It’s been nearly four years since Donald Trump was president, and just over that long since we entered the time-space blur of the COVID-19 pandemic—which is to say, your memory of that period might be a little hazy at this point. But with Trump running for reelection against Vice President Kamala Harris, it’s worth getting reacquainted with his views, particularly on the crucial issues that could impact your health.
You might recall that Trump’s history on health policy is all over the place, sometimes toeing the Republican line on efforts to cut government spending, other times wavering in a seemingly populist direction, and in some moments taking a completely rogue path not at all backed by science or substance. His campaign speeches and commentary on social media have proven similarly unpredictable, as he walks the tightrope on issues like access to health care (whether he really wants to repeal the Affordable Care Act or just tweak it) and abortion (exactly to what extent he disapproves of it).
There’s far less gray area elsewhere in Trump’s party: A playbook for the next Republican administration called Project 2025, spearheaded by the conservative think tank the Heritage Foundation, includes a host of damaging health policy ideas. Though a CNN review found that at least 140 people who worked in the Trump administration were involved in its creation, Trump has claimed to “know nothing” about it. And yet, a CBS News review found that more than a third of the policies included in Project 2025 mirror ones that Trump has enacted or promised to implement (from gutting public education to removing protections for trans people).
But in the interest of sharing the proposals that Trump has currently aligned himself with, we’ve gone directly to the source—culling his political record and recent statements—to give you the bottom line on his stance in six key areas of health policy.
Read where Kamala Harris stands on these health issues here.
Health care costsMedical debtReproductive rightsGun violenceCOVID-19Paid leaveHealth care costs
When it comes to how we should pay for health care, Trump’s views are nebulous. As president, he sought—and failed—to “repeal and replace” the Affordable Care Act (ACA, a.k.a. Obamacare), claiming it was too expensive, sucking up too many taxpayer dollars and federal funds. But in taking action to weaken the program, ostensibly to save people money, his administration substantially reduced access to quality, low-cost care.
For starters, in 2017, Trump passed a tax law zeroing out the ACA penalty for having no health insurance, which may have spared people money short-term (by letting them opt out with no fee) but resulted in, predictably, a hike in the number of uninsured folks (who tend to spend a greater portion of their income on health-related costs and face substantial financial risks, research shows). Fewer total people enrolled in the marketplace also left insurers with no option but to raise their premiums—meaning, higher upfront costs for insured people. A similarly backward outcome happened when Trump’s administration expanded access to more affordable short-term health plans; it seems like a good thing, but in actuality these plans don’t have to comply with ACA rules, meaning they typically exclude people with pre-existing conditions and don’t offer coverage for things like maternity care and substance use treatment. All the while, big cuts in funding for ACA advertising and “navigator” programming to help people with the enrollment process further lowered the number of people with coverage.
But even as Trump stripped down the ACA, ultimately making health coverage inaccessible for millions of Americans, he aimed to lower drug prices—a rare topic on which there’s bipartisan agreement among voters. He signed a bill to let pharmacists disclose when you could save money by purchasing a drug for its cash price versus using your insurance, and his administration issued a rule allowing states to import cheaper prescription drugs from Canada (though the latter has been tough to enact). He’s also committed to “taking on Big Pharma” as part of his Agenda47 plan, pledging to revive his “Most Favored Nation” rule, which sought to peg the price of certain drugs covered by Medicare to their lowest price in other countries (but was blocked by district courts for procedural reasons).
Whether Trump would also continue whacking away at the ACA remains to be seen, but luckily for the 45 million-plus folks insured under the legislation, he seems to have given up on dismantling it. He has recently promised instead to make it “much better” (though he hasn’t shared any concrete details on how). It’s clearly a more convenient stance, given public approval of the ACA has only gone up since Trump’s presidency.
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Medical debt
Trump has said or done little in the way of alleviating medical debt or the consequences it creates for folks burdened by it—a stark contrast to Harris, who’s made it one of her priorities as vice president and committed to canceling even more of this debt in her New Way Forward policy plan. Where Trump has taken action, though, is on medical billing: In 2020, he signed the bipartisan No Surprises Act, which went into effect in 2022; the law eliminates unexpected bills you might’ve received for, say, getting emergency care at a hospital you didn’t know was out-of-network for your insurance, or even for supplemental services (like imaging and anesthesia) from an out-of-network health care provider working at an in-network facility.
Trump also signed an executive order on price transparency that requires hospitals to share their rates for all standard offerings in a single data file and do the same for “shoppable services” (things you can schedule in advance, like an X-ray or colonoscopy) in a consumer-friendly format. His administration followed that with another transparency-oriented rule requiring insurers to show people how much they can expect to pay out-of-pocket for nonemergency services via an online tool. The idea for all of the above: More information gives you the chance to shop around for lower-cost care.
There’s reason to think Trump would keep pushing similar measures forward if reelected, given the American people broadly agree that getting slapped with higher-than-expected medical bills sucks. And there’s more to do in terms of enforcing the above policies (President Biden actually raised the fines on hospitals for not complying with them) and making all the data they provide easily usable by and understandable for everyday people.
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Reproductive rights
Trump’s stance on reproductive health issues might give you a bit of whiplash. Since the overturning of Roe v. Wade—made possible by the Supreme Court justices Trump appointed—eliminated the constitutional right to abortion, Trump has waffled on the issue.
Throughout most of his administration, he toed the Republican party line by opposing abortion in statements and actions, while supporting exceptions for “rape, incest, and protecting the life of the mother.” In 2018, he endorsed a 20-week national abortion ban and promised to sign it if it passed the Senate (though it did not); in 2019, his administration barred facilities offering abortion from the Title X program (which provides reproductive health services for low-income folks) and passed a rule allowing health care providers to deny offering services like abortion on the basis of their religious beliefs. And when Roe later fell at the hands of the Dobbs decision in 2022, Trump proudly took credit.
But not long after, when Democrats swept the midterm elections that year, Trump seemed to backtrack: He criticized “Republicans, especially those that firmly insisted on No Exceptions [for abortion bans]” for losing voters. In an interview with NBC in 2023, he floated the idea of a compromise that “both sides” would like (without clarifying what that might be). And this year, he’s wavered in both support and criticism for proposed abortion bans—reportedly favoring a 16-week and then a 15-week national ban before retreating to a stance that the issue should be left to the states. (Meanwhile, he also said that Florida’s six-week ban is “too short” but that he’d still vote no on a referendum to overturn it.)
Trump’s most head-scratching stance in this arena, however, is on in-vitro fertilization (IVF). Though he’s celebrated Roe’s reversal, which opened the door for abortion bans that could also restrict the use of embryos in IVF, he’s also come out openly in favor of IVF, most recently going so far as to suggest that the government or insurance should pay for it.
Both softening his anti-abortion stance and shoring up his support of IVF reflect moves to align with the collective consciousness, as the majority of Americans are in favor of keeping abortion legal and protecting access to fertility treatments. Trump seemingly views reproductive health as more of a political pawn—something he can wield as a means of gaining particular voters—than an issue with real effects on people’s livelihoods.
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Gun violence
To borrow from Trump’s own speech earlier this year to an audience of National Rifle Association (NRA) members, he “did nothing” during his four years as president to stop gun violence, which experts say has grown into a public health epidemic in the United States. Far worse, he and his administration did plenty to increase the threat: He reversed an Obama-era regulation that required certain people with mental illnesses to get background checks in order to buy a gun, and he refused to close loopholes that allow gun manufacturers to sell firearms without compatible child safety devices.
Trump’s recent statements on the matter leave zero question about where he stands: He’s suggested that parents grieving the loss of their children in a school shooting in Iowa should “get over it,” while assuring audiences at the NRA event this year that “no one will lay a finger on your firearms” if he is reelected and that Biden-era gun regulations “will be terminated my very first week back in office.” He’s also previously suggested a tax credit to subsidize arming teachers with guns and providing them firearm training, and that he would push for legislation that allows people to carry concealed weapons across state lines. And in his Agenda47 plan, he proposed that in order to qualify for new federal funding, police forces will be required to return to “stop-and-frisk” measures—which have been proven ineffective to reduce crime and disproportionately target people of color.
Let’s not forget that Trump also appointed three justices to a Supreme Court that has expanded gun rights, citing the Second Amendment in ruling that Americans have a right to carry a firearm in public. There’s no reason to suspect future Trump appointees would rule any differently, nor that Trump would take any action himself to protect the public from gun violence.
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COVID-19
Trump’s botched COVID-19 response overshadows just about every other aspect of his legacy on health. As he left office, the COVID death toll in the United States exceeded that of any other country, at a whopping total of 400,000 people. It’s a figure undoubtedly magnified by the Trump administration’s downplaying of the threat, delayed launch of insufficient travel bans, refusal to use a test approved by the World Health Organization to quickly create a testing infrastructure in the US, and inaction on face mask and other personal protective equipment shortages.
Trump also repeatedly flouted scientific consensus on COVID and promoted pseudoscience instead: He praised the powers of therapies not supported by any medical body for the treatment of COVID (including antimalarial drugs hydroxychloroquine and chloroquine) and even noted the potential benefit of “disinfectant” via “injection inside” the body. He consistently refused to wear a face mask in public, even when he contracted the virus himself. And he continued to host large rallies, which research later estimated may have led to more than 30,000 COVID cases and at least 700 deaths (not necessarily among those who attended). All the while, he and his administration meddled with CDC efforts to disseminate COVID information, rejected the agency’s plan for reopening the country, and pressured it into relaxing testing guidance.
Perhaps the singular positive thing Trump’s administration did in response to COVID was launch Operation Warp Speed, an initiative that funneled tons of funding to various pharma companies so they could all start work on a vaccine and authorized them to begin manufacturing certain vaccine candidates while they were still in testing to allow for the quickest possible distribution. There were concerns at the time that Trump was so adamant about having vaccines available by election day that the pharma companies would be forced to cut safety corners; ultimately, the date was pushed back, and the vaccines developed would go on to help millions avoid contracting and getting sick from the virus.
Even so, Trump has been reluctant to take credit for Operation Warp Speed during his current campaign and has gone so far as to criticize schools with immunization mandates, perhaps to align with the anti-vaccine folks in his base. More recently, he hasn’t mentioned COVID much, if at all, which is notably a tack also taken by Harris (even though confirmed infections are on a steep rise in the US). In Trump’s case, the decision to shy away from the issue mirrors his denial in the early stages of the pandemic, suggesting that a second Trump administration would do little to limit the spread of COVID—or bolster our defenses against any other public health threat, for that matter.
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Paid leave
Trump has openly stated his support of paid leave in prior campaigns and as president—a departure from the typical Republican stance, which opposes paid leave (because it usually requires raising taxes to fund it and placing a mandate on businesses to offer it). And with the encouragement of his daughter Ivanka Trump, a paid-leave advocate, Trump signed into law the Federal Employee Paid Leave Act (FEPLA), providing all federal employees with 12 weeks of paid parental leave—notably, double the six weeks he’d promised while campaigning (though not including caregiving or sick leave).
That said, paid leave did not expand to any nonfederal workers under Trump’s watch, and the plans he’s supported for doing so are weak. His 2021 budget would’ve pushed all the details and costs onto the states, requiring them to offer six weeks of paid parental leave through their existing Unemployment Insurance trust funds; not only is that a brief offering, but it also opens the door for state-by-state disparities and suggests tapping an already-limited resource. The congressional paid leave proposal that Trump has supported, the Advancing Support for Working Families Act, has similar gaps: It, too, fails to designate a federal source of funding, instead allowing new parents to essentially borrow from themselves by collecting a part of their future child tax credits early—not exactly helping them out financially. Also worth noting: Neither of the above proposals includes leave to care for sick family members or tend to personal medical issues.
It’s all to say, Trump could move us closer to a federal paid-leave program if he’s reelected, but if he does, it’s likely to be a limited one (nowhere near the six months Harris has proposed). And it’s still murky whether he’ll prioritize the policy at all, especially given that he seems to have a pretty…loose understanding of how child care works in this country.
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Source : Self.com