, Biden-Harris have proposed caps on out-of-pocket costs for Medicare beneficiaries, further alleviating the financial strain on seniors.

Policies to Reduce Out-of-Pocket Costs for Consumers:

Biden-Harris's Healthcare Policies include measures to reduce out-of-pocket costs for consumers. This includes limiting the cost of insulin to $35 per month for Medicare beneficiaries and proposing limits on the price of other essential medications. By increasing ACA subsidies, the administration has also made health insurance more affordable, reducing the financial barriers to accessing care.

Public Health and Pandemic Response

COVID-19 Response and Vaccination Efforts:

The Biden-Harris administration’s handling of the COVID-19 pandemic has been marked by a robust federal response and an aggressive vaccination campaign. Upon taking office, Biden-Harris set ambitious vaccination targets and implemented measures to increase vaccine supply and distribution. The administration achieved the milestone of administering over 200 million doses within the first 100 days. Additionally, Biden-Harris have emphasized the importance of public health guidelines and the support for state and local health departments.

Building Public Health Infrastructure and Preparedness:

Recognizing the weaknesses exposed by the pandemic, the Biden-Harris administration has focused on strengthening public health infrastructure and preparedness. This includes significant investments in the CDC and other public health agencies, to improve disease surveillance, laboratory capacity, and emergency response capabilities. Biden-Harris's policies aim to ensure that the United States is better prepared for future public health crises. 

Regulatory and Administrative Changes:

Reversing Trump-Era Regulations:

The Biden-Harris administration has reversed several Trump-era healthcare regulations that were seen as undermining the ACA and consumer protections. This includes reimposing restrictions on short-term health plans and association health plans that did not meet ACA standards. By restoring these regulations, Biden-Harris aim to stabilize insurance markets and protect consumers from inadequate coverage.

New Regulations to Improve the Healthcare Quality and Access:

In addition to reversing previous policies, Biden-Harris have introduced new regulations to enhance healthcare quality and access. This includes implementing stricter hospital price transparency rules to help consumers understand the cost of care and introducing measures to ensure mental health parity in insurance coverage. The administration has also proposed new rules to address surprise medical billing and protecting patients from unexpected charges.

Comparative Analysis

Fundamental Differences in Healthcare Philosophy and Goals:

The Trump-Pence and Biden-Harris administrations represent totally different healthcare philosophies. Trump-Pence focused on reducing federal involvement and promoting market-based solutions, aiming to increase competition and lower costs through deregulation.

Conversely, Biden-Harris emphasizes expanding federal support and intervention to ensure broader access and affordability, aiming to build on and strengthen the ACA. These fundamental differences reflect broader ideological divides, with Trump-Pence favoring limited government involvement and Biden-Harris advocating for a more active government involvement in addressing the healthcare challenges.

Coverage and Access:

Comparative Impact on Insurance Coverage and Access to Care:

Under Trump-Pence efforts to repeal the ACA and promote short-term health plans led to an increase in the uninsured rate and reduced comprehensive coverage options. 

The Biden-Harris administration, by expanding ACA subsidies and encouraging Medicaid expansion, has significantly increased insurance coverage and have improved access to care. Biden-Harris's policies have resulted in millions gaining coverage and a reduction in the uninsured rate, demonstrating a more inclusive approach to Healthcare access.

Healthcare Costs

Differences in Policies Aimed at Controlling Healthcare Costs:

Both administrations sought to address healthcare costs but approached the issue differently. Trump-Pence focused on market-based strategies, such as promoting price transparency and reducing drug prices through international price comparisons. Biden-Harris, while continuing efforts on price transparency, places greater emphasis on federal intervention, such as allowing Medicare to negotiate drug prices and increasing subsidies to lower out-of-pocket costs for consumers. These differing approaches reflect their broader healthcare philosophies.

Public Health and Pandemic Response

Effectiveness and Outcomes of COVID-19 Response Under Both Administrations:

The Trump administration's response to COVID-19 was criticized for its delayed actions and lack of coordination, which contributed to high Infection Rates and eventually high Mortality Rates. In contrast, the Biden-Harris administration implemented a more co-ordinated federal response, prioritized vaccinations, and provided substantial support to state and local health departments. Biden-Harris's approach led to significant improvements in vaccination rates and pandemic management, highlighting the difference in crisis handling between the two administrations. 

Regulatory Environment

Comparison of Regulatory Changes and Their Impacts on the Healthcare System:

Trump-Pence's regulatory changes aimed at reducing federal oversight and increasing state flexibility often resulted in increased variability in healthcare access and quality. 

Biden-Harris's regulatory approach focuses on reversing these changes and implementing new rules to enhance consumer protections and improve healthcare quality. This includes stricter regulations on short-term plans and new measures to address surprise billing, reflecting a more protective stance towards Healthcare consumers.

Conclusion 

Summary of Key Findings:

The Healthcare Policies of the Trump-Pence and Biden-Harris administrations reflect fundamentally different approaches and have led to distinct impacts on the U.S. Healthcare System. 

Under Trump-Pence the emphasis was on reducing federal involvement, increasing market competition, and attempting to repeal and replace the Affordable Care Act (ACA). Key actions included promoting short-term health plans, introducing the American Health Care Act (AHCA), and implementing the regulatory changes aimed at increasing the transparency in drug prices and hospital billing. However, these efforts resulted in increased uninsured rates and variability in coverage quality. 

Conversely, the Biden-Harris administration has focused on strengthening and expanding the ACA, increasing the federal support, and addressing healthcare disparities. Significant policies include the American Rescue Plan, which expanded ACA subsidies, incentivized Medicaid expansion, and implemented comprehensive public health initiatives. Biden-Harris's approach has led to a significant reduction in the uninsured rate, improved access to care, and enhanced public health infrastructure, especially in response to the COVID-19 pandemic. The administration has also emphasized lowering of prescription drug prices and reducing out-of-pocket costs for consumers.

Implications for the Future

The long-term implications of these divergent Healthcare Policies will shape the U.S. Healthcare landscape for years to come. The Biden-Harris administration’s focus on expanding coverage and strengthening the ACA is likely to continue reducing the uninsured rate and improving access to care, particularly for low-income and minority populations. Efforts to address prescription drug prices and out-of-pocket costs may alleviate the financial burdens on consumers and enhance the overall affordability of Healthcare.

However, challenges still remain. The ongoing debate over the role of federal control versus state control in Healthcare, the sustainability of increased federal spending, and the need for bipartisan support for significant reforms -- will continue to influence the Policy Development. Future administrations will need to address these challenges, while building on the achievements of Trump-Pence and Biden-Harris administrations and at the same time, learning from the shortcomings of these two administrations. 

Potential areas for policy development include further strengthening the ACA, implementing comprehensive drug price reforms, and addressing the social determinants of health, in order to reduce disparities. Additionally, enhancing the public health preparedness and infrastructure will be crucial in preventing and managing future health crises.  

Final Thoughts

The Healthcare policies under the Trump-Pence and Biden-Harris administrations highlight the critical importance of healthcare policy in presidential leadership. Trump-Pence's market-oriented approach aimed at reducing the federal involvement, had mixed results, with some success in transparency initiatives but increased the uninsured rates. Biden-Harris’s expansion-oriented policies have significantly improved the coverage and access, particularly through strengthening the ACA and addressing the disparities.

Thus, an effective Healthcare Policy requires balancing affordability, accessibility, and quality of care. Presidential leadership plays a vital role in shaping these policies, and the contrasting approaches of Trump-Pence and Biden-Harris underscore the impact that different philosophies can have on the health and well-being of Americans. As the U.S. continues to navigate complex healthcare challenges, a thoughtful and inclusive Policy Development, will be essential in ensuring a healthy future for all citizens.

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