With less than 70 days until the election, Americans are beginning to learn about the differing visions that Vice President Kamala Harris and former President Donald Trump have for our country's future. Nowhere are the candidates more divided than in health care. Health care has often played a pivotal role in presidential elections, and November's election may be one of the most important for patients.
While Ms. Harris and Gov. Tim Walz are looking to build on the successes of the past four years of the Biden-Harris administration, such as lowering prescription drug costs and easing the burden of paying for care, Mr. Trump and his running mate, J.D. Vance, have not spoken much about health policy issues. But Project 2025 offers a glimpse of what could be.
The Project 2025 policy agenda, backed by the right-wing think tank The Heritage Foundation, was written by more than 400 conservative experts and published in a book called “A Call to Leadership: A Conservative Promise.” Although President Trump has publicly rejected the initiative, he supports (and even seeks to implement) many of its core proposals, some of which were written by his former staff.
Here is an example of how Project 2025’s plans will make my patients, and those of clinicians across the country, worse off.
Drug prices soar
I have seen countless patients who rely on insulin to control their diabetes. When these patients don't take their insulin, not only do they risk their diabetes getting worse (increasing their risk of heart attack and stroke), but they also risk life-threatening medical emergencies from dangerously high blood sugar levels. In the decades prior to the Biden-Harris Administration, out-of-pocket costs for insulin steadily increased, forcing many patients to cut back on other expenses to afford insulin and others to stop taking insulin altogether.
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The Inflation Control Act (IRA), signed into law by President Biden two years ago, capped insulin costs for Medicare beneficiaries at $35 per month. Data shows that this cap has led to increased insulin prescriptions being filled, ensuring more people with diabetes can get what they need to stay healthy. The IRA also caps seniors’ annual out-of-pocket costs for prescription drugs (not just insulin) starting next year. And, despite aggressive lobbying and legal challenges from pharmaceutical companies, the law allows Medicare to negotiate prices with big pharmaceutical companies for the first time in history, resulting in significant discounts and billions of dollars in savings. These are just a few of the many reasons why more than 500 medical professionals recently signed an open letter in defense of the IRA.
But at a time when one-third of Americans report not following through on their prescriptions due to cost, Project 2025 calls for repealing these life-saving provisions. The IRA repeal that Trump and Vance support would make drugs like insulin more expensive, force patients to shoulder much of the cost of their prescription drugs, and force them to make impossible choices between their health and their lives.
Reduced access to Medicaid
Project 2025 not only seeks to roll back recent successes in reducing the financial burden of care for Medicare beneficiaries; it also seeks to weaken Medicaid, which more than 70 million low-income Americans rely on for their health care. The authors propose to impose lifetime caps on benefits and add work requirements as a condition of enrollment, creating administrative hurdles that would make life harder for the most disadvantaged. These provisions could cause millions of people to lose their insurance, including those who are currently working. These policies would punish patients in the harshest way possible by denying them care because they are poor.
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Restrictions on reproductive medicine
And at a time when reproductive rights are under attack in many states, Project 2025 would not only further restrict abortion at the national level, but would also eliminate free coverage of some contraception, further raising barriers to evidence-based care for patients of reproductive age.
endangering children's health
Finally, Project 2025 specifically focuses on child welfare. The authors seek to block public health agencies from mandating vaccinations for schoolchildren, which could lead to further outbreaks of preventable diseases like measles. They also propose nullifying state laws aimed at preventing gun violence, one of the leading causes of child deaths in the United States. Project 2025 even goes so far as to eliminate Head Start, a program vital to early childhood development, especially in low-income and rural areas.
If elected, Trump may not adopt all of these proposals, but even some of them would roll back decades of progress in medicine and public health.
As physicians, we know these issues have not progressed easily. Obamacare was bitterly contested and survived multiple partisan attempts to dismantle it, including during President Trump's first term. Medicaid expansion has been hard-fought, state by state, for over a decade. The pharmaceutical industry fought tooth and nail to negotiate drug prices. Along the way, countless physicians have stood up for their patients and advocated for expanded access to affordable health care. The possibility that these hard-fought victories could be overturned, and the suffering that would cause for patients, makes it worth fighting again.
