The outcome of the 2024 election will have a significant effect on the future of health policy in the U.S., according to a special report published in the New England Journal of Medicine on Oct. 2. The report describes findings on the top health issues in the 2024 election based on data from 28 national opinion polls ranging in sample size from 1000 to 8709 interviews, and includes deeper looks at the public’s views about health-related policies, support for increases in health spending and confidence in health professionals.

According to the report, health care costs, prescription drug prices and large medical bills rank among the top health care issues heading into the election, with 45% of U.S. adults reporting financial insecurity in managing their health care costs. The vast partisan divide in public confidence in medical experts and health agencies following the COVID-19 pandemic is also a hot topic, with one third of Republicans saying they have no confidence in medical scientists compared to 12% of Democrats sharing similar sentiments.

Views about future health spending also differ among party lines. While the majority of both Republicans and Democrats support increased spending on veterans’ medical care and Medicare, Democrats favor higher spending for the Affordable Care Act (ACA) and the Centers for Disease Control and Prevention, which more than one third of Republicans oppose.

“Bipartisan actions will include some level of effort to increase funding for Medicare and veterans’ medical care,” write Robert J. Blendon, ScD, et al. “But Republicans are likely to support efforts to encourage more Medicare beneficiaries to join private Medicare Advantage plans, and Democrats will support the existing Medicare program and its expansion.”

The special report also features additional perspective articles on the affordability of health care, health coverage and access, and health equity – all of which are key focuses for the ACC and the College’s advocacy efforts.

In their article on affordability, J. Michael McWilliams, MD, PhD, and Stacie B. Dusetzina, PhD, propose two factors in how the public views the health system’s overall affordability: 1) how the system is distributed across households; and 2) what is sacrificed to spend more on health care. They also “highlight key policy challenges posed by various failures in the market-based U.S. system and consider the prospects for reform under a new administration.”

When discussing health coverage, access, and the impact of the 2024 U.S. election on these issues, Sherry Glied, PhD, and Benjamin D. Sommers, MD, PhD, highlight the health insurance coverage gains in recent years attributable to the ACA through its insurance marketplaces and Medicaid expansion. “Despite the absence of broadly disseminated policy proposals, the track records of the candidates and their parties offer strong signals that they would take very different approaches to highly consequential issues related to the marketplaces, Medicaid and Medicare,” write the authors.

Marcella Alsan, MD, MPH, PhD, and Ruqaiijah Yearby, MPH, JD, spotlight the role of health equity in determining policy, as issues such as maternal mortality, firearm-related mortality, synthetic opioid use and childhood obesity rates are concentrated differently among demographics. They write: “Policy responses to health differences are steeped in some rationale of their root cause, and Harris and Trump seem to endorse divergent explanations: structural barriers and privilege vs. individual merit and grit.”

Keywords: ACC Advocacy, Health Policy, Health Equity