Abortion dominant, but health sidelined: the road to Trump’s win

Convention season

Trump announced his plan to run again for the presidency in November 2022. His hour long speech mentioned healthcare once, in promising to “systematically” bring it back to “the American middle class and to America itself.” By July 2024, at the Republican National Convention, where Trump became the official nominee of the Republican Party, health policy was, in the words of Kaiser Health News, “missing in action.”3 The 28 page convention platform statement4 didn’t even mention the Affordable Care Act, also known as “Obamacare,” the health insurance reform instituted by Barack Obama.

In his speech at the convention Trump also promised that, unlike the man who in 2021 succeeded him as president, Joe Biden, “We’re going to get to the cure for cancer and Alzheimer’s and so many other things.”

The word abortion appeared only once in the platform statement—a contrast to Trump’s 2016 presidential campaign, where Obamacare and abortion were major issues. In one of 20 promises the platform said that it would not cut funding for Medicare (with one other proposal to clamp down on “illegal immigrants” who enrol in the programme, to keep it solvent). It also mentioned keeping men out of women’s sports, presumably a reference to controversies over transgender athletes competing in tournaments such as the Olympics.

The Democrats went the polar opposite, placing healthcare, abortion, and Medicare front and centre of their campaign.3 Abortion and reproductive rights were a rallying cry for the party throughout the campaign and a key issue for women under 30—and one that has engulfed the country since 2022, when the Republican controlled Supreme Court overturned the longstanding Roe v Wade ruling that made the right to abortion available throughout the US.5

In a survey of young women in late spring, 20% said abortion was their most important voting issue; in a poll in late September and early October nearly 40% named abortion. By the time of the Democrats’ nominating convention three weeks later, a KFF poll showed that a majority of all voters (53%) trusted Harris on abortion (34% for Trump), and 61% preferred a federal guarantee to abortion.

Still, how much the issue of abortion actually affected voting choices is questionable. The same KFF poll found that abortion was the most important healthcare issue for only 7% of voters, and only 14% of Democrats and Democratic leaning voters said that among healthcare issues abortion was what they most wanted to hear Harris talk about during the convention. For context, 42% wanted to hear about healthcare costs. And they did, at least occasionally—specifically, the high cost of prescription drugs even for people with health insurance.

Presidential debates

By the time of the first and only presidential candidate debate between Trump and Harris, on 10 September, the healthcare issues were abortion, the covid pandemic, and Obamacare. Abortion, as headlines had it, took centre stage at the debate: about 10 minutes of the 90 minute time slot. While Trump falsely claimed that the Democrats “have abortion in the ninth month,” Harris said she strongly supported the reinstitution of abortion rights and would proudly sign a bill to protect access to abortion. And with in vitro fertilisation caught up in the abortion debate because of the issue of unused embryos, Trump said that he had been a “leader on IVF” and opened himself up to mockery from the Democrats in early October when he claimed at an all women town hall event that he was the “father of IVF.”6

In the September debate Trump highlighted how six of the nine Supreme Court justices, three of whom he appointed while president between 2016 and 2020, had overturned Roe v Wade.7 Leaving decisions to the individual states was the way to go, he reiterated. Harris said she’d protect abortion access up until the stage of fetal viability.

Harris accused Trump of failing to handle the pandemic as it played out, dumping the situation on Biden.7 Trump countered by saying that the US had supplied ventilators to the world. (Critics said that the government had sent out ventilators but probably not to places where they were needed.8)

On Obamacare, Harris criticised Trump for not having a plan and for trying to repeal the Affordable Care Act during his previous presidency. Trump, who had promised a replacement healthcare plan several times during his first term but never delivered, retorted by saying that he had the “concepts of a plan” but offered no details.

After the September debate healthcare made an occasional appearance. In the first week of October Harris took to a daytime television talk show to promise to provide home care,9 a revolution for Medicare, which currently covers people only in the days or weeks after hospital treatment, and the same day promised other new benefits: hearing aids, eyeglasses, and hearing and vision exams.10 The Republican platform promised to “shift resources back to at-home senior care” but offered no specific details or new or expanded benefits.

Access to healthcare—or lack of it

Medicaid did not come up at either the Republicans’ summer convention or the presidential debate, though some political watchers believe that a Republican administration is likely to cut it. But the Democratic National Convention platform mentioned it 26 times, with promises to support and strengthen the programme, and repeatedly castigated Trump and the Republican party for working to weaken it.

Americans pay the highest prices for drugs in the world, and insulin prices have become a focus of the problem. In various speeches throughout the campaign both Trump and Harris took credit for lowering the price of insulin to $35 (£27; €33) a month. Fact checkers at media outlets across the country were quick to point out that Trump simply allowed Medicare drug plans, which are optional in the first place, to charge less than $35, and many did not. Biden signed a law requiring all Medicare drug insurance policies to do so, and the Democratic platform promised to extend the $35 cap to everyone else. Harris also vowed to expand an endeavour that would have the government negotiating lower drug prices within Medicare for 10 popular drugs this year to 50 drugs a year.

Of greater concern, throughout the election season health related rumblings were heard from Robert F Kennedy Jr, a one time third party candidate and nephew of former president John F Kennedy. Health researchers were “in a state of panic,” reported the journal Science, after Trump announced in late October that he’d allow Kennedy, a long time vaccine sceptic who has tweeted criticism of the FDA for suppressing “psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins” and more, to “go wild on health.”11 And on the weekend before the election Kennedy said that one of his first acts in a new Trump administration would be to advise US water systems to remove fluoride from water supplies.12

Whether any new laws or regulations will appear is now up to Trump. Whatever gets done is likely to take some doing. Obamacare, seen as one of Obama’s major achievements, came only after major campaign promises and a tight focus on the goal. Campaign rhetoric from both sides has not suggested any likely revamps of the US healthcare system, the most expensive in the world but far from the most effective.