KFF Tool Compares Trump and Biden on Health Care Issues

A new KFF side-by-side examines the health care positions of President Biden and former President Trump. The election-year tool functions as a “quick resource for understanding each candidate’s record as president, positions, public statements, and proposed policies.” It covers key topics like prescription drug prices, mental health, and long-term care, as well as issues related to foundational programs like Medicare, Medicaid, and the Affordable Care Act. KFF plans to update the tracker throughout the campaign.

In a companion piece, KFF President and CEO Drew Altman explains that compiling the tool was an “especially tricky assignment” as “Trump avoids policy and policy details” while “Biden… is not running on big new plans for health care” and “both camps are skipping over the usual policy planning process.” The resulting analysis presents a “worm’s eye view” of discernible differences, to which Altman offers context:

 “From the bird’s eye view, however, the differences are bigger, amounting to a fork in the road in direction on the role of the federal government in health and federal health spending. Conservative Republicans envision, and will try to sell Trump on, an agenda that would dramatically dial back the federal role in health while expanding the role of states and market choices. Deep cuts in federal health spending would accompany these changes. By contrast (and also in contrast to the Medicare for All agenda of the progressive left), Biden will try to build incrementally on recent expansions in public programs: Medicaid, the ACA and Medicare. Biden’s approach is not small ball, nor is it sweeping health system reform; it’s an aggressive form of incrementalism.”

Altman notes that under either president, the likelihood of any sweeping changes would depend on an array of other political and environmental factors, like congressional control and public opinion. That said, here are several potential health policy flashpoints:

• Efforts to reduce federal health care spending could focus on Medicaid and the ACA. “One prominent Republican proposal would create a complex series of block grants, combining ACA subsidies and Medicaid coverage and slashing program funding by $4.5 trillion dollars over ten years. Altman notes that although a “cut of that magnitude sounds fantastical,” it “would decimate coverage” for over 100 million lower income Americans, and face opposition from consumers, states, and providers, a Medicaid/ACA block grant “could be the main drama in health policy following a Trump election.”

• Medicare could also be targeted for cost savings and restructuring. This could include transforming Medicare into a premium support program using vouchers or coupons. The beneficiary effects of such a program would hinge on details like how the value of the voucher would be set; whether its value would increase over time; whether coverage and voucher value would be based on the lowest cost plans or on ones providing better coverage; and whether the program’s ultimate goal is federal savings or a policy goal of further privatizing Medicare.

Medicare Rights will be exploring these policy issues and their implications in more depth over the coming year.

View the KFF tool, “Compare the Candidates on Health Care Policy,” and the companion column, “Unraveling the Mysteries of Biden vs. Trump on Health Care.”