KFF's CEO: Final Thoughts on Health Care and the Election

Drew Altman heads the nonpartisan Kaiser Family Foundation, a reliable source of health care data and analysis. His "Quick Take" (Oct. 30) is important reading, and I've reprinted a few key points below (emphasis added):

• This is a fork-in-the-road-election between one side—Vice President Harris—committed to building on existing public programs and protecting consumers, and the other—former President Trump—whose administration will attempt to devolve responsibility to states, and deregulate and dramatically cut federal health funding, both as a policy goal and to pay for tax cuts. 
• Regardless of who is elected, there will be a debate about extending the enhanced ACA premium subsidies. . . . Premium subsidies sound obscure, but the consequences for people and spending are real and substantial:
• The subsidies affect about 20 million people.
• Failure to extend them means a 79% increase in premiums, an average $705 increase.
• It costs $335 billion over 10 years to do it.
• The biggest thing that happens if Vice President Harris is elected is that all of the possible dramatic changes a Trump administration could make for the federal role in health evaporate overnight. . . .
• Agencies like the FTC and CMMI and, above all the FDA, will breathe a sigh of relief, not to mention the Department of Education. 
• There will be no leadership position anywhere in the federal government in health for RFK Jr.
• Mifepristone will continue to be distributed as it is today. 
• Equity will continue to be a priority in federal health programs.
• If former President Trump wins, an alternative history will play out. 
• Medicaid and Mifepristone are likely to be prominent targets; one to pay for tax cuts and the other because it’s the primary way women get abortions now. . . . 
• Some ideas favored by Trump will get through, and others will hit a wall of laws and regulations and bureaucratic resistance. Trump cannot simply decree that RFK Jr. “go wild” on health, food and medicines, and, like Star Trek’s Captain Picard, “make it so.” But a lot will get through. Everyone will need a law degree as legal challenges to Trump regulations, waivers, executive orders and agency reorganizations dot the health policy landscape and command attention. 
• Philosophically, this election is a choice in health between aggressive incrementalism and a sharp right-hand turn in federal policy and spending but take it from this political scientist: no one should doubt the capacity of our system and institutions to thwart dramatic change in any direction.