Understand how we got here — and how to move forward.


September 30, 2020

Biden & Trump: Their biggest health care clashes in last night's debate

Daily Briefing

    President Trump, the Republican Party's nominee for president, and former Vice President Joe Biden, the Democratic Party's nominee, squared off last night in their first presidential debate. The candidates exchanged some heated jabs over major health care issues, including the future of the Affordable Care Act (ACA) and America's response to the coronavirus epidemic. Here's what you need to know.

    The ACA: Biden wants to expand it, Trump wants to replace it

    One of the first health care issues to come up during Tuesday's debate was the future of the ACA. The issue surfaced while Biden was answering a question from Fox News' Chris Wallace, who served as the debate's moderator, about Trump's and Republican lawmakers' push to quickly confirm a new Supreme Court justice to replace the late Justice Ruth Bader Ginsburg.

    Biden said Trump's push to confirm a new Supreme Court justice before November's presidential election puts the ACA's future at risk. "What's at stake here is [that Trump's] made it clear, he wants to get rid of the [ACA]. He's been running on that, he ran on that and he's been governing on that. He's in the Supreme Court right now trying to get rid of the [ACA], which will strip 20 million people from having insurance health insurance now," Biden said.

    Biden was alluding to a case currently before the Supreme Court that challenges the ACA's constitutionality. The lawsuit seeks to strike down the health reform law's individual mandate penalty, and by extension the entire law. The Supreme Court is scheduled to hear oral arguments in the case on November 10—one week after the presidential election.

    Biden noted that Trump's nominee to replace Ginsburg, U.S. Circuit Court Judge Amy Coney Barrett, has written that she thinks the ACA is unconstitutional. For instance, in 2017, before Barrett joined the federal circuit court, Barrett wrote a law review article criticizing the Supreme Court's 2012 ruling upholding the ACA's individual mandate as a tax. In addition, Barrett has lauded the late Supreme Court Justice Antonin Scalia's dissenting opinion in King v. Burwell, a case in which the Court upheld the ACA's subsidies as constitutional.

    Biden explained that, if the ACA is struck down, the law's protections that ensure women and individuals with pre-existing medical conditions cannot be charged more for or denied coverage will be eliminated—a notion that's become particularly concerning amid America's coronavirus epidemic. Biden also noted that more than seven million Americans have contracted the coronavirus—and some legal experts have said people who develop Covid-19 and experience long-term health effects potentially could qualify as having a pre-existing condition if they seek new health coverage in the future.

    Instead of eliminating the ACA, Biden said he's proposed to protect and expand on the health reform law. Biden has released proposals calling for eliminating the current income cap for receiving federal subsidies intended to help offset the cost of ACA exchange plans, as well as increasing the amounts of subsidies that enrollees are eligible to receive.

    In addition, Biden has called for creating a so-called "public option" health plan in the United States to further expand the types of coverage options available to Americans. During the debate, Biden said his proposal would automatically enroll individuals who qualify for Medicaid into the new public option health plan. However, he stressed that Americans who want to remain enrolled in private health plans will have the option to do so.

    In comparison, Trump during the debate framed the ACA as a failure.

    During the debate, Wallace asked Trump how he plans to replace the ACA if it is eliminated, saying Trump has "never in these [past] four years come up with a plan, a comprehensive plan to replace" the health reform law—an argument Trump disagreed with.

    Trump said he had eliminated the law's individual mandate penalty, but he claimed that the law remains problematic. "No matter how well you run [the ACA], it will still be a disaster," he said.

    Trump did not detail how he plans to replace the ACA if it is struck down, but he said he has "guaranteed" protections for people with pre-existing conditions. (Many legal experts—and Wallace during last night's debate—have noted that the actions Trump has taken so far regarding protections for people with pre-existing conditions have been largely symbolic, and haven't included detailed or binding proposals that would ensure those protections exist if the ACA is eliminated.)

    Trump also said he "want[s] to give people better, lower-cost health care." For instance, Trump touted an executive order he signed earlier this year, often referred to as the "favored nations" proposal, which he said will cut prescription drug prices in the United States. Observers have noted that the Trump administration hasn't yet implemented the proposal, so it hasn't yet generated any savings.

    In addition, Trump said that he has implemented policies that have made insulin "so cheap, it's like water." While the Trump administration has taken some steps to lower insulin costs for a subset of Medicare beneficiaries, STAT News reports that "insulin still retails for roughly $300 a vial," with "[m]ost patients with diabetes need[ing] two to three vials per month, and some … require[ing] much more."

    The coronavirus epidemic: Trump touts his success, Biden touts his plan to move forward

    The other major health care issue that sparked contentious debate among the candidates was how to handle America's coronavirus epidemic. Wallace asked the candidates: "Why should people trust you, more than your opponent, to deal with the coronavirus crisis?"

    During his response, Biden said Trump has mishandled America's response to the coronavirus epidemic, and he cited reports from interviews in which Trump said he initially downplayed the epidemic to avoid creating "panic" in the United States. Biden also said Trump "still doesn't have a plan" to mitigate the epidemic. "A lot of people died, and a lot more are going to unless [Trump] gets a lot smarter," Biden said.

    Biden touted proposals he released in March and July detailing how he would seek to get curb America's coronavirus epidemic. Biden said those plans center on ensuring Americans, businesses, and schools have the protective equipment and funding needed to "save lives" and reopen safely. Biden also said he is skeptical of moving forward with reopening schools and businesses and easing restrictions intended to mitigate the virus' spread given the current state of the country's epidemic, noting that many states are seeing increases in coronavirus infection rates and related deaths.

    Biden said Trump hasn't implemented a plan to help the country move forward safely, and he called for providing schools and businesses with funding. "You can't fix the economy until you fix the Covid crisis," Biden said.

    During his response, Trump said that he saved American lives by quickly implementing a ban on travelers to the United States from China. Trump said that if Biden had been president when the coronavirus pandemic first emerged, he would have delayed implementing the travel ban, and "millions" of people would have died as a result.

    Trump also noted that his administration "shut down" the country earlier this year, and he said keeping businesses and schools closed longer will do more harm to Americans and "destroy" the country.

    "People know what to do. They can social distance. They can wash their hands. They can wear masks," he said.

    Overall, Trump said he's done "a phenomenal job" of addressing America's coronavirus epidemic. He said his administration has gotten "gowns, … masks, … and made the ventilators," and is "weeks away" from having a vaccine against the novel coronavirus.

    The candidates also clashed over plans on how the country can move forward amid the coronavirus epidemic.

    In response to a question on when a coronavirus vaccine will likely be distributed, Trump responded, "This has become very political." Trump said that he has spoken with the heads of pharmaceutical companies working to develop and test experimental coronavirus vaccines, and he claimed that those leaders believe they can have a vaccine available "much sooner."

    Biden cautioned Americans against believing Trump's claims when it comes to the timeline for a coronavirus vaccine, and Wallace asked if Biden and his campaign were contributing to public fear of a vaccine against the virus. Biden said Americans should trust the "thousands" of private scientists in the country who don't work for Trump when it comes to a coronavirus vaccine  (Brancaccio et al., "Marketplace Morning Report," 9/30; Florko, STAT News, 9/29; New York Times, 9/30; New York Times, 8/28; Facher, STAT News, 9/29; Lemire et al., Associated Press, 9/30; Barrow/Miller, Associated Press, 9/30; Seligman et al, Politico, 9/30; Gearan et al., Washington Post, 9/30; Cohrs, Modern Healthcare, 9/29; Hellmann, The Hill, 9/29; Timm/Kapur, NBC News, 9/30; Forgey/Choi, Politico, 9/30; Ault, Medscape, 9/30; Scott, Vox, 9/30).

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.