The Morning: The stakes on health care - frederick.lapides@gmail.com

October 28, 2024

Good morning. Today, my colleague Margot Sanger-Katz writes about the presidential candidates’ health policy proposals. We’re also covering the Middle East, the South China Sea and the N.F.L.’s Uncrustables obsession. —David Leonhardt

The hand of a doctor holds a stethoscope to a person’s back.

In Ortonville, Minn. Erin Schaff/The New York Times

	THE STAKES

On health care

After several elections with health care at the forefront, the issue has faded into the background this cycle. But the stakes are still high.

The next president could influence how many people have health insurance, how much many pay for it, the prices of prescription drugs and more through regulatory power alone. In the event that either candidate is elected with legislative majorities, the differences could be even larger.

The Morning has been writing on how the election will matter for major areas of public policy. Today, I’ll break down the stakes for health care.

Insurance

For people who use Obamacare, a lot of money is at stake.

During the pandemic, Democrats raised the subsidies that help 20 million Americans buy their own insurance. Poor Americans can get covered without paying a cent, and even people making north of $100,000 got help with premiums. But if Congress does nothing, the new subsidies will expire at the end of next year. That would likely leave more than three million uninsured — and would make nearly everyone insured through Obamacare pay more.

Donald Trump’s campaign says he opposes an extension, which might cost hundreds of billions of dollars. Kamala Harris wants the subsidies to be permanent, though she probably wouldn’t get her way if Republicans control Congress.

At Harborview Medical Center in Seattle. Grant Hindsley for The New York Times

The candidates are also likely to approach key regulations of Obamacare differently. In his first term, Trump encouraged the sale of lightly regulated insurance plans that cost less — and covered fewer medical problems. He also pulled back on advertising for people to enroll in Obamacare. The Biden administration reversed most of these changes, and Harris would likely keep such moves in place.

Trump could also weaken the requirement for insurers to cover all forms of contraception. In his first term, he let employers claim exemption on religious or moral grounds.

Drug prices

A rare point of agreement between the two candidates is that the United States should pay less for prescription drugs. This is an area where the president could have a lot of influence, even if Congress doesn’t cooperate.

The Biden administration signed legislation allowing Medicare to negotiate the price of certain drugs with the companies that make them. Ozempic and Wegovy, the blockbuster diabetes and weight loss drugs, could be negotiated next year. How aggressively will officials haggle over their price? It depends who’s running Medicare.

A pair of hands holds a weekly medication organizer filled with pills.

In Centreville, Ala. Charity Rachelle for The New York Times

Harris is a fan of the new law and wants it to apply to more drugs. Trump has been quiet about the specific provision, but he has lamented for years that Americans pay more for drugs than the rest of the world. When he was president, he wasn’t able to get any major legislation passed, but he tried various rules — blessing Canadian drug imports, forcing drug companies to mention most prices on television ads — to achieve similar goals.

But Trump’s policies here are difficult to predict. On this topic, he is out of step with congressional Republicans and conservative health care scholars, who mostly oppose the drug negotiation law. How far he goes may depend on whom he appoints to the big government jobs.

Medicare and Medicaid

On Medicare, the federal insurance program for Americans over 65, both Trump and Harris have vowed not to cut benefits.

But when it comes to Medicaid, which covers poor and disabled Americans, there are major differences between the candidates. Trump allowed state Medicaid programs to impose work requirements, limiting coverage to people who could prove they worked a certain number of hours a week. He could let Republican-led states try other experiments.

With a congressional majority

If allies of either candidate control both houses of Congress, the differences could be huge. Lawmakers could authorize Harris to negotiate for more drugs. She has also proposed to expand Medicare so it covers seniors’ hearing, vision and home-based care. Those changes would be costly but could be accomplished with a bare-majority vote in the Senate. Her other proposals — such as limiting insulin co-payments to $35 for all Americans or capping everyone’s out-of-pocket drug spending to $2,000 a year — would probably require either 60 Senate votes or the end of the filibuster.

If Republicans control Congress and the White House, they might cut Medicaid. Trump has not campaigned on reductions. But he has not pledged to protect the program, and he proposed major cuts in every one of his presidential budgets. None passed.

Trump has suggested he might be open to another Obamacare repeal attempt. But Republicans in Congress don’t seem interested.

Bottom line: Kamala Harris has offered policies that would lower out-of-pocket costs for many Americans and preserve or expand health insurance coverage. Donald Trump has been vaguer, and his agenda is a little harder to predict. But his allies have embraced policies that would probably increase insurance premiums for people who buy their own insurance — and raise the number of Americans who are uninsured. Both candidates would probably take steps to lower the price of prescription drugs.

Related: An opaque industry — pharmacy benefit managers — secretly inflates the price of prescription drugs.

THE LATEST NEWS

Republican Campaigns

Donald Trump, hands extended, gives a speech behind a lectern.

Donald Trump at Madison Square Garden. Hiroko Masuike/The New York Times

Trump held a rally at Madison Square Garden. Speakers likened Harris to a prostitute, called her “the Antichrist” and mocked her ethnicity.
A comedian at the rally called Puerto Rico an “island of garbage.” (Trump’s campaign said the joke “does not reflect the views of President Trump.”)
For years, a network of Republican activists and officials have met on video calls to plan to contest a Trump defeat. The Times has obtained the recordings.
Republicans are clinging to slim leads in Nebraska and Texas Senate races, according to Times/Siena College polls. These polls show that Senate control may still be in play, Nate Cohn writes.

Democratic Campaign

Harris now leads Trump by less than one percentage point nationally, according to The Times’s polling average.
She is trying to become a candidate small business owners love. That’s tough: They tend to lean Republican or Independent.
Harris is targeting Trump’s age and competence. She’s employing the same playbook Trump and his allies used against Biden, The Washington Post reports.
Last week, several celebrities — including Beyoncé and Bruce Springsteen — appeared on the campaign trail for Harris. Trump supporters feel anger and envy, Shawn McCreesh writes.

Middle East

Israel’s recent strikes against Iran made clear that it is dictating events in the Middle East, and the U.S. has been relegated to the role of wing man, Mark Landler writes.
Iranian leaders emphasized that Tehran had the right to retaliate against Israel for the strikes, but they appeared to take a measured tone.

Asia

Fisherman and fishing boats at a Vietnamese port.

In Vietnam. Linh Pham for The New York Times

Chinese officials boarded a Vietnamese fishing boat and beat a man with iron pipes in a part of the South China Sea claimed by both China and Vietnam.
Japan’s governing party lost its majority in parliamentary elections. It had a political finance scandal.
A tropical storm, Trami, made landfall in Vietnam. It killed at least 80 people in the Philippines.

MORNING READS

A group of people, some holding torchlights, walk through a graveyard at night.

In Pluckley, England. Andrew Testa for The New York Times

Pluckley: Visit England’s most haunted village.

“Ketamine queen”: Read about the woman at the center of the investigation into Matthew Perry’s death.

Endangered: Can whale moms save their species? Meet one of them.

Metropolitan Diary: Deli meat math.

Lives Lived: Antonio Franklin, known as DJ Clark Kent, was a respected hip-hop insider who had influential relationships with many leading rappers. He died at 58.

SPORTS

Jayden Daniels’s 52-yard Hail Mary. NFL

N.F.L.: The Washington Commanders defeated the Chicago Bears with Jayden Daniels’s game-winning Hail Mary pass.

N.B.A.: Golden State Warriors star Steph Curry sprained his ankle. His team lost, 112-104, to the Los Angeles Clippers.

M.L.B.: Shohei Ohtani will play for the Los Angeles Dodgers in Game 3 of the World Series tonight after injuring his shoulder in Game 2.

ARTS AND IDEAS

Gustaf Öhrnell Hjalmars

Uncrustables, peanut butter and jelly sandwiches found in supermarket freezers, are popular in the N.F.L. Brock Purdy ate one at his locker before the Super Bowl. Andy Reid once offered them to his players as a reward. At the end of 2023, The Athletic tried to find out just how many of these snacks the league went through that year. The answer: Some 80,000. See a breakdown by team.

THE STAKES