A factual analysis of health care in the 2020 election

Blake Madden
5 min readOct 26, 2020


Healthcare Election Issues to know

  • This edition will provide you with an unbiased analysis of positions on big healthcare issues.
  • For those wanting to dig deeper, I’ve referenced all reputable sources used at the end of the edition. I’ve marked more opinionated pieces as such.
  • This write-up focuses on the candidates’ policies themselves. To remain neutral, I’m less inclined to discuss the ability of candidates to execute or fund said policies.

I write about healthcare pretty often here.

Issue #1: the Affordable Care Act.

Background: The latest Affordable Care Act (ACA, or Obamacare) case is back in the Supreme Court. This case, Texas v. California, is a hot-button issue for about 20 or so million Americans covered by the ACA.

The legal case challenges whether the ACA is still valid after the repeal of the individual mandate in late 2017. Remember that the individual mandate was a tax penalty for not having health insurance. This case marks the ACA’s third appearance in front of the Supreme Court. In its first two appearances, the ACA made it out unscathed with minor tweaks.

In Texas v. California, the prosecution’s case seems even weaker than the first two challenges because the main argument relies on the fact that the individual mandate clause cannot be severed from the rest of the healthcare law. So, because Congress repealed the individual mandate, that makes the entire ACA illegal.

While the argument isn’t the strongest, a conservative shifting of justices could end badly for the ACA. At that point, the Supreme Court would decide whether the entire ACA needs to be struck down or if it can still exist in an altered form.

Should the ACA be replaced? Republicans argue that the ACA resulted in rising health care costs for families. Democrats contend that the ACA led to better health care access for low-income populations. You decide for yourself!

  • Trump: Wants to repeal and replace the ACA. He attempted to do so back in 2017 with tax reform, but efforts stalled. While criticized for attacking the ACA without his own comprehensive plan, Trump aims to release a plan after the ruling in .
  • Biden: Wants to build on the current structure of the ACA and install a public option. Biden would expand subsidies for ACA plans and provide a tax break on premiums for middle-class families.
  • Biden’s plan would allow everyone to buy insurance through the government rather than through your employer. i.e., the public option competes with commercial insurance.
  • Biden does not support Medicare for All proposals. But these expanded programs could provide a stepping stone toward M4A in the future.

Issue #2: Coronavirus response.

Background: We will never know how a Biden-led administration would have handled the pandemic’s early stages. As we’re all aware, hindsight is 20/20.

With that in mind, coronavirus information is now widespread and the candidates are on an even playing field. Here’s how the candidates differ on future approaches to the pandemic:

  • Trump (Delegate): Keep coronavirus responses in the states’ hands. Rely on each state government to choose appropriate policies for its region (e.g., contact tracing, testing). Provide national support for identified hot spots. Get a vaccine as fast and as safe as possible (Operation Warp Speed). Try to keep the economy churning as much as possible.
  • Biden (National): Install a more aggressive national response to the coronavirus. Create a national testing program; speed up at-home and rapid testing. Form a national public health team comprised of 100,000 contact tracers. Invest in vaccine infrastructure & distribution. Listen to scientists even if policies clash with economic growth.

Issue #3: Medicare.

Background: Medicare is a key issue for senior voters and Baby Boomers aging into the program. In particular, the next president may face the Medicare program going bankrupt: a potential solvency crisis if left unaddressed

  • Trump: Favors putting Medicare in the hands of private markets through Medicare Advantage.
  • Biden: Will lower the Medicare eligibility age to 60. He also plans to provide supplemental benefits (vision, hearing, dental) as a part of standard Medicare coverage.

Issue #4: Pricing reform.

Trump and Biden agree on a lot of key cost reform issues, including drug pricing, surprise billing, price transparency, and more. The problem more so lies with troubles PASSING the legislation.

  • 4a: Drug pricing reform.
  • Trump: Wants to create an international pricing index that pegs U.S. drug payments to that of other developed countries. This policy is known as a ‘most favored nation’ program. He also floated the idea of importing drugs from other countries (e.g., insulin from Canada). Finally, Trump proposed ending rebates between drugmakers and pharmacy benefit managers. Learn more about Trump’s four drug pricing executive orders here.
  • Biden: Biden would allow Medicare to negotiate drug discounts directly with drugmakers to lower costs for beneficiaries. He also wants to cap drug list price inflation at the market-wide inflation rate. Biden plans to impose taxes on firms that ignore this mandate. Learn more about Medicare Direct Negotiation here.
  • 4b: Surprise billing reform.

Biden in Summary.

Summary positions:

  • Expand ACA subsidies to provide health care for families making income up to 400% of the poverty line.
  • Begin a Public Option that competes against private employer-sponsored insurance.
  • Provide a tax break for middle-class families and limit premium costs to 8.5% of income.
  • Lower the Medicare age to 60 and cap out-of-pocket drug costs for Medicare enrollees.
  • Control and lower drug pricing inflation.
  • Stop surprise billing.
  • Reduce health care M&A to prevent anti-competitive markets.

Trump in Summary.

Link to White House health care section.

During his first four years, Trump engaged in step-wise health care reform. He introduced cost saving features like expanded health reimbursement arrangements.

In true Republican fashion, he attempted to shift Medicaid to a block grant structure.

Finally, Trump laid the groundwork for price transparency in health care and enacted site neutral payment policy. These policies were two key steps forward in a price-opaque industry.

Other summary positions:

  • Repeal and replace Obamacare.
  • Provide more oversight for state Medicaid programs
  • Overhaul state Medicaid spending into block grants.
  • Increase price transparency for patients.
  • Cap insulin costs for Medicare enrollees.
  • Control and lower drug pricing inflation.
  • Stop surprise billing.

Data & Resources.

(Healthy Muse) The Healthy Muse Election 2020 Healthcare HUB

(Biden) Joe Biden’s health care plan from his own website.

(Rand) Potential effects of a Public Option.

(Trump) HHS’ strategic goals.

(HHS) Republicans’ 2017 Repeal and Replace Health Care Plan

(Healthcare Dive) A timeline of the ACA and its past two appearances in the SCOTUS.

(SCOTUS Blog) Texas v. California timeline.

(Kaiser Family Foundation) Explaining Texas v. California.

(Kaiser Family Foundation) The Public’s views on the Affordable Care Act

(Brookings) What the ACA has changed over the past decade, and where things would revert if the health law were struck down in its entirety.

Commentaries & Opinions.

(Commonwealth Fund) Health Care 2020 and the Presidential election — what’s at stake

(The Hill) Trump’s Health Care Plan

(Healthcare Dive) Election 2020: Trump and Biden’s starkly diverging views on healthcare

(OPINION — WSJ) Biden’s public option would mean massive tax hikes

(CNBC) Trump vs. Biden on Medicare — how each wants to change it.

Originally published at https://thehealthymuse.com.



Blake Madden

I write about healthcare. Policy, business, digital health, & more. Written in plain English. Here to connect, learn, and continue the healthcare convo.