Politics in health care: insights from an expert

Since its inception and implementation in 2010, the Affordable Care Act (ACA), also known as Obamacare, has been a contentious political issue in the U.S. Republicans and Democrats have debated the issue, and how it should be handled, in almost every major election. 2024 is no different.

As this political cycle continues to progress, we will continue to hear more and more about the directions candidates want to see health care go. Will we see a move towards the middle from both parties or will we see just the opposite?

In this interview, Nick Karls, Director of Compliance, Employee Benefits, at Holmes Murphy, shares his thoughts on what to expect in the coming months – and beyond.

What differences are we seeing this election cycle regarding each party’s approach to the health care industry, and the impacts it might have on benefits?

In past election cycles, health care has been a top issue, discussed often by both parties which had very different ideas for the best solutions to health care. In 2024, we have heard very little from the Republican side when compared to past election cycles. Other issues seem to have taken the lead in the priorities of the Republican candidates. Health care, however, has long been a top campaign issue for the Democratic Party.

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The Democratic position generally appears to be the continuation and enhancement of the Affordable Care Act (ACA), including the increased subsidy eligibility for exchange coverage that is set to expire at the end of 2025. This has been an easier campaign message to deliver than in past years because of the building popularity of the law across the country. Medicare for All is another Democratic health care position, one that would shake up the health insurance industry by eliminating private health insurance completely as everyone would receive health care through the Medicare program. That being said, it has not been adopted or promoted by as many Democratic candidates as in past years.

The Republican impact on health care and benefits is harder to pinpoint. Given that the little we have heard from Republicans on their plans for health care has been vague, it’s a guessing game. That said, it can be inferred that Republicans will continue to work to increase the number of alternative coverage options, such as short-term, limited-duration health insurance, that are outside of what is generally allowed under the ACA. 

How does the addition of Tim Walz to the Democratic ticket impact health care policy for Harris?

Historically, Tim Walz has held health care positions in line with the Democratic policy. Being the governor of Minnesota has implications as well. Minnesota is home to the headquarters of some of the largest health care and health insurance institutions in the United States. While it could be assumed that Tim Walz brings Vice President Harris’s health care policy a little closer to the center, the State of Minnesota has passed progressive health care laws during his time as governor, including recently enacted legislation that significantly limits how medical debt can be reported and collected in Minnesota. 

How does the addition of J.D. Vance to the Republican ticket impact health care policy for Trump?

Sen. J.D. Vance has previously held health care positions closer to the center than his running mate. Former President Trump’s policy of “repeal and replace” was not one that J.D. Vance shared. Similarly to the Democratic ticket, Sen. Vance appears to push his running mate closer to the center. 

Harris and Trump have both held differing policies in the past regarding the Affordable Care Act (ACA). Trump has previously touted “repeal and replace,” Harris has previously touted “Medicare for All,” both of which are departures from the ACA. How have these stances changed going into the 2024 election? 

Ever since the ACA was implemented, it has been the top health care issue discussed by both parties. Both of the current presidential candidates have supported positions opposite one another in the past, but in 2024, it appears we have seen a shift to the center from both.

Also: Harris v. Trump: Voters show some interest in health care costs

Former President Trump’s previous ACA position of “repeal and replace” seems to have faded ever since he was unable to garner the support he needed to accomplish that feat. Trump has now expressed that he plans to make the ACA better, but he has yet to release any details for how he plans to do so.

Vice President Harris has, similarly, eased off her support of “Medicare for All” as she, and its other supporters, struggled to garner further support for the policy. She has shifted focus to expanding upon and enhancing the ACA.