Affordable health care is on the ballot in November

“Low Insulin pricing was gotten for millions of Americans by me,” Donald Trump recently declared on Truth Social, his social media platform. And “Crooked” Joe Biden “had NOTHING to do with it.”

Trump’s claim is apparently based on his announcement in 2020 that some, but not all, pharmaceutical companies had agreed to cap out-of-pocket costs for insulin — which more than seven million Americans need to manage their diabetes — at $35 per month for individuals enrolled in Medicare drugs plans. This voluntary plan was never actually implemented.

By contrast, Biden’s Inflation Reduction Act, which every Republican in Congress opposed, requires companies to implement a $35 monthly cap on insulin for Medicare recipients.

Trump also issued an executive order in 2020, providing some prescription drugs for free or at discounted prices to low-income Americans served by Federally Qualified Health Centers. When Trump left office, Congress hadn’t appropriated funds to implement the executive order, which had not yet cleared the Health and Human Services rule-making processes. In October 2021, HHS rescinded the proposed initiative “due to excessive administrative costs and burdens.”

So when Trump was in the White House, “millions of Americans” did not get insulin — or other drugs — at low prices.

Trump adamantly opposed the Affordable Care Act, even though it included an extremely popular provision preventing companies from denying coverage to or increasing prices for individuals with preexisting medical conditions (about 27 percent of adults under 65). Obamacare, moreover, had reduced the share of uninsured Americans from 16 percent to about 10 percent, by providing subsidies to them and to states that expanded Medicaid coverage to low-income adults.

After Trump failed to persuade Congress to repeal the ACA, his administration cut the open-enrollment period for the program in half, to six weeks; slashed the advertising budget by 90 percent; decreased funds for enrollment assistance; and eliminated government appropriations that reduced deductibles and out-of-pocket costs for low-income participants. Sign-ups fell from 12.7 million in 2016 to 11.4 million in 2020, before returning to 12 million during the pandemic.

As president, Trump, despite repeated promises, never presented a detailed plan to reform health care, which constitutes over 17 percent of U.S. GDP. As a candidate for reelection, Trump has not gone beyond vague, vacuous and vitriolic generalities, such as “Obamacare is too expensive, and otherwise, not good healthcare. I will come up with a better and less expensive alternative! People will be happy, not sad!”

Meanwhile, President Biden has made accessible, affordable, higher quality health care one of his top priorities.

The Inflation Reduction Act authorizes HHS to negotiate the Medicare-approved prices of 10 popular drugs with pharmaceutical companies in 2026; 15 in 2027 and 2028; and 20 in 2029. The legislation requires such companies to rebate Medicare if the price increases for any of their drugs exceed inflation. The law caps out-of-pocket per-person costs under Medicare Part D to $2,000 annually. And it increases subsidies to middle-class Americans to purchase plans on the ACA marketplace.

Biden has also laid out a health care agenda for a second term: increase enrollment among uninsured Americans (about 7.7 percent of the population) by adding a public option to the choices available to them under Obamacare; cover more people in the 12 states that have not expanded Medicaid eligibility; continue to reduce prescription drug costs by benchmarking them against prices in other countries; expand coverage of mental health and substance abuse disorders; and, most ambitious of all, cap annual expenditures on health care at 8.5 percent of an individual’s income.

Health care tops the list of costs Americans worry most about, ahead of gas and groceries. Fifty-seven percent of Americans believe government should ensure that all Americans have health coverage, with most of them preferring private over public insurance. Sixty-two percent have a favorable view of the Affordable Care Act, whose tax credit subsidies are set to expire after 2025. And fully 80 percent think it “very important” for Biden and Trump to address health care policies, including insurance costs, abortion and opioid addiction.

On this issue, the differences between the candidates seem clear. Don’t they?

Glenn C. Altschuler is the Thomas and Dorothy Litwin Emeritus Professor of American Studies at Cornell University.