And indeed, abortion opponents held their breath when, during Trump’s first few days in office, his piles of executive orders did not include any on abortion. 

But he has more than made up for it since, having gone further in his first two weeks in office to restrict abortion than any president since Roe v. Wade was decided in 1973. 

As was widely expected, Trump has reinstated the “Mexico City Policy,” an order issued by every GOP president since it was adopted by former President Ronald Reagan in 1984. It bars funding to international aid organizations that “perform or actively promote” abortion. 

He also issued a similar-sounding order seeking to end “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs. It in fact goes further to restrict abortion than previous presidents in the modern era. 

Trump’s order, and a memo from the Department of Health and Human Services following up on it, says that the basis for this policy is the Hyde Amendment, which was named for the late GOP congressman and anti-abortion crusader Henry Hyde. That measure has barred federal funding of most abortions since Congress first passed it in the late 1970s. 

In its current iteration (it has changed several times over the years), the Hyde Amendment says that no HHS funding “shall be expended for health benefits coverage that includes coverage of abortion.” 

But Hyde bars only payment. Unlike the Mexico City Policy, it says nothing about “promoting” abortion. 

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that grantee providers give patients with unintended pregnancies “nondirective” counseling about all their options, including abortion, and be referred for abortions if they request it. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term. 

With Roe now in the rearview mirror, the Trump administration could take even more dramatic action to restrict abortion at the federal level, including by canceling FDA approval of the abortion pill mifepristone. His anti-abortion backers are expecting he will. So are those who support abortion rights. 

“We said they were coming for us,” said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. “And they are.” 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Their concerns mounted after Trump named Robert F. Kennedy Jr., a longtime supporter of abortion rights, to lead the Department of Health and Human Services — and then as he signed a slew of Day 1 executive orders that said nothing about abortion.

As it turns out, they had nothing to worry about. In its first two weeks, the Trump administration went further to restrict abortion than any president since the original Roe decision in 1973.

Hours after Trump and Vice President JD Vance spoke to abortion opponents gathered in Washington for the annual March for Life, the president issued a memorandum reinstating what’s known as the Mexico City Policy, which bars funding to international aid organizations that “perform or actively promote” abortion — an action taken by every modern Republican president.

But Trump also did something new, signing an executive order ending “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs — effectively ordering government agencies to halt funding to programs that can be construed to “promote” abortion, such as family planning counseling.

Dorothy Fink, the acting secretary of Health and Human Services, followed up with a memo early last week ordering the department to “reevaluate all programs, regulations, and guidance to ensure Federal taxpayer dollars are not being used to pay for or promote elective abortion, consistent with the Hyde Amendment.”

The emphasis on the word “promote” is mine, because that’s not what the Hyde Amendment says. It is true that the amendment — which has been included in every HHS spending bill since the 1970s — prohibits the use of federal dollars to pay for abortions except in cases of rape or incest or to save the mother’s life.

But it bars only payment. As the current HHS appropriation says, none of the funding “shall be expended for health benefits coverage that includes coverage of abortion.”

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that patients with unintended pregnancies be given “nondirective” counseling about all their options, including abortion. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term.

So, what is the upshot of Trump’s order?

For one thing, it directly overturned two of Biden’s executive orders. One was intended to strengthen medical privacy protections for people seeking abortion care and enforce a 1994 law criminalizing harassment of people attempting to enter clinics that provide abortions. The other sought to ensure women with pregnancy complications have access to emergency abortions in hospitals that accept Medicare even in states with abortion bans. The latter policy is making its way through federal court.

Trump’s order is also leading government agencies to reverse other key Biden administration policies implemented after the fall of Roe v. Wade. They include a 2022 Department of Defense policy explicitly allowing service members and their dependents to travel out of states with abortion bans to access the procedure and providing travel allowances for those trips. (The Pentagon officially followed through on that change on Jan. 30, just a few days after Defense Secretary Pete Hegseth took over the job: Service members are no longer allowed leave or travel allowances for such trips.) The order is also likely to reverse a policy allowing the Department of Veterans Affairs to provide abortions in some cases, as well as to provide abortion counseling.

But it could also have more wide-ranging effects.

“This executive order could affect other major policies related to access to reproductive health care,” former Biden administration official Katie Keith wrote in the policy journal Health Affairs. These include protections for medication abortion, emergency medical care for women experiencing pregnancy complications, and even in vitro fertilization.

“These and similar changes would, if and when adopted, make it even more challenging for women and their families to access reproductive health care, especially in the more than 20 states with abortion bans,” she wrote.

Anti-abortion groups praised the new administration — not just for the executive orders, but also for pardoning activists convicted of violating a law that protects physical access to abortion clinics.

“One after another, President Trump’s great pro-life victories are being restored and this is just the beginning,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.

Abortion rights groups, meanwhile, were not surprised by the actions or even their timing, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. The association represents grantees of Title X, which has been a longtime target of abortion opponents.

“We said we didn’t think it would be a Day 1 thing,” Coleman said in an interview. “But we said they were coming for us, and they are.”

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

The picks hold different views on matters such as limits on abortion, the safety of childhood vaccines, the covid-19 response, and the use of weight-loss medications. The divide pits Trump picks who adhere to more traditional and orthodox science, such as the long-held, scientifically supported findings that vaccines are safe, against often unsubstantiated views advanced by Kennedy and other selections who have claimed vaccines are linked with autism.

The Trump transition team and the designated nominees mentioned in this article did not respond to requests for comment.

It’s a potential “team of opponents” at the government’s health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization.

Kennedy, he said, is known for rejecting opposing views when confronted with science.

“The heads of the FDA and NIH will be spending all their time explaining to their boss what a confidence interval is,” Cannon said, referring to a statistical term used in medical studies.

Those whose views prevail will have significant power in shaping policy, from who is appointed to sit on federal vaccine advisory committees to federal authorization for covid vaccines to restrictions on abortion medications. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.

“If President Trump’s nomination of RFK Jr. to be secretary is confirmed, if you don’t subscribe to his views, it will be very hard to rise in that department,” said Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security. “They will need to suppress their views to fit with RFK Jr’s. In this administration, and any administration, independent public disagreement isn’t welcome.”

Kennedy is chair of Children’s Health Defense, an anti-vaccine nonprofit. He has vowed to curb the country’s appetite for ultra-processed food and its incidence of chronic disease. He helped select Trump’s choices to lead the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. If confirmed, he would lead them from the helm of HHS, with its more than $1.7 trillion budget.

Clashes are likely. Kennedy has supported access to abortion until a fetus is viable. That puts him at odds with Dave Weldon, the former Florida congressman whom Trump has chosen to run the CDC. Weldon, a physician, is an abortion opponent who wrote one of the major laws allowing health professionals to opt out of participating in the procedure.

Weldon would head an agency that’s been in the crosshairs of conservatives since the covid pandemic began. He has touted his “100% pro-life voting record” on his campaign website. (He unsuccessfully ran earlier this year for a seat in Florida’s House of Representatives.)

Trump has said he would leave decisions about abortion to the states, but the CDC under Weldon could, for example, fund studies on abortion risks. The agency could require states to provide information about abortions performed within their borders to the federal government or risk the loss of federal funds.

Weldon, like Kennedy, has questioned the safety of vaccines and has said he believes they can cause autism. That’s at odds with the views of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate for FDA commissioner. The British American said on the “Brian Kilmeade Show” on Fox News Radio that vaccines “save lives,” although he added that it’s good to question the U.S. vaccine schedule for children.

The American Academy of Pediatricians encourages parents and their children’s doctors to stick to the recommended schedule of childhood vaccines. “Nonstandard schedules that spread out vaccines or start when a child is older put entire communities at risk of serious illnesses, including infants and young children,” the group says in guidance for its members.

Jay Bhattacharya, a doctor and economist who is Trump’s selection to lead NIH, has also supported vaccines.

Kennedy has said on NPR that federal authorities under his leadership wouldn’t “take vaccines away from anybody.” But the FDA oversees approval of vaccines, and, under his leadership, the agency could put vaccine skeptics on advisory panels or could make changes to a program that largely protects vaccine makers from consumer injury lawsuits.

“I do believe that autism does come from vaccines,” Kennedy said in 2023 on Fox News. Many scientific studies have discredited the claim that vaccines cause autism.

Ashish Jha, a doctor who served as the White House covid response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and would bring decades of experience to these top jobs. But, he said, it “is going to be a lot more difficult than they think” to stand up for their views in the new administration.

It’s hard “to do things that displease your boss, and if [Kennedy] gets confirmed, he will be their boss,” Jha said. “They have their work cut out for them if they’re going to stand up for their opinions on science. If they don’t, it will just demoralize the staff.”

Most of Trump’s picks share the view that federal health agencies bungled the pandemic response, a stance that resonated with many of the president-elect’s voters and supporters — even though Trump led that response until Joe Biden took office in 2021.

Kennedy said in a 2021 Louisiana House oversight meeting that the covid vaccine was the “deadliest” ever made. He has cited no evidence to back the claim.

Federal health officials say the vaccines have saved millions of lives around the globe and offer important protection against covid. Protection lasts even though their effectiveness wanes over time.

The vaccines’ effectiveness against infection stood at 52% after four weeks, according to a May study in The New England Journal of Medicine, and their effectiveness against hospitalization was about 67% after four weeks. The vaccines were produced through Operation Warp Speed, a public-private partnership Trump launched in his first term to fast-track the shots as well as other treatments.

Makary criticized covid vaccine guidance that called for giving young children the shots. He argued that, for many people, natural immunity from infections could substitute for the vaccine. Bhattacharya opposed measures used to curb the spread of covid in 2020 and advised that everyone except the most vulnerable go about their lives as usual. The World Health Organization warned that such an approach would overwhelm hospitals.

Mehmet Oz, Trump’s choice to head the Centers for Medicare & Medicaid Services, an agency within HHS, has said the vaccines were oversold. He promoted the use of the anti-malaria drug hydroxychloroquine as a treatment. The FDA in 2020 revoked emergency authorization of hydroxychloroquine for covid, saying that it was unlikely to be effective against the virus and that the risk of dangerous side effects was too high.

Janette Nesheiwat, meanwhile, a former Fox News contributor and Trump’s pick for surgeon general, has taken a different stance. The doctor described covid vaccines as a gift from God in a Fox News opinion piece.

Kennedy’s qualms about vaccines are likely to be a central issue early in the administration. He has said he wants federal health agencies to shift their focus from preparing for and combating infectious disease to addressing chronic disease.

The shifting focus and questioning of vaccines concern some public health leaders amid the spread of the H5N1 bird flu virus among dairy cattle. There have been 60 human infections reported in the U.S. this year, all but two of them linked to exposure to cattle or poultry.

“Early on, they’re going to have to have a discussion about vaccinating people and animals” against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. “We all bring opinions to the table. A department’s cohesive policy is driven by the secretary.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

But once he returns to the White House in January, Trump can make abortions difficult — or illegal —across the United States without Congress taking action at all.

The president-elect will have a variety of tools to restrict reproductive rights in general and abortion rights in particular, both directly from 1600 Pennsylvania Ave. and from the executive agencies he’ll oversee. They include strategies he used during his first term, but also new ones that emerged in the wake of the Supreme Court’s overturn of Roe v. Wade in 2022.

The Trump transition team did not respond to a request for comment on this topic.

By far the most sweeping thing Trump could do without Congress would be to order the Justice Department to enforce the Comstock Act, an 1873 anti-vice law that bars the mailing of “obscene matter and articles used to produce abortion.”

While Roe was in effect, the law was presumed unconstitutional, but many legal scholars say it could be resurrected. “And it is so broad that it would ban abortion nationwide from the beginning of a pregnancy without exception. Procedural abortion, pills, everything,” Greer Donley, an associate professor and abortion policy researcher at the University of Pittsburgh Law School, said on KFF Health News’ “What the Health?” podcast early this year.

Even if he does not turn to Comstock, Trump is expected to quickly reimpose restrictions embraced by every GOP president for the past four decades. When Trump took office in 2017, he reinstituted the “Mexico City Policy” (also known as the “global gag rule”), a Ronald Reagan-era rule that banned U.S. aid to international organizations that support abortion rights. He also pulled U.S. funding for the United Nations Population Fund. Both actions were undone when President Joe Biden took office in 2021.

Those aren’t the only policies Trump could resurrect. Others that Trump imposed and Biden overturned include:

• Barring providers who perform abortions and entities that provide referrals for abortion (such as Planned Parenthood) from the federal family planning program, Title X. The Trump administration imposed the rules in 2019; Biden formally overturned them in 2021.
• Banning the use of human fetal tissue in research funded by the National Institutes of Health. The Trump administration issued guidance barring the practice in 2019; the Biden administration overturned it in 2021.
• Requiring health plans under the Affordable Care Act to collect separate premiums if they offer coverage for abortion. The 2019 Trump administration regulation was overturned by Biden officials in 2021.
• Allowing health providers to refuse to offer any service that violates their conscience. The 2019 Trump administration regulation — a revision of one originally implemented by President George W. Bush — had already been blocked by several appeals courts before being rescinded and rewritten by the Biden administration. The new, narrower rule was issued in January.

Anti-abortion groups say those changes are the minimum they expect. “The commonsense policies of President Trump’s first term become the baseline for the second, along with reversing Biden-Harris administration’s unprecedented violation of longstanding federal laws,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement to KFF Health News.

Dannenfelser was referring to the expectation that Trump will overturn actions that Biden took toward protecting abortion rights after the Supreme Court’s decision. Some included:

• Providing that members of the military and their dependents who live in states with abortion bans be permitted to take leave and travel to other states for reproductive health care.
• Allowing VA medical facilities to provide abortion counseling and, in limited circumstances, abortions to veterans and VA beneficiaries, regardless of the laws in the state where the facility is located.
• Expanding the availability of the abortion pill mifepristone.
• Clarifying that the Emergency Medical Treatment and Active Labor Act of 1986 requires hospitals to provide abortions to women with pregnancy complications that threaten their health, not just their life regardless of state law.

Even easier than formal changes of policy, though, Trump could simply order the Justice Department to drop several cases being heard in federal court in which the federal government is effectively arguing to preserve abortion rights. Those cases include:

• FDA v. The Alliance for Hippocratic Medicine. This case out of Texas challenges the FDA’s approval of the abortion pill mifepristone. The Supreme Court in June ruled that the original plaintiffs lacked standing to sue, but attorneys general in three states (Missouri, Idaho, and Kansas) have stepped in as plaintiffs. The case has been revived at the U.S. District Court for the Northern District of Texas.
• Texas v. Becerra. In this case, the state of Texas is suing the Department of Health and Human Services, charging that the Biden administration’s interpretation of a law requiring emergency abortions to protect the health of the pregnant woman oversteps its authority. The Supreme Court denied a petition to hear the case in October, but that left the possibility that the court would have to step in later — depending on the outcome of a similar case from Idaho that the justices sent back to the Court of Appeals.

Whether Trump will take any or all of these actions is anyone’s guess. Whether he can take these actions, however, is unquestioned.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers — who will now have control over both the House and the Senate — have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.

The governing trifecta sets the stage for potentially seismic changes that could curtail the law’s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.

“The Republican plans — they don’t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,” said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. “It could happen through legislation and regulation. We’re on alert for anything and everything. It could take many forms.”

Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn’t support legislation they said would cause such a marked increase in the uninsured rate.

Similar opposition to revamping the law could emerge again, especially because polls show the ACA’s protections are popular.

While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs “massive reform” and would be on the party’s agenda should Trump win.

Congress could theoretically change the ACA without a single Democratic vote, using a process known as “reconciliation.” The narrow margins by which Republicans control the House and Senate mean just a handful of “no” votes could sink that effort, though.

Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers’ approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don’t have children rather than “traditional” Medicaid beneficiaries such as pregnant women, children, and people with disabilities.

A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don’t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.

“It’s similar to an ACA repeal plan,” said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. “It’s repeal with a different name.”

Congress would likely be needed to enact a proposal to shift a portion of consumers’ ACA subsidies to health savings accounts to pay for eligible medical expenses.

Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for — capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.

“Trump will do whatever he thinks he can get away with,” said Chris Edelson, an assistant professor of government at American University. “If he wants to do something, he’ll just do it.”

Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs — and contributed to the nation’s lowest uninsured rate on record — are set to expire at the end of next year without congressional action. Premiums would then double or more, on average, for subsidized consumers in 12 states who enrolled using the federal ACA exchange, according to data from KFF.

That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, according to federal estimates.

Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.

The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases challenges the ACA requirement that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. About 150 million people now benefit from the coverage requirement.

If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement — which could inspire similar challenges, with broader implications. A recent ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University’s Center for Health Policy and the Law.

In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.

“The early executive orders will give us a sense of policies that the administration plans to pursue,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. “Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.”

In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn’t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.

The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions depressed enrollment during the previous Trump administration.

Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don’t comply with ACA consumer protections.

The Biden administration walked back Trump’s efforts to expand what are often known as short-term health plans, disparaging the plans as “junk” insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.

The Trump administration is expected to use regulation to reverse Biden’s reversal, allowing consumers to keep and renew the plans for much longer.

But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.

Some people with ACA plans say they’re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA — and doesn’t want to go back to a time when insurance was hard to get and afford.

In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with joint pain and numbness in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.

He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.

“It’s definitely a terrifying thought,” Reed said. “I would probably survive. I would just be in a lot of pain.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Trump, que durante mucho tiempo se opuso a ACA, expresó durante la campaña su interés en modificar la ley de salud. Además, algunos legisladores republicanos de alto rango —que ahora tendrán el control tanto de la Cámara de Representantes como del Senado— han dicho que para ellos sería una prioridad renovar la histórica legislación de 2010, conocida como Obamacare. Afirman que es una ley demasiado cara y que representa una intromisión excesiva del Gobierno.

El futuro gobernante prepara el terreno para hacer cambios potencialmente sísmicos que podrían limitar la expansión de Medicaid, aumentar la tasa de personas sin seguro, debilitar las protecciones para los pacientes y elevar los costos de las primas para millones de personas.

“Los planes republicanos no dicen que vayan a derogar ACA, pero el conjunto de sus políticas podría equivaler a lo mismo o a algo peor”, dijo Sarah Lueck, vicepresidenta de política sanitaria del Center on Budget and Policy Priorities, un instituto de investigación y política. “Los cambios podrían sobrevenir a través de la legislación y de las regulaciones. Estamos alerta ante cualquier cosa porque sabemos que podrían adoptar muchas formas”.

En estos años, los republicanos del Congreso han votado docenas de veces intentando derogar la ley. No pudieron lograrlo en 2017, después que Trump se convirtiera en presidente, a pesar de que tenían la Casa Blanca y mayoría en ambas cámaras.

Esto ocurrió, en gran parte, porque algunos legisladores del GOP no quería apoyar una legislación que, explicaban, podía causar un aumento tan marcado en la tasa de personas sin seguro.

En esta oportunidad podría surgir una oposición similar a reformar la ley, especialmente porque las encuestas muestran que las protecciones que establece ACA son populares.

Aunque ni Trump ni sus aliados del Partido Republicano han dado detalles sobre lo que cambiarían, el presidente de la Cámara de Representantes, Mike Johnson, dijo en octubre que ACA necesita una “reforma profunda” y que esa política estaría en la agenda del partido.

Teóricamente, el Congreso podría cambiar ACA sin un solo voto demócrata, utilizando un proceso conocido como “reconciliación”. Sin embargo, como los republicanos controlan la Cámara de Representantes y el Senado por márgenes estrechos, sólo un puñado de votos en contra podría hundir ese esfuerzo.

Muchos de los objetivos más ambiciosos requerirían la intervención del Congreso. Algunos conservadores han pedido que se modifique la fórmula de financiamiento de Medicaid, el programa de seguro médico del gobierno federal y estatal para personas de bajos ingresos y con discapacidades.

La idea sería utilizar la reconciliación presupuestaria para convencer a los legisladores de que  aprueben una reducción de la parte de los recursos que paga el gobierno federal para la población cubierta por la expansión.  El grupo que se vería más afectado está compuesto en gran parte por adultos de ingresos más altos y adultos sin hijos, en lugar de los beneficiarios “tradicionales” de Medicaid, como las mujeres embarazadas, los niños y las personas con discapacidades.

Una iniciativa conservadora que permitiría que las personas utilicen los subsidios de ACA para comprar en el mercado planes de salud que no cumplen con la ley, probablemente necesitaría de la aprobación del Congreso.

Esto podría provocar que las personas más saludables utilicen los subsidios para comprar planes más baratos y limitados, lo que aumentaría las primas para los consumidores de mayor edad y más enfermos, que necesitan una cobertura más completa.

“Es algo parecido a un plan de derogación de ACA”, dijo Cynthia Cox, vicepresidenta y directora del programa de la Ley de Cuidado de Salud a Bajo Precio en KFF. “Es una derogación con otro nombre”.

“Trump hará lo que crea que puede hacer sin consecuencias”, dijo Chris Edelson, profesor adjunto de Gobierno en American University. “Si quiere hacer algo, simplemente lo hará”.

Los republicanos tienen otra opción para debilitar ACA. Pueden simplemente no hacer nada.

Los subsidios temporales y mejorados que reducen los costos de las primas —y que contribuyeron a alcanzar la tasa de personas sin seguro más baja de la historia del país— expirarán a finales del próximo año si el Congreso no actúa. Según datos de KFF, en promedio, las primas se duplicarían o más para los consumidores subvencionados en 12 estados que se inscribieron a través del mercado federal de ACA.

Esto significaría que menos personas podrían permitirse esta cobertura. Y aunque es probable que aumente el número de personas cubiertas por planes ofrecidos por empresas, según estimaciones federales se proyecta que habrá 1.7 millones más de personas sin seguro cada año entre 2024 y 2033.

Muchos de los estados que se verían más afectados, incluidos Texas y Florida, están representados en el Congreso por republicanos, lo que podría hacer que algunos legisladores no estén convencidos de permitir que los subsidios caduquen.

La administración Trump también podría optar por dejar de defender la ley contra las demandas que buscan modificar algunas de sus partes esenciales.

Uno de los casos más notables cuestiona el requisito de ACA de que las aseguradoras cubran algunos servicios preventivos, como las pruebas gratuitas de detección del cáncer y el asesoramiento sobre el consumo de alcohol. En la actualidad, unas 150 millones de personas se benefician de este requisito de cobertura.

Si el Departamento de Justicia retirara su petición después que Trump asuma el cargo, los demandantes no estarían obligados a cumplir con el requisito de cobertura, lo que podría inspirar desafíos similares con implicaciones más amplias. Según Zachary Baron, director del Centro de Política Sanitaria y Derecho de la Universidad de Georgetown, una sentencia reciente deja la puerta abierta a que otras empresas y aseguradoras presenten recursos judiciales en busca de la misma reparación.

Mientras tanto, Trump podría iniciar cambios desde su primer día en el Despacho Oval a través de órdenes ejecutivas, que son directivas que no pasan por las aprobaciones del Congreso, y que tienen fuerza de ley.

“Las primeras órdenes ejecutivas nos darán una idea de las políticas que la administración planea seguir”, dijo Allison Orris, investigadora principal del Centro de Prioridades Presupuestarias y Políticas. “Las señales tempranas a través de órdenes ejecutivas enviarán un mensaje sobre qué tipo de orientación, regulaciones y políticas podrían venir después”.

De hecho, Trump se basó en gran medida en estas órdenes ejecutivas durante su mandato anterior. Una orden de octubre de 2017 ordenó a las agencias federales que comenzaran a modificar ACA y, como resultado, aumentó el acceso de los usuarios a planes de salud que no cumplían con la ley.

Al principio de su nuevo mandato, Trump podría emitir órdenes similares, utilizándolas para iniciar el proceso de cambios obligatorios a la ley, como por ejemplo con una supervisión más estricta para prevenir fraudes.

La administración podría tomar desde el principio otras medidas que vayan en contra de ACA, como recortar los fondos federales destinados a la divulgación y asistencia para inscribirse en estos planes. Estas acciones ya disminuyeron la inscripción durante la administración anterior de Trump.

El nuevo presidente también podría utilizar regulaciones para implementar otras propuestas conservadoras, como aumentar el acceso a planes de salud que no cumplan con las protecciones al consumidor que tiene ACA.

La administración Biden revirtió los esfuerzos de Trump para ampliar los llamados “planes de salud de corto plazo”, y los calificó como “seguros basura” porque pueden no cubrir ciertos beneficios y, también, negar la cobertura a personas con problemas de salud preexistentes.

Se espera que la administración de Trump utilice regulaciones para deshacer la decisión de Biden, permitiendo que los consumidores mantengan y renueven estos planes de corto plazo por períodos mucho más largos.

Sin embargo, redactar regulaciones se ha vuelto mucho más difícil debido a un fallo de la Corte Suprema que establece que los tribunales federales ya no están obligados a respaldar automáticamente las decisiones de las agencias federales cuando se cuestiona su autoridad legal. Como resultado, cualquier nueva regla emitida por el HHS durante una administración de Trump podría enfrentar más intentos de bloqueo en los tribunales.

Algunas personas con planes de ACA cuentan que están preocupadas. Dylan Reed, un pequeño empresario de 43 años, de Loveland, Colorado, recuerda los días anteriores a la existencia de ACA y no quiere volver a una época en la que era difícil conseguir seguro de salud, y también pagarlo.

Además del trastorno por déficit de atención con hiperactividad (TDAH) y ansiedad, Reed padece de esclerodermia, una enfermedad autoinmune asociada con dolores de las articulaciones y entumecimiento en las extremidades. Incluso con su plan de ACA, calcula que paga alrededor de $1,000 al mes solo en medicamentos.

Le preocupa que, sin las protecciones de ACA, le resulte difícil encontrar cobertura debido a sus enfermedades preexistentes.

“Definitivamente es un pensamiento aterrador”, confiesa Reed. “Probablemente sobreviviría, pero con mucho dolor”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Trump and his campaign have been vague about plans on health care policies, though current and former Trump aides have published blueprints that go well beyond reversing programs in force under the Biden administration, to overhauling public health agencies and enabling Trump to quickly fire officials who disagree.

Harris, on the other hand, has staked out positions primarily preserving and protecting existing health care access — on abortion, transgender health care, insurance coverage, and more.

Here are some of the most consequential changes in health policies that could hinge on who wins the White House.

ACA Premiums

The election is likely to affect the cost of health insurance for millions who buy coverage on the Affordable Care Act marketplaces.

That’s because extra, pandemic-era subsidies that lower the cost of premiums will expire at the end of 2025 — unless Congress and the next president act.

Harris has pledged to make the enhanced subsidies permanent, while Trump has made no such commitment.

Letting them expire “would reduce fraud and waste,” said Brian Blase, a former Trump adviser who is president of the Paragon Health Institute, a conservative policy research firm.

About 19.7 million people with ACA coverage benefit from a subsidy — 92% of all enrollees. The expanded subsidies, started in 2021, helped increase ACA enrollment to a record high and reduce the uninsured rate to a record low.

They have also cut premium payments by an estimated 44%. Many pay no premiums at all.

Without congressional action, almost all ACA enrollees will experience steep increases in premium payments in 2026, according to KFF. The Urban Institute estimates 4 million people could wind up uninsured.

Letting the subsidies lapse could cause blowback for Republicans in 2026, said Jonathan Oberlander, a health policy expert at the University of North Carolina’s School of Medicine: “Is it worth the pain politically?”

— Phil Galewitz

Abortion

When he was president, Trump promised — and delivered — Supreme Court justices who would vote to overturn the constitutional right to an abortion. In the event of a second term, he has promised to leave abortion policy to the states — though he would have significant leeway to reduce access nationwide.

Harris has promised to restore the protections of Roe v. Wade, though doing so would require Congress’ help. At the very least, a Harris presidency would mostly preserve existing protections and prevent new federal restrictions.

Trump’s first actions would likely mirror those of many Republican presidents since the 1980s: defunding Planned Parenthood and the United Nations’ family planning agency, and, more recently, allowing employers with religious or moral objections to contraception to decline coverage through job-sponsored health plans.

But Trump could go considerably further, effectively banning abortion even in states where it is legal. For instance, the FDA could reduce availability of the abortion pill mifepristone or cancel its approval. This has been the subject of numerous lawsuits, including one before the Supreme Court that was recently revived.

Trump could also order the Justice Department to enforce the Comstock Act, an 1873 law that bans mailing “every article or thing designed, adapted, or intended for producing abortion, or for any indecent or immoral use.” That could apply not just to abortion pills, but also to supplies for abortion procedures.

— Julie Rovner

Drug Prices

Both campaigns say they are committed to lowering drug prices. Trump has offered few specifics, though the America First Policy Institute, a think tank led by close Trump allies, has put forward policies that are considerably less aggressive than Harris’ proposals.

Harris has said she would expand drug pricing negotiations and out-of-pocket drug spending caps enabled by the Inflation Reduction Act. She has also called for more transparency requirements for pharmacy benefit managers, or PBMs, the powerful drug-industry middlemen.

America First’s plan would cut costs by lowering reimbursements to doctors for some expensive infused drugs, using trade policy to force other developed countries to increase what they pay for drugs, and making more prescription medications available over the counter.

The plan makes no mention of bipartisan legislation under consideration in both chambers of Congress that seeks to achieve lower drug prices through new transparency requirements for PBMs.

— Arthur Allen

Trans People’s Health

The presidential election could determine whether transgender Americans hold on to broad protections ensuring access to gender-affirming medical care. Trump has said he would seek to ban hormone replacement therapy, gender-affirmation surgery, and other treatments for minors — and make the services more difficult for adults to receive.

In the closing days of the campaign, Trump and his political action committees have leaned into divisive ads attacking Harris for past comments supporting access to care for transgender people who are incarcerated.

Backed by Republicans eager to stoke culture-war social issues, Trump has pledged to repeal Biden policies affecting transgender health care, including rules prohibiting federally funded providers and insurers from discriminating based on gender identity.

As some states passed legislation that opposed transgender rights, the Biden administration expanded coverage for gender-affirming care and increased research funding for the National Institutes of Health.

In a video on his campaign site, Trump vowed to order federal agencies to “cease all programs that promote the concept of sex and gender transition at any age” and bar government programs such as Medicare and Medicaid from paying for gender-affirming care.

Trump also said he would strip federal funding from hospitals that provide such care, create a right to sue doctors who perform gender-affirming procedures on children, and investigate whether the pharmaceutical industry and hospitals have “deliberately covered up horrific long-term side effects” of transition treatments.

Harris has been largely silent on the Trump campaign’s rhetoric targeting trans people. But she has said she would “follow the law” in providing transgender Americans the same right as others to access medically necessary care.

— Daniel Chang

Medicaid

Though the word “Medicaid” was barely uttered on the campaign trail this year, the election will determine future benefits for its 80 million primarily low-income and disabled enrollees.

“The stakes are very high,” said UNC’s Oberlander.

While Harris has described Medicaid as a key program to improve health, Trump has framed it as a broken welfare program in need of cuts.

Nearly half of Medicaid enrollees are children, and the program pays for about 40% of births nationwide.

The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, or $20,783 this year. All but 10 states, which are GOP-led, have opted to expand their program.

The Biden administration has largely focused on efforts to protect and expand Medicaid to reduce the number of uninsured people.

The Trump administration, and GOP proposals since then, sought to reduce Medicaid spending by stiffening eligibility standards, such as adding work requirements, and by changing federal financing to a block grant, which would put more burden on states.

— Phil Galewitz

Shaking Up Biomedical Agencies

Trump said at an Oct. 27 rally in New York City that he would give anti-vaccine activist Robert F. Kennedy Jr. free rein to “go wild” on health and food policy in a second term.

Even a Republican-controlled Senate would be unlikely to confirm Kennedy for any top government position. Regardless of whether he had a specific role, RFK Jr.’s influence could be powerful, said Georges Benjamin, executive director of the American Public Health Association.

Kennedy said Trump promised to give him “control” of public health, including naming leaders of the NIH, FDA, and the Centers for Disease Control and Prevention. He has advocated for a doctor who made a name for herself as a right-wing health guru, Casey Means, to head the FDA. This week, in a discussion on CNN during which he put forward the debunked theory that vaccines cause autism, Trump transition team co-chair Howard Lutnick said Kennedy wanted data on vaccines “so he can say these things are unsafe,” at which point “the companies will yank the vaccines right off … the market.”

Numerous Trump allies have urged disempowering public health agencies — stripping the CDC of much of its research and promotional authority while streamlining NIH and adding congressional oversight over its grant-making.

Project 2025, the Heritage Foundation blueprint disavowed by Trump but whose authors include many former Trump officials, says the drug industry and other corporations have “captured” regulatory agencies: “We must shut and lock the revolving door” between agencies like the NIH, CDC, and FDA, and the industries they regulate, it states.

Kennedy recently posted on the social platform X that “FDA’s war on public health” — by which he meant restrictions on disproven therapies and cure-alls like raw milk and ivermectin — “was about to end.”

He warned FDA employees who are “part of the corrupt system” that they should “1. Preserve your records, and 2. Pack your bags.”

— Arthur Allen

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Ahora, mientras los demócratas reconstruyen su candidatura presidencial a pocos meses de las elecciones, se esperaría que, de ser la nueva nominada, Harris adoptase una postura agresiva en apoyo al acceso al aborto, atacando al ex presidente Donald Trump en un tema que podría socavar sus posibilidades de victoria.

Biden respaldó a Harris el domingo 21 de julio cuando anunció su decisión de retirarse de la contienda.

Aunque Biden buscaba mantener el aborto como tema central de su campaña de reelección, defensores seguían teniendo dudas de que el presidente, un católico practicante que ha dicho que no es “muy partidario del aborto”, pudiera ser un abanderado efectivo. Especialmente mientras los esfuerzos republicanos erosionan el acceso al aborto y otros servicios de salud para mujeres en todo el país.

Por otro lado, Harris se convirtió en la primera vicepresidenta en visitar una clínica operada por Planned Parenthood Federation of America. Emprendió una gira nacional centrada en los derechos reproductivos. Y cuando el senador JD Vance de Ohio fue nombrado compañero de fórmula de Trump, Harris utilizó su siguiente mitín de campaña para criticarlo por bloquear protecciones para la fertilización in vitro.

“Lo más significativo es que Harris sería el rostro del impulso para proteger el derecho al aborto”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF, organización sin fines de lucro de información de salud de la que KFF Health News es parte, en una entrevista antes de que Biden se retirara. “El acceso al aborto probablemente sería el tema central en su campaña”.

Una postura firme sobre el aborto no es el único gran contraste con el Partido Republicano (GOP) que ofrece Harris: tiene un gran conocimiento en política de salud. De niña, a menudo acompañaba a su madre al laboratorio donde trabajaba los fines de semana, como investigadora del cáncer de mama.

Durante su campaña presidencial en 2019, apoyó el “Medicare para Todos”, una propuesta de seguro de pagador único, que estableció sus credenciales como una voz más progresista en políticas de salud. Y como fiscal general de California, luchó contra la consolidación en la industria de la salud debido a la preocupación de que esto aumentaría los precios.

En abril, defendió una norma de la administración Biden que establece niveles mínimos de personal en los hogares de adultos mayores financiados con fondos federales.

“Se merece crédito, ha hablado de estos temas en la campaña. No veo ningún cambio en las prioridades sobre lo que los demócratas quieren hacer en salud si ella se convierte en la nominada”, dijo Debbie Curtis, vicepresidenta de McDermott + Consulting.

Un enfoque intensificado en la salud de la mujer y el aborto podría ayudar a consolidar a los votantes demócratas en la recta final hacia las elecciones.

Desde que en 2022 los tres jueces de la Corte Suprema nombrados por Trump ayudaron a derogar Roe vs. Wade, la opinión pública se ha vuelto en contra de los republicanos en el tema del aborto, incluso contribuyendo a un resultado inesperadamente pobre en las elecciones intermedias de ese año.

El 32% de los votantes dijeron que solo votarían por un candidato para un cargo importante que compartiera sus opiniones sobre el aborto, según una encuesta de Gallup realizada en mayo. Ese es un récord alto desde que Gallup hizo la pregunta por primera vez en 1992. Casi el doble de votantes que apoyan el aborto, en comparación con aquellos que se oponen al aborto, tienen esa opinión.

El 63% de los adultos dijeron que el aborto debería ser legal en todos o en la mayoría de los casos, según una encuesta realizada en abril por el Pew Research Center. El 36% dijo que debería ser ilegal en todos o en la mayoría de los casos.

Mientras tanto, los republicanos han estado ansiosos por distanciarse de su propia victoria en este tema. Trump enfureció a algunos miembros de su base al decir que dejaría las decisiones sobre el aborto a los estados.

Sin embargo, defensores advierten que la nueva moderación por omisión del GOP en el tema enmascara su postura real, más extrema. Vance ha sido claro en el pasado sobre su apoyo a una prohibición nacional del aborto.

Y aunque la plataforma del GOP adoptada durante la convención del partido hace pocos días puede no pedir explícitamente una prohibición nacional del aborto, el reconocimiento de los líderes del partido de la “personalidad fetal”, la idea de que tan pronto como se fertiliza un óvulo se convierte en una persona con todos los derechos legales, crearía una prohibición automáticamente si la Corte Suprema la encontrara constitucional.

Esas opiniones contrastan con las de muchos republicanos, especialmente mujeres. Alrededor de la mitad de las votantes republicanas creen que el aborto debería ser legal en todos o en la mayoría de los casos, según una encuesta nacional reciente de KFF.

Y la mayoría de las mujeres que votan por el Partido Republicano creen que el aborto debería ser legal en casos de violación, incesto o una emergencia durante el embarazo.

Si Harris encabeza la candidatura, se esperaría que enfatice esos temas en los próximos meses.

“Ha sido uno de los temas principales, si no el principal, que ha remarcado en el último año o dos”, dijo Matthew Baum, profesor Marvin Kalb de comunicaciones globales en la Universidad de Harvard. “Claramente, los republicanos están tratando de desactivar el tema. Ha sido un desastre para ellos”.

Es probable, sin embargo, que los republicanos presenten las opiniones de Harris sobre el aborto como extremistas. Durante el debate presidencial contra Biden, Trump afirmó falsamente que los demócratas apoyan los abortos tardíos en el embarazo, “incluso después del nacimiento”.

Poco después que se diera la noticia de que Biden había respaldado a Harris, Susan B. Anthony Pro-Life America emitió un comunicado criticando el historial de Harris y ofreciendo una muestra de lo que está por venir. “Mientras Joe Biden tiene problemas para decir la palabra aborto, Kamala Harris la grita”, dijo Marjorie Dannenfelser, presidenta del grupo.

Algunos encuestadores han dicho que Harris tendrá que hacer más que simplemente hacer campaña contra los esfuerzos republicanos para revertir el acceso al aborto para realmente motivar a los votantes: temas como la inflación, la economía y la inmigración, están compitiendo por atención.

“Tiene que decir que está luchando por una ley federal que restablezca Roe vs. Wade”, dijo Robert Blendon, profesor emérito de salud pública en la Universidad de Harvard. “Necesita algo muy específico y claro”.

La elevación de Harris a la cima de la candidatura llegaría en un momento crítico en la lucha por los derechos reproductivos.

La Corte Suprema escuchó dos casos de aborto en el término que acaba de finalizar. Pero los jueces no abordaron los méritos de los temas en ninguno de los casos, fallando en su lugar sobre cuestiones técnicas. Se espera que ambos regresen a la Corte Suprema tan pronto como el próximo año.

Harris también tendría una considerable libertad para hablar sobre lo que se considera los principales logros de la política de salud de la administración Biden.

Estos incluyen mejores subsidios en la Ley de Cuidado de Salud a Bajo precio (ACA) destinados a ayudar a los consumidores a obtener seguro de salud, que se extendieron, a través de la Ley de Reducción de la Inflación, hasta 2025, el límite mensual de $35 en copagos que algunos pacientes pagan por la insulina, y la negociación de precios de medicamentos en Medicare.

“Creo que está bien posicionada. Harris es parte central de la administración y podrá atribuirse el mérito de esas cosas”, dijo Dan Mendelson, CEO de Morgan Health, una subsidiaria de J.P. Morgan Chase.

Dicho esto, puede ser difícil para cualquier candidato lograr que los votantes se enfoquen en algunos de esos logros, especialmente en los esfuerzos relacionados con los precios de los medicamentos.

Aunque la administración ha tomado algunos pasos importantes, “nuevos medicamentos costosos siguen saliendo al mercado”, dijo Mendelson. “Así que si miras la percepción de los consumidores, no creen que el costo de los medicamentos esté bajando”.

Joseph Antos, del American Enterprise Institute, dijo que es probable que Harris diga que la administración Biden-Harris “ya le está ahorrando dinero a la gente” en insulina. Pero tendrá que ir más allá de estos logros y redoblar sus esfuerzos en los precios de los medicamentos y otros temas de costo, no hablar únicamente sobre derechos reproductivos.

“Tiene que concentrarse, si quiere ganar, en temas que tengan un amplio atractivo”, dijo Antos. “El costo es uno y el acceso a tratamientos es otro gran tema”.

Samantha Young de KFF Health News contribuyó con este informe.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Now, as Democrats rebuild their presidential ticket just a few months before Election Day, Harris would widely be expected to take an aggressive stance in support of abortion access if she became the party’s new presumptive nominee — hitting former President Donald Trump on an issue that could undermine his chances of victory. Biden endorsed Harris on Sunday when he announced his decision to leave the race.

While Biden sought to keep abortion center stage in his reelection bid, abortion advocates had harbored doubts that the president — a practicing Catholic who has said he is not “big on abortion” — could be an effective standard-bearer as Republican efforts erode access to abortion and other women’s health care around the country.

Harris, on the other hand, became the first vice president to visit a clinic run by the Planned Parenthood Federation of America. She undertook a nationwide tour focused on reproductive rights. And when Sen. JD Vance of Ohio was named Trump’s running mate, Harris used her next campaign appearance to criticize him for blocking protections for in vitro fertilization.

“Most significantly, Harris would be the face of the drive to protect abortion rights,” Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News, said in an interview before Biden stepped aside. “Abortion access would likely be front and center in her campaign.”

A strong stance on abortion is not the only major contrast to the GOP that Harris offers: She is well versed in health policy. As a child, Harris often accompanied her mother to work on the weekends, visiting the lab where she was studying breast cancer.

While running for president in 2019, she backed “Medicare for All,” a single-payer insurance proposal that established her bona fides as a more progressive voice on health policy. And as California’s attorney general, she fought against consolidation in the health industry over concerns it would drive up prices. 

She stumped for a Biden administration rule setting minimum staffing levels at federally funded nursing homes in April.

“She deserves credit, she’s talked about them on the campaign trail. I don’t see any change there in the priorities on what Democrats want to do on health care if she becomes the nominee,” said Debbie Curtis, vice president at McDermott + Consulting. 

An intensified focus on women’s health and abortion could help galvanize Democratic voters in the final sprint to the election. Since the three Supreme Court justices named by Trump helped overturn Roe v. Wade in 2022, public opinion has turned against Republicans on abortion, even contributing to an unexpectedly poor showing in the 2022 midterm elections.

Thirty-two percent of voters said they would vote only for a candidate for a major office who shares their views on abortion, according to a Gallup Poll conducted in May. That’s a record high since Gallup first asked the question in 1992. Nearly twice as many voters who support abortion, compared with those who oppose abortion, hold that view. 

Sixty-three percent of adults said abortion should be legal in all or most cases, based on a poll conducted in April by Pew Research Center. Thirty-six percent said it should be illegal in all or most cases.

Republicans, in turn, have been eager to distance themselves from their own victory on the issue. Trump angered some members of his base by saying he would leave decisions on abortion to the states.

Regardless, advocates caution that the GOP’s new moderation-by-omission on the issue masks their actual, more extreme stance. Vance has been clear in the past about his support for a national abortion ban. And while the GOP platform adopted during the party’s convention last week may not explicitly call for a nationwide ban on abortion, party leaders’ recognition of “fetal personhood,” the idea that as soon as an egg is fertilized it becomes a person with full legal rights, would create such a ban automatically if the Supreme Court found it constitutional.

Those views stand in contrast to those of many Republicans, especially women. About half of Republican women voters think abortion should be legal in all or most cases, according to a recent national survey by KFF. And majorities of women who vote Republican believe abortion should be legal in cases of rape, incest, or a pregnancy emergency.

If Harris heads the ticket, she would be expected to hammer on those issues in the coming months. 

“It’s been one of if not the main issue she’s emphasized in the last year or two,” said Matthew Baum, Marvin Kalb professor of global communications at Harvard University. “Clearly the Republicans are trying to defang the issue. It’s been a disaster for them.”

It is likely, though, that Republicans would paint Harris’ views on abortion as extremist. During the presidential debate against Biden, Trump falsely claimed Democrats support abortions late in pregnancy, “even after birth.”

Shortly after news broke that Biden had endorsed Harris, Susan B. Anthony Pro-Life America issued a statement calling out Harris’ record and offering evidence of what is to come. “While Joe Biden has trouble saying the word abortion, Kamala Harris shouts it,” said Marjorie Dannenfelser, the group’s president.

Some pollsters have said Harris would have to do more than just campaign against Republican efforts to roll back abortion access to truly motivate voters because so many issues, such as inflation, the economy, and immigration, are competing for attention.

“She has to say she is running for a federal law that will bring back Roe v. Wade,” said Robert Blendon, an emeritus public health professor at Harvard University. “She needs something very specific and clear.”

Harris’ elevation to the top of the ticket would come at a critical juncture in the fight over reproductive rights.

The Supreme Court heard two abortion cases in the term that ended this month. But the justices did not address the merits of the issues in either case, ruling instead on technicalities. Both are expected to return to the high court as soon as next year.

In one case, challenging the FDA’s 2000 approval of the abortion pill mifepristone, the justices ruled that the group of anti-abortion medical professionals who challenged the drug lacked standing to sue because they failed to show they were personally injured by its availability. 

The other abortion-related case pitted a federal law requiring hospitals to provide emergency care against Idaho’s strict ban, which allows abortions when a pregnant patient’s life is in danger — but not in cases in which it is necessary to protect her health, including future fertility.

Harris would also have substantial leeway to talk about what are considered to be the Biden administration’s core health policy accomplishments. These include enhanced Affordable Care Act tax credits aimed at helping consumers get health insurance coverage, which were extended through the Inflation Reduction Act into 2025, the $35 monthly cap on copays some patients pay for insulin, and drug price negotiation in Medicare.

“I think she is well positioned. She is core to the administration and will be able to take credit for those things,” said Dan Mendelson, CEO of Morgan Health, a subsidiary of J.P. Morgan Chase.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

According to the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply for residency positions this year in states with abortion bans and other significant abortion restrictions.

In this episode of “The Indicator From Planet Money,” KFF Health News’ chief Washington correspondent, Julie Rovner, reports on how the medical labor force is changing post-Roe v. Wade and why graduating medical students, from OB-GYNs to pediatricians, are avoiding training in states with abortion bans.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).