How Medicare and Medicaid could change post-election

Unlike previous elections, experts note that this presidential campaign cycle hasn’t focused too heavily on healthcare policy—though both candidates have talked about modest changes to the Medicare and Medicaid programs.

Vice President Kamala Harris’s campaign has proposed policies that suggest support of expanding Medicaid and Medicare spending while former President Donald Trump’s campaign has seemed to focus on policies that would cut spending and add more regulations to Medicaid eligibility.

Healthcare Brew took a look at what changes could take place to the federal programs based on the types of proposals the candidates have made along the campaign trail.

Potential changes to Medicare

The Harris and Trump campaigns have been relatively aligned when it comes to Medicare.

“In my view, both candidates are going to protect the Medicare program. I don’t think any candidate’s going to try to do something that’s going to make it difficult for seniors—that’s just not politically palatable,” Seema Verma, EVP and general manager of Big Tech company Oracle, said during an October 22 panel at the HLTH conference in Las Vegas. Verma served as the Centers for Medicare and Medicaid Services (CMS) administrator from 2017 to 2021 under Trump.

One potential change both candidates have proposed is covering in-home long-term care under Medicare, though their methods would likely vary.

Harris proposed creating a new in-home care benefit for Medicare recipients who are unable to independently complete daily tasks like eating or bathing.

A change like that “could be really substantial,” according to Brandy Lipton, an associate professor of health, society, and behavior at the University of California, Irvine, as it would allow Medicare beneficiaries to stay in their homes.

Trump proposed providing tax incentives for in-home care workers rather than directly creating a new benefit, Lipton said.

Drug price negotiations under Medicare

One area where the two candidates do seem to differ when it comes to Medicare is how to approach drug price negotiations.

In 2022, Congress passed a law as part of the Inflation Reduction Act (IRA) that allows Medicare to negotiate the prices of a limited number of brand-name drugs covered under Medicare Part B or Part D, including Eliquis, a Bristol-Myers Squibb and Pfizer drug that prevents blood clots, and Januvia, a Type 2 diabetes drug from Merck.

According to the Harris campaign’s website, if elected, Harris would “accelerate the negotiations to cover more drugs and lower prices for Americans.”

Republican lawmakers have previously opposed Medicare drug price negotiations, and the Republican Study Committee—a congressional caucus of conservative Republicans—has called to repeal the IRA.

But the Trump campaign has been largely silent on the issue, declining in early October to comment to the New York Times on whether the former president would repeal drug price negotiations.

Potential changes to Medicaid

While the Harris campaign has aligned closely with President Joe Biden’s administration when it comes to Medicaid, the Trump campaign has proposed several changes.

One of the biggest sticking points is what’s called work requirements, which requires people to work, volunteer, or complete educational activities for a certain period of time to be eligible for coverage.

Under the previous Trump administration, CMS approved proposals for 11 states, including Alabama and Ohio, to implement Medicaid work requirements, with each state taking a slightly different approach to the rules.

The Biden administration overturned all those proposals in 2021, but both Verma and Lipton projected that if Trump were reelected, CMS would likely revisit the idea of implementing such requirements. “Under the Trump administration, many states did propose having work requirements of their Medicaid programs, and several states did get their waivers approved,” Lipton said. “I would think that that might be something that could happen under a Trump administration, potentially, that I wouldn't expect to happen as much under the Harris administration.”

The Trump campaign has also proposed changes to Medicaid enrollment, eligibility, and verification that could reduce the total number of Medicaid recipients, according to health policy research firm KFF.

“There are concerns around Medicaid eligibility,” Verma said during HLTH. “I do think Trump would look at how Medicaid money is being spent and make sure dollars are going to the recipient and not unintended uses.”

The Republican Study Committee has also proposed policies surrounding enrollment and eligibility, such as eliminating minimum eligibility thresholds.

The big picture

Overall, the most significant changes are likely to occur under the Medicaid program rather than Medicare, depending on the upcoming election’s outcome, but it will also depend upon how Congress votes on them.

Healthcare Brew reached out to both presidential candidates’ campaigns for comment but did not receive responses.

“A first-term president and a second-term president—the actions that they take are very different,” Verma said during HLTH. “A second-term president, they’re going to be more bold, because they’re not worried about reelection. So they may be going a lot further and a lot faster.”