Donald Trump's health care plan would retain the status quo

During the televised debate between Republican Donald Trump and Democrat Kamala Harris on Sept. 10, Trump was unable to respond to moderators pressing him for details on his plan to replace the Affordable Care Act (ACA). "I have concepts of a plan," Trump said, inviting widespread ridicule.

But Trump was telling the truth — neither he nor his party have released a health care plan since their efforts to repeal the ACA fell apart early in Trump's presidency. The U.S. health care system is both extraordinarily complex and deeply resistant to change, and the Trump campaign appears to be gambling that voters would mostly prefer the status quo to any significant reforms.

A focus on pharmaceuticals

Trump's policy blueprints are compiled on a section of his website labeled Agenda 47. One item is dedicated to drugs and drug prices. The former president continues to promise lower Medicare drug prices, although details are sparse. His campaign has also pledged to tackle a shortage of certain critical drugs by bringing their production back to the United States. The campaign assails "the extreme national vulnerability caused by the lack of an adequate domestic manufacturing capability for critical pharmaceuticals" and promises to ramp up domestic production. It is an assessment that is shared by a 2023 report produced by the Senate Homeland Security and Governmental Affairs Committee.

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Trump is critical of U.S. reliance on drugs exported from China. And drug shortages, particularly those used to treat diabetes, as well as some cancers, are a real problem. "A significant majority of the ingredients in the drugs people take in the U.S. are produced overseas, mostly in China and India," said Jen Christensen at CNN. Trump says he will take executive action to address the problem by supporting U.S. manufacturers.

Vague promises about bigger changes

Apart from drugs and drug prices, the Trump campaign is not openly campaigning behind health care ideas. While Republican-aligned think tanks have certainly offered proposals to reform the health care system, the party itself has been unwilling or unable to go on record with concrete specifics in recent years. "Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options," said the 2024 Republican Party platform in its only effort to address the issue.

The uncertainty was also reflected in remarks by the GOP's vice presidential candidate, Sen. J.D. Vance (R-Ohio), speaking about health care during his Oct. 1 debate with Democratic vice presidential nominee Gov. Tim Walz (D-Minn.). The campaign hasn't released policy details about health care because "you're not going to propose a 900 page bill standing on a debate stage," said Vance. Reforms would happen, instead, as part of "the give and take of bipartisan negotiation." Vance talked about how it does not make sense to force younger, healthier people into the same risk pools as older Americans with more expensive needs. "We're going to actually implement some regulatory reform in the health care system that allows people to choose a health care plan that works for them," Vance said at a September rally in Raleigh, North Carolina.

Competing interpretations of the Trump-Vance plan

The Trump campaign says it will protect Medicare funding, and both Trump and Vance have promised to protect Americans with preexisting conditions. However, critics have noted that Vance's comments about separating sick from healthy Americans sound ominously like a return to the days before the Affordable Care Act was passed. "This would appear to roll back some of the Affordable Care Act, which got rid of insurance companies' ability to deny coverage based on preexisting conditions," said Hafiz Rashid at The New Republic.

Not everyone shares that assessment. "The reforms recommended by Senator Vance would protect people with preexisting conditions and give people better health-coverage options, aims that are not mutually exclusive," said Brian Blase at the National Review. But unless the Trump campaign releases a policy blueprint, it will likely have a hard time settling these disagreements about the intent and outcomes of their ideas.