US Healthcare at a Crossroads: Harris' Expansion of Government Intervention or Trump's Demand for a Market-Driven Approach?
Healthcare has become one of the most pressing issues in American politics, with millions of lives hanging in the balance. The issue centers around affordability and access, ranking as a top concern for voters, second only to the economy. As healthcare costs soar and disparities in access persist, Kamala Harris’ advocacy for greater government intervention and Donald Trump’s insistence on a market-based approach offer two starkly different visions for the future of U.S. healthcare. The policies enacted by the succeeding administration will, at the very least, influence who can afford coverage, alter the delivery of critical services, and determine how the system addresses the needs of vulnerable populations. The choice between these approaches will shape the healthcare landscape for years to come; the stakes are high.
The Patient Protection and Affordable Care Act (ACA), enacted in 2010 under President Barack Obama, remains one of the most transformative yet contentious pieces of healthcare legislation in U.S. history. The ACA aimed to expand healthcare access to nearly all Americans, from birth through retirement, primarily through Medicaid expansion and the creation of insurance marketplaces. Despite its goal to lower the uninsured rate and improve healthcare equity, less than 50% of Americans support the ACA. The plan has faced significant opposition from conservative lawmakers, who argue that the ACA represents government overreach, undermining the free-market principles of healthcare. They contend that increased regulations and mandates can stifle competition and innovation, ultimately driving up costs for consumers. Additionally, many conservatives expressed concerns about the long-term sustainability of expanded entitlement programs, fearing that such measures may lead to increased taxes and a larger federal deficit. The debate surrounding the ACA reflects the deeper ideological divides behind Harris’ and Trump’s campaigns regarding the role of government in healthcare and the principles of personal responsibility and choice.
Trump's healthcare agenda is built around two primary cornerstones: reducing government involvement and promoting market competition. Throughout his presidency, Trump consistently sought to repeal or dismantle the ACA, but his administration’s most notable success was the elimination of the individual mandate penalty, which required Americans to maintain health insurance or face a financial penalty. Trump argued that repealing this provision would give Americans more freedom in choosing healthcare plans without government coercion.
At the end of his term in 2020, Trump passed the No Surprises Act to protect Americans from unexpected out-of-network medical bills, a significant issue for many families. Additionally, while he was unable to completely repeal the ACA, Trump’s administration introduced various deregulations aimed at fostering competition in the healthcare market. For instance, Trump issued an executive order (EO) titled “Lowering Drug Prices by Putting America First.” Under this EO, though later rescinded by the Biden administration, drug companies would be required to sell their products to Medicare at the lowest price they charge any other developed country.
Vice President Harris, as a staunch supporter of the ACA, has taken the opposite approach, emphasizing the importance of government involvement in shaping healthcare delivery. Alongside President Joe Biden, Harris has worked to strengthen the ACA, pushing for further Medicaid expansion and supporting policies that allow Medicare to negotiate drug prices, through, for example, the Inflation Reduction Act’s Medicare Prescription Drug Inflation Rebate Program. Harris has framed healthcare as a fundamental right and has claimed to focus on addressing healthcare disparities, especially among marginalized communities.
The presidential debate on September 10th further highlighted the sharp differences between Harris’ and Trump’s healthcare policy goals, setting the stage for a broader ideological battle over the future of healthcare in America. Harris, defending the Biden administration's record, touted the recent successes in strengthening the ACA and reducing prescription drug prices. She emphasized the tangible benefits these actions had on American families, especially seniors, who faced exorbitant medication costs. She positioned her healthcare approach as one of ensuring fairness and equity, particularly for low-income individuals, women, and communities of color, who have long faced systemic barriers to access. For Harris, the goal is clear: continue to build on the ACA’s framework while addressing healthcare inequities.
In stark contrast, Trump’s debate performance focused on critiquing the ACA as a system that had failed to deliver on its promises. Trump argued that, despite its good intentions, the ACA had driven up premiums for many Americans and reduced consumer choice by forcing people into narrow networks. He contended that repealing the individual mandate was one of the most important steps his administration took, as it removed a coercive government penalty. However, Trump fell short of offering a detailed alternative to the ACA, instead doubling down on his belief in deregulation and competition as the answer to lowering healthcare costs. Trump’s ‘concept of a plan,’ while lacking specifics, emphasized empowering individuals to make healthcare decisions through a competitive marketplace, rather than through what he termed “government overreach.”
Another central issue in the debate was healthcare affordability, with both candidates focusing on how their policies would address rising costs. Harris underscored the Biden administration’s achievements in reducing prescription drug prices and making insurance more affordable for millions of Americans through increased government intervention. Trump, alternatively, warned that Harris’ focus on expanding government programs was unsustainable and would ultimately lead to higher taxes and reduced innovation in the healthcare sector. Harris further criticized Trump’s record, arguing that his focus on deregulation had left millions of Americans without adequate healthcare coverage and had not delivered the promised reductions in healthcare costs. She specifically attacked Trump’s handling of the COVID-19 pandemic for causing significant economic damage, leaving the country “in the worst public health epidemic in a century.” In response, Trump highlighted his administration’s efforts to increase the availability of ventilators, gowns, and other medical supplies, claiming they had done a “phenomenal job” during the crisis, although he notably did not mention the development of COVID-19 vaccines, which the Biden administration later distributed. On this issue, too, Harris called for deeper government involvement to ensure equity and affordability in healthcare, while Trump focused on reducing regulation and letting market forces drive efficiency.
The debate over healthcare policy in the U.S. has never been more critical with millions of Americans facing rising costs and disparities in access. The contrasting approaches presented by Kamala Harris and Donald Trump offer voters a choice: a path focused on expanding federal involvement to ensure healthcare as a right, or a market-driven approach aimed at reducing government influence in favor of personal choice. The future of U.S. healthcare ultimately hinges on which of these competing visions prevails. If Harris’ policies continue to build on the ACA, the U.S. may see expanded access for marginalized populations but higher government spending. Conversely, Trump’s market-based model could foster innovation but might leave vulnerable groups with less protection. The decisions made at the ballot box will undoubtedly shape the future of healthcare—its impact on millions of lives cannot be overstated.