Health care: How much of an issue in the election?

Health care has not been one of the central issues in the upcoming presidential and congressional elections. But Democratic presidential nominee Kamala Harris has campaigned on health-related issues more than her Republican opponent, Donald Trump, has.

Those were among the takeaways from a recent webinar by The Advisory Board, where two analysts from McDermott+Consulting gave their views on what the upcoming election could mean for health care.

During a campaign, “Democrats tend to lean into health care while Republicans tend to avoid it,” said Debbie Curtis, vice president at McDermott+Consulting.

She said Harris has focused on continuing and expanding Medicare prescription drug price negotiation, expanding Medicare’s $2,000 annual cap on out-of-pocket prescription drug costs to everyone, expanding $35 monthly insulin costs to everyone and ensuring that the enhanced tax credits that enable more Americans to purchase health insurance on the Affordable Care Act exchanges will continue after they are set to expire in 2025. More recently, Harris proposed expanding Medicare to cover home health care for older Americans.

Meanwhile, during Trump’s term as president, the COVID-19 pandemic and ACA repeal and replace were the two dominant health care issues, said Rodney Whitlock, vice president at McDermott+Consulting. Those two issues aren’t dominant this time around, but Whitlock said health care issues in a second Trump presidency would depend on who Trump would appoint to positions such as Secretary of Health and Human Services.

But much of what a president wants to accomplish depends on getting bills passed through Congress. So the makeup of the incoming Congress is crucial to the president’s health care agenda becoming law. With all 435 seats in the House of Representatives and one-third of the Senate seats up for election in November, the results of the congressional election will determine whether policy becomes reality.

Whitlock predicted the House would flip from Republican to Democratic control and the Senate would flip from Democratic to Republican control.

“Which would mean we would have divided government where no party is in control. If one party controls all three [White House, House and Senate], they get to be far more adventurous in their policy choices. They can do more of the things they want.”

However, the president still has some authority to influence health care policy through the regulatory arm of government, he said, regardless of which party controls Congress.

Congress returns for its lame duck session on Nov. 12, and health care legislation will be far down its list of priorities, Curtis said. Its top priority will be approving funding for disaster relief in the wake of two devastating hurricanes that hit the South this fall. Congress also is faced with approving a bill to continue funding the federal government beyond Dec. 20.

“Anybody in Congress who has a health care priority they want to get done this year wants to attach it to those bills in whatever way they pass at the end of the year,” she said. Extending Medicare’s telehealth flexibility and passing pharmacy benefit manager reform are two health care proposals that she believes will be discussed in Congress during the lame duck session.

Congress also must decide next year on whether to extend the enhanced ACA subsidies.

“There is a decision point for Congress next year, whether to extend those subsidies or not, and who is in the White House and who controls each body of Congress will have a big role to play in what happens there and when people become uninsured,” Curtis said. “There are state costs involved, provider costs, hospital costs. Those of us with private insurance pay more to cover those uncompensated care costs. It’s a big-ticket item - to extend the enhanced subsidies permanently would cost $335 billion over 10 years. That’s not chump change.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].