As the November 2024 elections draw near, questions abound in many areas of Americans’ lives, including what the impact could be on health insurance.
Although health insurance issues are rarely on the ballot directly, many ballot box decisions carry implications that could be felt directly in the healthcare world – be it Medicaid expansion, the future trajectory of the Affordable Care Act (ACA), the long-term funding of Medicare, strategies for negotiating prescription drug prices or even the future of abortion and reproductive care.
See also: Our Crazy Healthcare System
Medicaid and the ACA
Medicaid expansion in the few holdout states dominates this year’s health-related election topics.
So far, 40 states and D.C. have expanded Medicaid coverage in line with the ACA, while 10 states, including Florida, Georgia, Kansas, Mississippi, South Carolina, Wisconsin and Wyoming, have not.
Kansas’s governor has included Medicaid expansion in the 2025 state budget for legislative consideration, despite previous pushback from the state legislature. Similarly, Wisconsin’s governor previously proposed expansion, only to be blocked by the state’s legislature.
Some states are working on limited Medicaid expansions and seeking waivers from the Centers for Medicare and Medicaid Services (CMS), including work requirements, but none would fully qualify as expansions without a federal waiver.
Looking ahead, Florida is considering a 2025 ballot initiative to expand Medicaid, though no states have put an expansion initiative on the 2024 ballot yet.
For its part, the Affordable Care Act enjoys broad popularity, and reducing health costs appears to be a major concern for many voters. A recent poll by the healthcare nonprofit KFF found that 48% of voters consider lowering out-of-pocket costs a top priority for the country.
Additionally, 59% of Americans have a favorable view of the ACA. This support is evident in enrollment numbers, with a record 21 million people signing up for an ACA marketplace plan during the 2024 open enrollment period.
In recent years, the White House has increased funding for Affordable Care Act outreach programs to encourage enrollment in marketplace plans, and Congress has passed legislation to boost subsidies, reducing premium costs for many families. Those subsidies are set to expire soon, though – which is one area where the election could hold a direct impact on the healthcare industry.
Medicare
Whoever wins in November is sure to be hit with decisions very quickly regarding the future of Medicare funding. If no action is taken, projections indicate that the Medicare Hospital Insurance Trust Fund will become insolvent by 2031.
Medicare has several funding sources. Medicare Part A, which covers hospital expenses, is primarily funded by FICA taxes. When revenues exceed expenses, the surplus is deposited into the Hospital Insurance Trust Fund for use in lean years.
Several factors affect the health of this fund, including economic growth, the retirement rate of seniors, the number of new workers entering the economy and overall healthcare costs.
The projection that the fund will be depleted in seven years doesn't mean Medicare will cease to operate, but it does mean that decisions need to be made soon.
Current proposed solutions include increasing payroll taxes on high earners, raising the retirement age or reducing benefits for certain procedures and treatments. Another possibility is that Congress might allow the fund to run out of money and then cover the shortfall with general funds.
Medicare Parts B and D are already supplemented by general federal funds, but there is currently no mechanism for using these funds to support the hospital trust fund, so doing so would require congressional action.
Congress could also choose to cut Medicare benefits to align with payroll tax revenues.
Although there is no concrete plan yet, it is almost certain that the newly elected president and Congress will need to address these Medicare issues during their next terms.
See also: How to Predict Healthcare Costs
Drug price negotiations
A recent KFF poll found that voters trusted President Joe Biden more than former President Donald Trump on health issues. But nearly three in 10 respondents said they trusted neither (and the poll was taken before Vice President Kamala Harris became the Democratic nominee for president).
One area where the candidates align more than they differ is their disdain for the price of prescription drugs.
Last year, the White House announced deals with drug makers to negotiate down the price of 10 popular prescription drugs as part of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program.
Those new prices will take effect in 2026. CMS has plans to negotiate prices for 60 more drugs over four years, with plans for 20 additional drugs each year moving forward.
For any future president to back off the Inflation Reduction Act’s negotiation mandates would require action from Congress.
Abortion and reproductive services
After the Supreme Court's Dobbs v. Jackson Women’s Health decision, many previously settled healthcare laws are now up for debate and might be influenced by future elections.
So far, 27 states have implemented some restrictions on abortion access.
In Alabama, a State Supreme Court case following the Dobbs decision has raised questions about the future of in vitro fertilization. Consequently, many states have been quick to enact specific protections for parents and doctors to allow IVF to continue.
Some advocates are concerned that restrictions on abortion could eventually lead to limitations on certain methods of birth control, although no current proposals have advanced significantly. Although some lawmakers have introduced federal protections for birth control, these measures have not progressed in the divided Congress.
The Affordable Care Act requires that birth control be covered at no cost for women. However, if states outlaw certain types of birth control, this coverage could also be affected.
While abortion and birth control are not set to appear as direct ballot questions in the November elections, the outcomes will undoubtedly influence state and, in some cases, federal policies for years to come.
