Intended for healthcare professionals


US election 2020: how the candidates will determine the shape of American healthcare

BMJ 2020; 371 doi: (Published 13 October 2020) Cite this as: BMJ 2020;371:m3947
  1. Julie Rovner, chief Washington correspondent
  1. Kaiser Health News, Washington DC, USA
  1. JulieR{at}

As the US readies for a presidential election, talk is mostly about President Donald Trump’s covid-19 status and his handling of the pandemic. But there are plenty more health matters at stake, writes Julie Rovner

The two candidates for the US presidency, Donald Trump and Joe Biden, have a few health matters on which they seem to agree: prescription drug prices are too high, for example, and patients should not get surprise bills from out-of-network doctors when they follow their insurers’ rules.

They would, however, steer the nation’s health system in very different directions.


Healthcare in the US relies on private and government based health insurance. The system has been shaped by the Affordable Care Act (ACA), passed by a Democratic Congress and signed by Democrat president Barack Obama in 2010. The ACA, among other things, guarantees that people with pre-existing health conditions can still get health insurance, and subsidises insurance for millions of people. Despite that, about 26 million Americans had no health insurance at all in 2019,1 and that number has grown during the coronavirus pandemic.

Incumbent Republican president Donald Trump has made his distaste for the ACA clear. Trump and Republicans in the US Senate are rushing to fill a Supreme Court seat in part because that court is about to hear a case that could declare the ACA null and void.

Democrat candidate Joe Biden, on the other …

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