When President Joe Biden and former President Donald Trump face off Thursday during the first general election debate, health policy experts say tackling the exorbitant cost of health care is as much a top issue for voters as the U.S. economy.
Health care costs in the United States continue to rise — and Americans increasingly say they are unable to afford the care they need.
There is no issue in health care even remotely close to voter frustration over the high prices patients have to pay for medical care, said Drew Altman, president and CEO of KFF, a nonprofit group that researches health policy issues.
“People tend to think about health care as separate from the economy,” he said. “But when you talk to voters, it’s not separate at all in their heads. Health care is a dimension of their pocketbook economic concerns.”
National health care spending is projected to have increased 7.5% in 2023 to almost $4.8 trillion, faster than the projected growth of the overall economy, according to the Centers for Medicare and Medicaid Services.
The estimated health care spending per person — the average amount spent on health care services for each individual — reached $14,423 in 2023, up from $13,493 in 2022 and $13,012 in 2021.
The rising cost is hitting Americans’ wallets. About half of U.S. adults say it is difficult to afford their health care costs, according to a recent poll from KFF. About 1 in 4 say they — or a family member — had problems paying for health care in the past year.
That often means people will have to skip or delay the care that they need, said Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance, who was not involved in the polling. A family member may try to provide financial aid, he added, but attempts to help another can sometimes aggravate problems for the entire family — most notably with medical debt.
"For American households, health care costs are one of the most important economic issues," he said. “What we spend on health care is going to be one of the biggest line items for a lot of families, particularly families with children or with elderly people with chronic diseases.”
No sweeping reform
Although Trump has revived threats to dismantle the Affordable Care Act, also known as Obamacare, major health care reform is unlikely to be a central issue during the debate, Altman said.
Biden is likely to tout the Inflation Reduction Act, which he signed into law in 2022.
Among the provisions is allowing Medicare, for the first time, to directly negotiate drug prices with pharmaceutical companies. Earlier this year, the government began negotiating prices on the 10 costliest prescription drugs covered by Medicare, which included heart medications and diabetes drugs. The government is expected to publish the new negotiated prices by Sept. 1.
Earlier this month, the administration also announced a plan to eliminate debt from medical reports.
Aside from Obamacare and abortion, Trump has provided little detail on what health care policy would look like in a potential second term. He made addressing the high cost of prescription drugs a tentpole of his previous term, including a push to allow states to import drugs from Canada and a rule that would tie prices for certain drugs to prices paid by countries overseas.
The greatest challenge for both Biden and Trump will be pitching health care cost policies that both sides of Congress can get behind, said Robin Feldman, a professor of law and director of the Center for Innovation at UC Law San Francisco.
“Notions of unity and compromise seem to be a distant memory in Congress, as they are in the nation,” she said.
”The idea of a big major sweeping reform has felt unlikely in recent years,” Gaffney said.
Breakthrough reforms remain challenging — but important.
“This distinction between health care as an issue and the economy as an issue at this point drives me crazy, because for real people, there is no distinction,” Altman said. “It’s one of their biggest economic concerns.”
