ELECTION 2024

Compare the Candidates on Health Care Policy

A photo illustration with Kamala Harris on a blue background and Donald Trump on a red backgrond

The following content was last updated on October 8, 2024

The general election campaign is underway, spotlighting former President Trump, the Republican nominee, and Vice President Harris, the Democratic nominee, as the viable contenders for the presidency. Although health care reform may not be a central issue in this election as in the past, health care remains a significant concern for voters. Trump and Harris have distinctly different records and positions on health care. This side-by-side analysis provides a quick resource for understanding Trump’s presidential record and Harris’ record in the Biden-Harris administration and in previously held public office, as well as their current positions and proposed policies. Proposals are from when candidates served as president and vice president respectively unless text or links indicate otherwise. This tool will be continuously updated as new information and policy details emerge throughout the campaign.

Prescription Drug Prices

Immigrant Health Coverage

Affordable Care Act

In 2017, unsuccessfully attempted to repeal and replace the ACA with various plans that would have increased the number of uninsured Americans to 51 million.
Deprioritized enforcement of the individual mandate penalty, then reduced the penalty to $0.
Stopped payments for cost-sharing subsidies (CSRs), which contributed to premiums increasing, as well as federal subsidies growing.
Reduced funding for outreach, which may have contributed to enrollment stagnating.
Expanded non-ACA-compliant short-term plans, which restrict coverage for pre-existing conditions.
Allowed Enhanced Direct Enrollment in ACA plans through online brokers.
In budget plans, proposed changes to the ACA that would weaken pre-existing protections and reduce funding substantially through a block grant to states.
As a candidate for this election, he called to “never give up” on repealing the ACA, later adding “Obamacare Sucks” and that he would replace it with “much better healthcare.” He also said he was not running on terminating the ACA and would rather make it “much much better and far less money,” though has provided no specific plans.

The Biden-Harris administration enacted the American Rescue Plan Act (ARPA), which temporarily expanded eligibility for and increased ACA Marketplace subsidies. These were extended by the Inflation Reduction Act (IRA) through 2025.
The administration fixed the “family glitch,” allowing dependents of people with unaffordable employer-based family coverage to receive ACA subsidies.
The administration reversed Trump administration expansion of short-term plans and restored outreach and enrollment assistance and funding.
The administration achieved record-high enrollment in ACA Marketplace plans.
Proposes to build on provisions in the IRA by making permanent the expanded ACA subsidies.

Medicaid

Supported unsuccessful efforts to repeal and replace the ACA, including the Medicaid expansion, and proposed restructuring Medicaid financing into a block grant or a per capita cap as well as limiting Medicaid eligibility and benefits. These proposals, included in Trump budget plans as president, were estimated to reduce federal Medicaid spending by roughly $1 trillion over 10 years.
Approved waivers that included work requirements as a condition of Medicaid eligibility, premiums, and other eligibility restrictions.
Took administrative action to relax Medicaid managed care rules and increase eligibility verification requirements.
Signed legislation that included a continuous enrollment requirement in exchange for enhanced federal Medicaid funding during the COVID-19 public health emergency.

Championed Biden-Harris administration efforts to reduce maternal mortality and morbidity, including encouraging states to adopt the postpartum Medicaid coverage extension.
The administration supported legislation to establish a federal option to close the coverage gap (not passed by Congress) and passed a fiscal incentive for states to newly adopt the ACA Medicaid expansion.
The administration withdrew demonstration waivers approved in the Trump Administration related to work requirements, and encouraged waivers to expand coverage, reduce health disparities, address the social determinants of health, and help individuals transition out of incarceration.
The administration issued comprehensive regulations and guidance to streamline enrollment, promote continuity of coverage and to help bolster access in Medicaid fee-for-service and managed care.

GO DEEPER: What the Outcome of the Election Could Mean for Medicaid

Abortion

Takes credit for overturning Roe v. Wade by appointing three anti-choice judges to the Supreme Court, claiming, “After 50 years of failure, with nobody coming even close, I was able to kill Roe v. Wade.”
Has said he would consider a national 15 or 16-week ban on abortion, but more recently has said he supports leaving abortion policy to states, which allows full bans to stay in effect and tweeted that he would veto a federal abortion ban. Supports exceptions in cases of rape, incest, and to save the life of the pregnant woman.
Has stated that he would generally not use the Comstock Act to ban mail delivery of medication abortion pills, but will be coming out with specifics.
Administration issued regulations that blocked clinicians from providing counseling that includes abortion information or referrals in clinics that receive federal Title X family planning funds.
Reinstated and expanded Mexico City Policy prohibiting U.S. global health funds from going to foreign NGOs that perform or promote abortions.

As an outspoken defender of reproductive rights and the leading voice of Biden-Harris administration’s stance on abortion, has highlighted the harmful impacts from the Dobbs ruling and advocated for protecting abortion access, including for travel, privacy, emergency care, and bodily autonomy.
As part of national “Fight for Reproductive Freedoms” tour, the only vice president or president to visit a Planned Parenthood clinic while in office.
Supports a federal law to restore Roe v. Wade’s national standard of abortion legality up to viability and has also stated she supports eliminating the Senate filibuster to do this.
The administration’s FDA revised restrictions on medication abortion pills, allowing dispensing via certified pharmacies and telehealth.
The administration issued guidance affirming that abortions performed to stabilize the health of people experiencing pregnancy-related emergencies are protected by the federal Emergency Medical Treatment and Active Labor Act (EMTALA), even in states that ban abortions.
The administration has defended abortion access and the administration’s actions in two major Supreme Court cases on medication abortion and emergency abortions.
The administration strengthened HIPAA protections for data privacy, added nondiscrimination protections for people seeking abortion care, and defends right to travel to seek abortion.
The administration revoked Trump’s Mexico City Policy restrictions.
As U.S. senator, opposed Hyde Amendment, co-sponsored Women’s Health Protection Act, which would have blocked states from imposing restrictive policies limiting access to abortion, and voted against a bill that would have banned abortions later in pregnancy.
As attorney general in California, supported state’s Reproductive FACT Act, requiring so called crisis pregnancy centers (CPCs) to post information about availability of free and low-cost contraceptives and abortion services in the state.
During 2020 primary, while Roe v. Wade was still in place, proposed a pre-clearance requirement that states trying to pass pre-viability abortion restrictions must obtain federal approval.

Contraception

Prohibited family planning clinics such as Planned Parenthood that also offer abortion services (with separate funding) from receiving funds from the federal Title X family planning program, leading to the disqualification or departure of approximately 1000 sites – about 25% of participating clinics.
Issued regulations allowing nearly any employer with a religious or moral objection an exemption from the ACA’s contraceptive coverage requirement.  
Approved Texas’s Medicaid program waiver blocking Medicaid payments to Planned Parenthood and other clinics for non-abortion family planning services and excluding coverage of emergency contraceptive pills in state’s family planning program.

Supports ACA and its contraceptive coverage requirement and Biden-Harris administration defended challenge to the preventive services requirements in the Braidwood case.
The administration restored rules of federal Title X family planning program requiring participating entities to offer full range of contraceptives, pregnancy options counseling (including abortion referral), and re-allowing clinics that also offer abortion services (with non-federal funds) to qualify for the program.
The administration’s FDA approved first over-the-counter oral contraceptive pills and supports increased access and full coverage.
Supports policies to expand access to contraceptives for military members and dependents.

GO DEEPER: Harris v. Trump: Records and Positions on Reproductive Health

Maternity Care

Signed the Preventing Maternal Deaths Act of 2018 which provided funding for state, local, and tribal maternal mortality review committees, and administration implemented the Maternal Opioid Misuse (MOM) model to improve care for pregnant and postpartum women with opioid use disorder
Supports access to IVF care and would require insurance companies or the government to cover all costs (without detailing implementation or funding), but party platform includes language about 14^th Amendment, which many legal experts believe could threaten IVF access

As a longtime leader on maternal health, she championed Congressional bills to improve pregnancy care and reduce racial and ethnic disparities. This includes extension of Medicaid coverage to one year postpartum (enacted under the Biden-Harris Administration). The Administration issued a Blueprint on maternal health that set cross-agency priorities, including workforce development, enhanced data collection, mental health, and doula coverage
Supports guaranteed right to IVF and spoke out against the Alabama Supreme Court ruling

LGBTQ Health

Worked to restrict or remove LGBT rights and access to health care.
Issued revised regulations on Section 1557 of the ACA removing protections in health care based on gender identity and sexual orientation.
Created Division of Conscience and Religious Freedom at HHS and issued final conscience regulation broadening nondiscrimination protections for health care entities to include conscience and executive order directing federal agencies to expand religious protections, actions that created opportunities for LGBTQ-based discrimination in certain circumstances.
Removed and sought to curtail data collection on sexual orientation and gender identity in federal surveys.
Proposes to prohibit gender-affirming care for young people and limit for people of any age nationwide, including prohibiting the use of federal funds for these services.

Made campaign commitment to work to pass the Equality Act which would provide non-discrimination protections for LGBTQ+ people.
Worked to expand and protect LGBTQ rights and access to health care as attorney general of California, as a U.S. senator from California, and through the Biden-Harris administration.
As attorney general of California, supported marriage equality, which has implications for health care access.
As U.S. senator, Harris: introduced a bill seeking to include LGBTQ identity in the U.S. Census, which has implications for identifying health care trends for the population; cosponsored The Health Equity and Accountability Act and the Equality Act, bills seeking to promote equity, access, and data collection, including in health care for LGBTQ people, among others; and introduced the PrEP Access and Coverage Act, a bill aiming to increase access to PrEP, an HIV prevention medication.
The Biden-Harris administration issued guidance and regulations on Section 1557 of the ACA providing the broadest protections to date in health care based on gender identity and sexual orientation, for transgender people, and for gender-affirming care.
The administration enacted the Respect for Marriage Act, enshrining the right for same-sex couples to marry into law.
The administration modernized FDA restrictions on blood donation to align with risk rather than identity.
The administration issued regulation providing protections for LGBTQ people in HHS grants and services.
The administration rescinded Trump administration regulatory expansions of conscience regulations that had created potential opportunities for LGBTQ-based discrimination (which multiple federal courts had found to be unlawful).
The administration intervened, through DOJ, to support plaintiffs in lawsuits challenging state bans on youth access to gender-affirming care and has requested SCOTUS review of the state law.
The administration issued executive order seeking to advance equity for LGBTQ people
The administration adopted a Federal Evidence Agenda on LGBTQ Equity and an HHS-wide action plan promoting sexual orientation and gender identity data collection and equity in federal programs and surveys.

Gun Violence

Banned bump stocks in response to the 2017 Las Vegas mass shooting, though the ban has since been overturned by the Supreme Court. His campaign stated, “The Court has spoken and their decision should be respected.”
Reversed Obama-era regulations that required those eligible for Social Security Administration mental disability payments to be blocked from buying guns and made it easier for gun-safety devices to be more widely accessible.
Asked the Supreme Court to overturn New York City’s restrictions on transporting handguns in New York State Rifle & Pistol Association, Inc. v. City of New York, New York.
On multiple occasions, has suggested that armed citizens could stop mass shootings, including after the Pulse nightclub shooting stating, “you wouldn’t have had the tragedy that you had.” At times, he has partially walked back this suggestion.
Has frequently attributed community gun violence and violent crime to both mental illness and immigration, stating that “they’re not humans, they’re animals.”
Trump is a gun owner and has stated in the past that he “always carries a gun.”

Wants to implement gun safety laws to reduce gun violence, including red flag laws, universal background checks, and a ban on assault weapons and high-capacity magazines. She recently stated, “It is a false choice to suggest that you’re either in favor of the Second Amendment or you want to take everyone’s guns away. I’m in favor of the Second Amendment and we need an assault weapons ban.”
Disagreed with the recent Supreme Court decision to overturn the banning of bump stocks, used in the 2017 Las Vegas mass shooting at a music festival. In a statement after the decision, she called on Congress to ban bump stocks immediately.
As vice president oversees the newly established White House Office of Gun Violence Prevention, which aims to address gun violence by partnering directly with states and encouraging them to institute their own gun violence prevention offices.
The Biden-Harris administration supported and signed the Bipartisan Safer Communities Act into law, which enhanced background checks for individuals under 21, funds crisis intervention orders, and invests in mental health services, including school-based mental health services.
The administration issued executive actions to reduce gun violence, including rules to curb the proliferation of “ghost guns,” reclassify some firearms to require stricter regulation, and promote the use of Extreme Risk Protection Orders or “red flag laws.”
The administration launched cross-jurisdictional strike forces to reduce illegal firearm trafficking in key regions affected by gun violence and stepped up enforcement against firearm dealers who sold firearms illegally or did not abide by background check requirements.
Through both executive action and the American Rescue Plan Act, the administration funded and supported local public safety and community violence prevention programs.
As a presidential candidate in 2019, Harris shared that she owned a gun for personal safety, but also called for “reasonable gun safety” laws.

Public Health

Despite creating Operation Warp Speed, which successfully developed effective COVID-19 vaccines within record time, and initially promoting vaccines, regularly questioned science and public health.
Consistently downplayed COVID-19 as a health threat and routinely countered federal agency and expert advice on pandemic response, including on school re-openings, testing, and masking. Touted the use of unproven therapies such as hydroxychloroquine and suggested that applying ultraviolet light to or inside the body, or injecting disinfectant, could combat coronavirus.
Delegated most responsibility for the COVID-19 response to the states, with the federal government serving as “merely a back-up” and “supplier of last resort.” 
Proposed significant budget cuts to CDC and other federal public health programs.
Has vowed to “stop all COVID mandates” and said he would cut federal funding to schools with a “vaccine mandate or a mask mandate.”
Said he “probably would” disband the White House Office of Pandemic Preparedness and Response Policy, established by Congress in 2023.

Biden-Harris administration committed to listening to science, public health advice, and evidence-based guidance in the COVID-19 response.
The administration enacted new federal COVID response policies such as mask and vaccine mandates, expanded access to testing and vaccines, and a major effort to bolster the national public health workforce.
The administration focused on federal responsibility for giving states “the critical supplies they need.”
The administration established a new White House Office of Pandemic Preparedness and Response Policy.
The administration initiated a CDC reorganization and modernization project “to better share science and data to better serve and protect the American public.”
The administration has proposed significant increases in the nation’s public health budget each year, including in the FY 2025 budget, which calls for $20 billion in new mandatory funding for pandemic preparedness and response, and $12 billion over ten years for a new Vaccines for Adults program.
The administration started new initiatives to combat health misinformation and address health inequities.

Prescription Drug Prices

Established a voluntary model allowing participating Medicare Part D plans to limit monthly insulin costs to $35 (in effect from 2021 through 2023).
Created a new pathway to allow states to import prescription drugs from Canada.
Proposed to eliminate drug rebates in Medicare Part D, which was projected to increase Part D premiums and Medicare spending while lowering out-of-pocket costs (implementation subsequently delayed by legislation until 2032).
Proposed to establish a “Most Favored Nation” system of international reference prices for some Medicare-covered drugs, where U.S. prices would be based on prices in certain other countries (blocked by court action and later rescinded), and to require drug manufacturers to disclose drug prices in television ads (blocked by court ruling). According to the 2024 Trump campaign, “There is no push to renew the most favored nations drug pricing policy.”
Proposed several Medicare Part D benefit design changes, including an out-of-pocket cap and weaker formulary standards (proposals not implemented).

As vice president, cast the tiebreaking vote in the U.S. Senate for the Inflation Reduction Act, which requires the government to negotiate prices for some Medicare-covered drugs (with the number growing over time), requires drug companies to pay rebates if prices rise faster than inflation, caps out-of-pocket drug spending, limits monthly insulin costs to $35 for Medicare beneficiaries in Part B and all Part D plans, improves financial assistance for low-income beneficiaries, and other changes.
Proposes to accelerate Medicare price negotiation of drugs (the Democratic platform calls for 50 drugs per year) and extend $35 insulin copay cap and drug out-of-pocket cap to all Americans. Also stated she will increase competition and transparency, starting with cracking down on pharmaceutical companies blocking competition and abusive practices of drug middlemen.
The administration approved Florida’s plan to import some prescription drugs from Canada; implementation contingent on further action by Florida.
The administration delayed implementation of the Trump administration’s drug rebate rule until 2032, which will delay projected increases in Medicare spending.
The administration established a voluntary model to increase access to cell and gene therapies for people with Medicaid.

Medicare

Promises to “always protect Medicare, Social Security, and patients with pre-existing conditions” including no changes to the retirement age (no specific policies proposed).
Proposes to eliminate taxes on Social Security benefits, which would accelerate insolvency of the Medicare Hospital Insurance and Social Security Trust Funds.
Proposed various policies to reduce prescription drug prices, including a “Most Favored Nation” system of international reference prices and banning drug rebates (neither proposal implemented) and prescription drug importation (final rule issued). According to the 2024 Trump campaign, “There is no push to renew the most favored nations drug pricing policy,” (see also Prescription Drug Prices).
Enacted tax reductions that accelerated the depletion of the Medicare Part A Trust Fund, and repealed IPAB, a federal board that was designed to help slow the growth of Medicare spending.
Signed legislation that expanded treatment for substance use disorders and other mental health conditions and allowed Medicare Advantage plans to offer additional benefits for chronically ill enrollees.
Increased Medicare premiums for higher-income beneficiaries.
Broadened coverage of telehealth, provided advanced payments to providers, and eased staffing requirements for Medicare-certified nursing homes in response to the COVID-19 pandemic (see also Long-Term Care).

Biden-Harris administration proposes to “protect Medicare for future generations” in part by extending solvency of the Medicare Part A Trust Fund by raising Medicare taxes on high earners and closing tax loopholes, and proposes to expand Medicare and Social Security (details not specified).
Proposes expanding home care services under Medicare to help people with functional or cognitive impairments (see also Long-term Care), and adds a vision and hearing benefit to Medicare, paid for by expanding Medicare drug negotiations and other policies.
As vice president, cast the tiebreaking vote in the U.S. Senate for the Inflation Reduction Act, which included several provisions to lower Medicare prescription drug expenses, including negotiated drug prices and a $35 monthly insulin cap (see also Prescription Drug Prices).
The administration expanded coverage of mental health services and access to additional mental health providers.
The administration extended broader coverage of telehealth through December 2024.
The administration established new rules for Medicare Advantage insurers, including restrictions on prior authorization and marketing practices.
The administration established new staffing requirements for Medicare-certified nursing facilities (see also Long-Term Care).
During the 2019 Democratic presidential primary, supported a Medicare for all approach with a role for private insurance, however her campaign has since indicated she would not seek to advance Medicare for all as president and has supported the ACA and expansions to broaden coverage and make health care more affordable.

Health Care Costs

Signed the bipartisan No Surprises Act into law, protecting patients from unexpected medical bills when receiving out-of-network care unknowingly.
Issued an executive order on price transparency, leading to a rule requiring hospitals to post negotiated charges for their services online using authority from the ACA.
Proposed establishing a “Most Favored Nation” system of international reference prices for some Medicare-covered drugs. However, this was blocked by court action and later rescinded. According to the 2024 Trump campaign, “There is no push to renew the most favored nations drug pricing policy.”
Supported efforts to repeal and replace the Affordable Care Act, and in 2024 says he would make the ACA much less expensive (more details in ACA section).
On his 2024 campaign site, he vows to continue his earlier efforts regarding surprise medical bills, price transparency, and prescription drug prices. He also promises to lower health insurance premiums but does not provide details on how he plans to do so.
The administration challenged anticompetitive behavior, including health care mergers. Approved, with conditions, a merger between CVS Health and Aetna, one of the largest health care mergers in history.

Proposes to work with states to cancel medical debt for millions of Americans. In June 2024, Harris announced an administration proposal to remove medical debt from credit reports of 15 million Americans and encouraged state and local governments to act to reduce the burden of medical debt.
In 2021, the Biden-Harris administration began implementing the No Surprises Act, establishing processes to determine payments for out-of-network bills and resolving payment disputes. The administration also proposed expanding surprise billing protections to ground ambulance providers.
The administration expanded the Trump-era rules on price transparency to address implementation challenges and enforce the legislation.
The administration supported the Inflation Reduction Act empowering Medicare to negotiate prices for certain drugs with pharmaceutical companies & increase subsides for ACA marketplace plans (more details in Prescription Drug Prices section).
The administration issued an executive order promoting competition, released updated merger guidelines, and has challenged anticompetitive behavior in the health care sector. As attorney general of California, joined lawsuits against health care mergers and laid the groundwork for an antitrust case against Sutter Health that settled for $575 million in 2019.

Mental Health

Proposes a return to mental institutionalization, stating, “for those who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions, where they belong” — moving away from longstanding policies that provide treatment and living in community settings.
Supported repeal of the ACA and cuts to Medicaid, which would reduce coverage and access to behavioral health services, and issued an executive order to expand non-ACA-compliant short-term policies that often limit or exclude mental health services.
Signed pandemic legislation (CARES Act) that included an expansion of Certified Community Behavioral Health Clinics (CCBHCs), signed legislation that established the 988 hotline, and issued an executive order on veteran suicide.

As vice president led the White House’s Blueprint for Addressing the Maternal Health Crisis, which has taken steps to address maternal mental health, such as launching the National Maternal Mental Health Hotline, training providers on maternal mental health and substance use disorders, and calling on states to expand and extend Medicaid postpartum medical and mental health coverage.
The Biden-Harris administration made investments to expand mental health and substance use treatment, including to children and families and underserved populations, and to address the mental health workforce shortage by increasing licensing flexibilities for social workers.
The administration supported and enacted the Safer Communities Act, which included provisions to increase school behavioral health services (building on the administration’s American Rescue Plan Act) and strengthen state requirements for behavioral health care for Medicaid-enrolled youth, in response to worsening youth mental health.
The administration enhanced behavioral health access opportunities for Medicaid enrollees by establishing maximum appointment wait times, surveying enrollee experiences, and adding rate transparency policies, which may result in improved rates and more provider participation.
The administration expanded the Medicaid CCBHC Demonstration by adding 10 new states to the program.
The administration enhanced crisis care by building up 988 and mobile crisis services, and released the National Strategy for Suicide Prevention, with focus on high-risk groups (e.g. LGBTQ+, veterans, moms).
The administration proposed updated requirements for health plans in order to comply with mental health parity.

Opioid Use Disorders

Declared the opioid crisis a public health emergency, signed bipartisan legislation (SUPPORT Act)
2024 campaign proposes a heavier-handed law and order response to opioids, including reviving restrictive border policies, increasing federal law enforcement involvement in local drug investigations, and seeking the death penalty for drug smugglers and drug dealers.
Plans to support faith-based substance use treatment and job placement but emphasizes a forceful approach for homeless people with mental health and substance use needs, stating ending “the nightmare of the homeless, drug addicts, and dangerously deranged” by arresting or relocating individuals to “tent cities” staffed with health workers on large parcels of inexpensive land.

The Biden-Harris administration established a multi-pronged response to the opioid epidemic, including reducing the supply of illicit substances like fentanyl, launching educational and awareness campaigns like “One Pill Can Kill” to raise awareness about fentanyl and emerging threats like xylazine, and improving prevention and access to evidence-based treatment.
The administration reduced barriers to medications for opioid use disorder by updating regulations for methadone dispensing programs to improve access, extending temporary rules that allow buprenorphine administration via telehealth, adding substance use treatment training requirements for providers, removing provider registration requirements prescribing treatment medication, and permanently requiring state Medicaid plans to cover medication-assisted treatment (through the 2024 Consolidated Appropriations Act). The administration extended funding for state and tribal opioid response grants to support states in distributing opioid overdose medication and continuing initiatives that increase access to opioid treatment services and medication.
The administration expanded access to medication treatment in correctional settings by allowing states with approval to use Medicaid funds for addiction treatment services up to 90 days before release and by updating regulations that improve access to methadone treatment in jails and prisons.
Following the FDA’s approval of over-the-counter opioid overdose reversal medication under the administration, the White House established the Challenge to Save Lives from Overdose, which is a nationwide initiative to increase training on overdose reversal and improve availability of overdose reversal medication in public and private organizations across all sectors.

Long-term Care

Proposes to protect seniors by “shifting resources back to at-home Senior Care,” addressing disincentives that contribute to workforce shortages, and supporting unpaid family caregivers through tax credits.
Issued regulations relaxing oversight for nursing facilities, including removing the requirement to employ an infection preventionist.
Suspended routine inspections in nursing facilities during early months of COVID-19.
Launched the Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccinations in facilities with residents ages 65+.
Issued guidance to delay the implementation of the “Settings Rule,” which established new protections for people using Medicaid home and community-based services (HCBS).

Proposes expanding home care services under Medicare to help people with functional or cognitive impairments, paid for by expanding Medicare drug negotiations and other policies.
Proposes to partner with private technology companies to expand remote patient monitoring and telehealth and strengthen the home-care workforce.
Proposes working with Congress to end Medicaid estate recovery, a practice in which the state recoups the costs of Medicaid LTSS from the home and estates of deceased enrollees; or using administrative action to expand the circumstances in which families may be exempted.
Biden-Harris administration required reporting of COVID-19 vaccination rates in nursing facilities.
The administration promoted newly established minimum staffing requirements for nursing facilities, including other requirements to support nursing facility workers; issued regulations to increase transparency of private equity ownership of nursing facilities.
The administration enacted legislation increasing federal funding for Medicaid HCBS; proposed $400 billion in new Medicaid funding for HCBS; established requirements to increase access to Medicaid HCBS, promote higher payment rates for home care workers, and reduce the time people wait for services.

Global Health

Pursued an “America First” approach to foreign policy, including for global health, prioritizing sovereignty and disengaging from multilateral agreements.
Halted U.S. funding for the World Health Organization and initiated a process to withdraw U.S. membership in the organization.
Significantly expanded the Mexico City Policy to apply to virtually all U.S. bilateral global health funding. When in place, the policy requires foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source as a condition of receiving U.S. funding.
Chose not to join COVAX, the global initiative to distribute COVID-19 vaccines.
Proposed eliminating/significantly reducing funding for most US global health programs in multiple Presidential budget requests; ended funding for United Nations Family Planning Agency (UNFPA).
Dissolved the National Security Council’s stand-alone Directorate for Global Health Security and Biodefense, moving its functions into other parts of the NSC.
Supported extending the Global Health Security Agenda (GHSA) initiative for an additional five-year period.

Biden-Harris administration promotes international cooperation and alliances in foreign policy and global health.
The administration reversed decision to withdraw from WHO and restored U.S. funding for the organization.
The administration rescinded the Mexico City Policy that was expanded under Trump. As a Senator, Harris co-sponsored bills to permanently repeal the policy.
The administration restored funding for UNFPA.
The administration released a National Security Memorandum and Executive Order that positioned global health as “top national security priority.”
The administration joined COVAX and committed to the U.S. being the largest donor of COVID-19 vaccines globally.
The administration re-established the NSC Directorate for Global Health Security and Biodefense.
The administration created new, elevated Bureau of Global Health Security and Diplomacy at the State Department.
The administration supported WHO-based negotiations to develop a new pandemic agreement and to revise the International Health Regulations.
The administration updated and expanded the U.S. Global Health Security Strategy.

Immigrant Health Coverage

Issued regulatory changes to public charge policies that newly considered the use of non-cash assistance programs, including Medicaid, in public charge determinations for people seeking to enter the U.S.
Issued a proclamation suspending entry of immigrants into the United States unless they provided proof of health insurance.
Rescinded the Deferred Action for Childhood Arrivals (DACA) program, but the Supreme Court ruled the rescission unlawful in 2020.

Biden-Harris administration rescinded the Trump administration’s public charge changes and, in 2022, issued regulations that largely codified 1999 guidance, which exclude the use of non-cash assistance programs, including most Medicaid coverage, from public charge determinations.
The administration revoked the Trump administration’s proclamation that suspended entry of immigrants unless they provided proof of health insurance.
The administration Issued regulations that extend Marketplace eligibility to DACA recipients, which is estimated to lead to 100,000 DACA recipients gaining coverage.

Proposals by Trump to carry out mass deportations of millions of immigrants and executive action by both the Biden-Harris administration and by the Trump administration to have stricter border enforcement may increase fears among immigrant families, making them reluctant to access health coverage and care.

Topics: Affordable Care Act, Elections, Global Health Policy, Health Costs, Immigrant Health, LGBTQ, Medicaid, Medicare, Mental Health, Private Insurance, Racial Equity and Health Policy, Uninsured, Women’s Health Policy

Senate Committee on Appropriations Approves FY 2025 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) Appropriations Bill & Accompanying Report

Published: Aug 5, 2024

The Senate Committee on Appropriations approved its FY 2025 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) appropriations bill, accompanying report, and amendments on August 1, 2024. The Labor HHS appropriations bill includes funding for U.S. global health programs provided to the Centers for Disease Control and Prevention (CDC) and funding for global health research activities provided to the National Institutes of Health (NIH). Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. Funding for global health programs at CDC totals $698 million, which is $4.8 million (1%) above the FY24 enacted and President’s FY25 request level ($693 million) and $134 million (24%) above the House level ($564 million). Funding for parasitic diseases and global public health protection at CDC increased while all other program areas, including the Fogarty International Center at NIH, remained flat compared to the FY24 enacted amounts. See the table below for additional detail on global health funding. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.

KFF Analysis of Global Health Funding in the FY25 Senate Labor Health & Human Services (Labor HHS) Appropriations Bill

Senate Appropriations Committee Approves FY 2025 State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill

Published: Aug 5, 2024

The Senate Committee on Appropriations approved the FY 2025 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill, accompanying report, and amendments on July 25, 2024. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID). The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID). Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.7 billion, a decrease of $886 million (-8%) below the FY 2024 enacted level. All of the decrease is due to reduced funding in the bill for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), though the accompanying report notes that the decline is “a result of the statutory cap on U.S. contributions related to other donor funds.” Funding for maternal and child health, UNICEF, nutrition, family planning and reproductive health (FP/RH), global health security, the Health Reserve Fund, and Global Health Worker Initiative increased compared to FY 2024 enacted levels; all other global health areas remained flat. The bill also included an extension of PEPFAR from March 25, 2025 to September 30, 2026. See the table below for additional detail on FY 2025 Senate levels compared to the FY 2024 Omnibus as well as the FY 2025 President’s Request and FY 2025 House levels. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.

KFF Analysis of Global Health Funding in the FY25 Senate State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill

News Release

Marketplace Insurers are Proposing a 7% Average Premium Hike for 2025 and Pointing to Rising Hospital Prices and GLP-1 Drugs as Key Drivers of Costs

Published: Aug 5, 2024

ACA Marketplace insurers are proposing a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024, according to a new KFF analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process.

Although the vast majority of Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases generally result in higher federal spending on subsidies. The justifications insurers provide for these premium changes also shed light on what is driving health spending more broadly.

Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025, as well as growing use of weight loss and other specialty drugs, according to KFF’s examination of publicly-available documents.

This year, increases in the prices insurers are paying for medical care tend to affect premiums more than growth in the utilization of care. Insurers say workforce shortages and hospital market consolidation, which can put upward pressure on health care costs and prices, are increasing 2025 health insurance premiums.

Meanwhile, growing demand for Ozempic, Wegovy, and other costly GLP-1 drugs, which are used to treat diabetes and obesity, is increasing prescription drug spending.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

Contact

Tammie Smith

KFF

tsmith@kff.org

How Much and Why ACA Marketplace Premiums Are Going Up in 2025

Authors: Jared Ortaliza, Matt McGough, Anna Cord, and Cynthia Cox

Published: Aug 5, 2024

This updated analysis of insurers’ preliminary rate filings shows that ACA Marketplace insurers are requesting a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024. Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025, as well as growing use of weight loss and other specialty drugs, according to KFF’s examination of publicly-available documents.

Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process. Although the vast majority of Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases generally result in higher federal spending on subsidies.

The analysis can be found on the Peterson-KFF Health System Tracker, an information hub dedicated to monitoring and assessing the performance of the U.S. health system.

What Drives Health Spending in the U.S. Compared to Other Countries

Authors: Emma Wager, Shameek Rakshit, and Cynthia Cox

Published: Aug 2, 2024

An updated issue brief looks at the drivers of health spending in the U.S. and key differences between the U.S. and other large, wealthy nations. The analysis finds that people in the U.S. spent $5,683 more per person on health care compared to those in similarly large and wealthy countries. Almost 80% of the difference in spending came from inpatient and outpatient care costs. Many retail prescription drugs also cost more in the U.S. In 2021, the U.S. spent $1,635 per capita on prescription drugs, including over-the counter drugs, while comparable countries spent $944 on average

The analysis is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

News Release

The Share of Young Adults Who Received Mental Health Treatment Jumped 45% from 2019 to 2022, the Largest Increase Among Any Age Group

Overall, Women Are Twice As Likely As Men To Report Receiving Mental Health Treatment Over the Past Year

Published: Aug 1, 2024

A new KFF analysis shows that the share of young adults (ages 18 to 26) receiving mental health treatment rose by 45% between 2019 and 2022 – a steeper increase than in any other age group.

More than 1 in 4 young adults (26%) received counseling and/or medication for mental health concerns in 2022, up from 18% three years earlier, according to the analysis of the most up-to-date National Health Interview Survey (NHIS) data available. That was a higher share than among adults in any other age group in 2022.

While other age groups experienced an increase in the share receiving treatment over the period as well, the increase was smaller: 29% for adults ages 27-50, 13% for adults ages 51-64, and 1% for adults 65 and above.

The spike in utilization among young adults roughly coincided with the onset and most challenging years of the COVID-19 pandemic – when school and work were significantly disrupted – although utilization of mental health services had been increasing even before the pandemic. Even so, research shows that among young adults with mental health conditions, many still report not receiving treatment.

Overall, 23% of adults received mental health treatment in 2022, up from 19% in 2019, the analysis showed. Specifically, the share of all adults saying they received mental health counseling rose from 10% in 2019 to 13% in 2022. At the same time, the share of adults reporting they took prescription medication for mental health conditions increased from 16% to 19%.

The analysis shows that women were nearly twice as likely as men to report receiving mental health treatment in the past year (29% vs. 17% in 2022). Other research suggests that men may be less likely to seek mental health care than women, and they are more likely to be uninsured and less likely to report a usual source of health care.

Other key takeaways include:

Across racial and ethnic groups, the share of people who said they received mental health treatment in 2022 was highest among White adults (28%) and lowest among Asian adults (9%). That compared to 16% each among Hispanic adults and Black adults.
Adults with insurance coverage are more likely to report receiving mental health care in the past year than adults without insurance coverage (25% vs. 11% in 2022).

Contact

Chris Lee

chrisl@kff.org

Exploring the Rise in Mental Health Care Use by Demographics and Insurance Status

Authors: Nirmita Panchal and Justin Lo

Published: Aug 1, 2024

Many people in the United States experience mental health conditions, which raises questions about mental health service utilization patterns and what barriers exist with connecting people to services. Prior research suggests that mental health service utilization increased over time. This analysis explores more recent data, from 2019 to 2022, to understand the latest trends in utilization of mental health services and how it differs by demographics and insured status. In this analysis, receipt of mental health care is measured as the share of people who say they received mental health counseling and/or prescription medication for mental health concerns in the last year. Estimates shown are KFF analyses of National Health Interview Survey (NHIS) data among adults in the U.S. from 2019 to 2022.

In 2022, 23% of adults received mental health treatment, up from 19% in 2019 (Figure 1). Specifically, the share of adults saying they received mental health counseling in the past year increased from 10% in 2019 to 13% in 2022. Similarly, the share of adults reporting they took prescription medication for mental health conditions increased from 16% to 19% during the same period. Receipt of prescription medication remained consistently higher than counseling (19% vs. 13%, respectively, in 2022).

More Adults Report Receiving Mental Health Treatment in Recent Years

Compared to older adults, young adults (ages 18-26) were more likely to receive mental health treatment and experienced the highest increase in receipt of treatment over time. In 2022, 26% of young adults reported receiving counseling and/or prescription medications for mental health conditions in the past year, representing a significantly higher share compared to all other adults (ages 27 and above) (Figure 2).

Young adults also experienced the largest percent increase in the share of adults receiving mental health treatment from 2019 to 2022 (45%), followed by adults ages 27-50 (29%), 51-64 (13%), and 65 and above (1%) (Figure 2). Although receipt of mental health services has increased among young adults in recent years, other KFF analyses found that leading up to the pandemic, many young adults with mental health conditions did not receive treatment. The lack of treatment among this population may be linked to costs, transitioning from pediatric to adult health care, and difficulties accessing mental health services in college settings.

Adults Ages 18-26 Experienced the Largest Increase in the Share Reporting Use of Mental Health Services from 2019 to 2022

Women are nearly twice as likely to report receiving mental health treatment in the past year compared to men. In 2022, 29% of women reported receiving mental health services, compared to 17% of men (Figure 3). Research suggests men may be less likely to seek mental health care than women. Men are also more likely to be uninsured and less likely to report a usual source of health care. Separately, women are more likely than men to report experiencing mental health disorders, including serious mental illness.

Women Are Nearly Twice as Likely to Report Receiving Mental Health Treatment Than Men

Across racial and ethnic groups, past year receipt of mental health treatment was highest among White adults and lowest among Asian adults. In 2022, 28% of White adults reported receiving counseling and/or prescription medication for mental health conditions in the past year, compared to 16% of Hispanic and Black adults and 9% of Asian adults. A recent KFF poll found that, compared to their White peers, Hispanic, Black, and Asian adults disproportionately report challenges with mental health care utilization, including finding a provider who can understand their background and experiences, lack of information, and stigma or embarrassment. Additionally, the lack of a diverse mental health care workforce, absence of culturally informed treatment options, and stereotypes and discrimination associated with poor mental health may also contribute to limited mental health treatment among Black and Asian adults. Specifically among Asian people, cultural attitudes towards mental health are a factor that may lead to both lower reporting of mental health concerns and lower service utilization.

Receipt of Mental Health Treatment Remains Highest Among White Adults and Lowest Among Asian Adults

Adults with insurance coverage are more likely to report past year receipt of mental health care than adults without insurance coverage (25% vs. 11% in 2022, Figure 5). Despite higher utilization of mental health care over time – driven by insured adults – challenges remain with accessing services. For instance, KFF’s 2023 Consumer Survey found that 43% of insured adults with mental health concerns said there was a time in the past year when they did not get the mental health treatment they thought they needed, and 45% gave their insurance a negative rating for the availability of mental health providers. Further, KFF’s 2023 Employer Health Benefits Survey found that among employers offering health benefits, a higher share reported having a sufficient number of primary care providers in their plan’s networks (91%) compared to those who reported having a sufficient number of behavioral health care providers (67%).

Uninsured Adults Are Less Likely to Report Receiving Mental Health Treatment Than Insured Adults

This work was supported in part by the Well Being Trust. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

What to Know About Medicare Part D Premiums

Authors: Juliette Cubanski and Tricia Neuman

Published: Aug 1, 2024

The Inflation Reduction Act of 2022 includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, including several changes to the Part D benefit. These changes, including a new $2,000 cap on out-of-pocket drug spending, will help to lower out-of-pocket costs for Part D enrollees but could also make it harder for some Part D plan sponsors to offer low-priced coverage, particularly sponsors of stand-alone prescription drug plans (PDPs).

In anticipation of potential premium increases by Part D sponsors to cover higher costs associated with a more generous Part D drug benefit, the Inflation Reduction Act included a provision designed to help limit annual premium increases. Specifically, the law caps growth in the base beneficiary premium to no more than 6% above the prior year’s amount, though it is important to note that the base premium is not the same as the individual plan-level premiums charged by Part D sponsors and paid by Part D enrollees. In addition, the Centers for Medicare & Medicaid Services (CMS) made changes to the Part D payment methodology for 2025 to better reflect expected increases in plan liability for the redesigned Part D benefit, with the goal of enhancing market stability. CMS has also announced a new voluntary demonstration to provide additional premium stabilization and enhanced protection against the risk of losses to stand-alone PDPs (see details below).

These FAQs provide context for understanding Medicare Part D premiums in 2025 and changes in recent years. While the impact of the Part D benefit redesign changes on the 2025 Part D market is unknown at this time, premiums for individual Part D plans are likely to continue to vary and annual plan-level premium increases may be higher or lower than 6% for 2025, as they were for 2024. The fall open enrollment period will present all Part D enrollees with the opportunity to evaluate their coverage and determine whether there are lower-cost plan options that meet their needs.

Key Takeaways

Changes to the Part D benefit in the Inflation Reduction Act will mean lower out-of-pocket costs for Part D enrollees but higher costs for Part D plans overall, leading to concerns about possible premium increases.
CMS is taking steps to mitigate potential premium increases through a new demonstration program for stand-alone drug plans, as well as payment changes designed to bring greater stability to the Part D market in 2025.
The Inflation Reduction Act includes a provision to cap growth in the base beneficiary premium to 6%. For 2025, the base premium is $36.78, an increase of $2.08 or 6% over the 2024 base premium. Although this 6% cap doesn’t apply to the individual premiums that plans charge, it does help to limit premium increases.
Actual Part D plan premiums for 2025 are not yet known and will be announced in September, but premiums are expected to vary, with lower monthly premiums for Medicare Advantage drug plans than stand-alone drug plans, on average, as in 2024. The annual open enrollment period, which runs from October 15 to December 7, presents an opportunity for Part D enrollees to compare plans and shop for lower-priced coverage that meets their needs.

How is the Part D benefit changing for 2025?

The Inflation Reduction Act includes a number of changes to the Medicare Part D drug benefit, including a new $2,000 cap on out-of-pocket drug spending in 2025 for enrollees in Medicare Part D plans. It also requires Part D plans and drug manufacturers to pay a greater share of costs for Part D enrollees with drug costs in the catastrophic coverage phase (above the $2,000 spending cap) and reduces Medicare’s reinsurance liability. The law also eliminates the coverage gap phase as of 2025, where enrollees are currently responsible for paying 25% of their drug costs, drug manufacturers provide a 70% price discount on brand-name drugs, and plans pay 5% of costs.

As of 2025, once enrollees have met their deductible (if their plan includes one), they will enter the initial coverage phase, where they will face cost sharing of 25% under the standard benefit (as in 2024), manufacturers will provide a 10% price discount, and Part D plans will pay 65% (Figure 1). Once enrollees reach the out-of-pocket spending cap and enter the catastrophic coverage phase, plans will be required to pay 60% of drug costs, up from 20% in 2024, and drug manufacturers will be required to provide a 20% price discount on brand-name drugs. Medicare’s share of total costs in the catastrophic phase will decrease from 80% to 20% for brand-name drugs and from 80% to 40% for generic drugs.

Although Part D plans will be taking on additional liability for high drug costs in 2025, Medicare will continue to limit their liability for higher-than-expected drug costs through risk corridors, a risk sharing mechanism that has been in place since the Part D program started in 2006. In addition, CMS is launching a new voluntary demonstration to provide enhanced risk-corridor protection against overall losses for participating stand-alone PDPs to help stabilize the market (see details below).

The Inflation Reduction Act Made Changes to the Share of Medicare Part D Drug Costs Paid by Enrollees, Plans, Drug Manufacturers, and Medicare in 2024 and 2025

What is known about Part D premiums for 2025?

CMS announced the Part D base beneficiary premium for 2025 on July 29, 2024 (this announcement typically occurs at the end of July each year). For 2025, the base beneficiary premium is $36.78, an increase of $2.08, or 6%, over the 2024 base premium of $34.70. A provision in the Inflation Reduction Act capped annual growth in the base beneficiary premium to 6% over the prior year’s amount (see details below).

The base premium is calculated as a share of average plan bids for basic Part D benefits submitted by both stand-alone PDPs and Medicare Advantage drug plans (MA-PDs). All Part D plans submit a bid for basic benefits, while plans that offer enhanced benefits, such as a lower Part D deductible, also report the portion of their bid that is for basic versus enhanced benefits. (In 2024, most Part D enrollees were in enhanced plans: 72% of all Part D enrollees, including 79% of MA-PD enrollees and 62% of PDP enrollees). Each year, CMS averages standardized bids submitted by PDPs and MA-PDs to cover basic Part D benefits and calculates the National Average Monthly Bid Amount, or NAMBA. The calculation of the base beneficiary premium is based on the national average bid adjusted for individual reinsurance subsidies. Because the base premium is an average across both types of plans and reflects the cost of basic benefits only, this amount does not equal what a Part D enrollee will pay for coverage in any given Part D plan.

Actual premiums for Part D plans available in 2025 will be released in September, as they are every year, just prior to the October 1 start date of marketing for the coming plan year and the open enrollment period that runs from October 15 to December 7.

How will the new CMS demonstration help to stabilize the Part D market for 2025?

CMS has announced new premium stabilization measures for stand-alone PDPs as part of a voluntary Section 402 demonstration program that will be in effect for 2025 and two additional years (though the exact parameters may vary beyond 2025). Because CMS observed more variation in plan bids for 2025 among PDPs than MA-PDs, the new Part D Premium Stabilization Demonstration is targeted exclusively to PDPs. CMS’s rationale for this demonstration is to stabilize the PDP market in the initial transition years of the Inflation Reduction Act’s Part D benefit improvements, and to test whether the premium changes and revised risk corridors “increase the efficiency and economy” of services as the law’s Part D benefit changes are fully implemented. Similar Section 402 demonstrations were conducted under the George W. Bush Administration in the early years of Part D as the program was being rolled out.

The Part D Premium Stabilization Demonstration has three components for PDPs that choose to participate:

Lowers the base beneficiary premium by $15 (or less if a $15 reduction would result in a plan premium of less than $0).
Limits total Part D premium increases to $35 between 2024 and 2025 (applied after taking into account the $15 reduction in the base beneficiary premium).
Narrows the upper thresholds of the risk corridors to reduce the range of spending where PDPs bear full risk for actual costs higher than their bids and increases the government’s risk sharing for a portion of plan losses from 80% to 90% (Figure 2).

What is the Inflation Reduction Act’s Part D premium stabilization provision and what impact has it had to date?

Beginning in 2024, the premium stabilization provision of the Inflation Reduction Act caps annual growth in the Part D base beneficiary premium at 6%. For 2024, the first year the premium stabilization provision was in effect, the Part D base beneficiary premium was $34.70, a 6% increase over the 2023 amount of $32.74 (Figure 3). Without the premium stabilization provision, the 2024 base beneficiary premium would have been $39.35, an increase of 20%, reflecting a higher average monthly bid amount for basic Part D coverage in 2024 ($68.28) than in 2023 ($34.71).

For 2025, the Part D base beneficiary premium is $36.78, capped at a 6% increase over the 2024 amount. Without premium stabilization, the 2025 base premium would have been $55.98, 42% higher than the 2024 unadjusted base premium (61% higher than the base premium with the 6% cap in 2024). Between 2024 and 2025, the average monthly bid amount for basic benefits increased from $64.28 to $179.45. (See below for examples of how the 6% cap on the base premium helps to limit growth in premiums paid by enrollees for two hypothetical plans.)

The Medicare Part D Premium Stabilization Provision Limits the Annual Increase in the Base Premium to 6%, Which Helps to Limit Growth in Premiums That Medicare Beneficiaries Pay for Part D Coverage

What other changes has CMS adopted to help to limit Part D premium increases for 2025?

In addition to the premium stabilization measures described above, CMS has also made changes to its plan payment methodologies for the 2025 plan year. While technical in nature, these changes are designed to enhance market stability through an improved payment methodology that accounts for the substantial changes to the Part D benefit for 2025.

Updates to the Part D risk adjustment model: The Part D risk adjustment model predicts plan liability for prescription drugs. The model is used to determine the amount of “direct subsidy” prospective payments that Part D plans receive from the federal government, which are adjusted for the health status of a plan’s enrollees. Enrollees with higher risk scores (which vary above and below an average of 1.0) translate to higher expected plan costs and higher subsidy payments. For 2025, CMS took steps to improve the predictive ability of the Part D risk adjustment model, including by recalibrating the model based on more current diagnosis and spending data than used in previous years.
Using different normalization factors for MA-PDs and PDPs: For individual Part D enrollees, risk scores are calculated based on individual demographic and disease factors, and then adjustments are applied, including a “normalization factor.” New for 2025, CMS is applying different normalization factors for MA-PDs and PDPs, which will have the effect of increasing PDP risk scores relative to what they would have been otherwise. Historically, due to differences in coding and utilization patterns across both types of plans, the Part D risk adjustment model has underpredicted costs for PDP plans and overpredicted costs for MA-PD plans, which has had the effect of increasing standardized plan bids (and premiums) for PDPs relative to MA-PDs. Using separate normalization factors is expected to increase PDP risk scores, which would lead to higher direct subsidy payments, which could mitigate potential premium increases to help stabilize the PDP market. Because MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums, most MA-PD enrollees pay no premium for their Part D drug coverage (see details below).

What factors contributed to the increase in plan bids for basic benefits since 2023?

For 2025, the new $2,000 out-of-pocket spending cap and the increase in Part D plan liability for drug costs incurred by enrollees above the cap, combined with the reduction in Medicare reinsurance, as explained above, are factors in the higher national average monthly plan bid. CMS has emphasized that while the NAMBA increased substantially for 2025, this will be accompanied by substantially higher upfront payments from the government to plans in the form of direct subsidies for basic benefits covered by the plan – a shift from previous years when reinsurance payments accounted for a much larger share of Part D spending than direct subsidy payments. CMS estimates that the average direct subsidy payment will be $142.67, or 80% of the national average bid amount of $179.45.

For 2024, part of the explanation for the higher national average bid for basic benefits was the elimination of Part D enrollees’ 5% coinsurance requirement for drug costs in the catastrophic coverage phase and the increase in plans’ share of these costs from 15% to 20%. Another factor was a revision to the definition of Part D’s “negotiated price” that took effect in 2024 (not to be confused with the new drug price negotiation program established by the Inflation Reduction Act). The definition of negotiated price has been in place since the start of Part D, and it matters because this is the price upon which beneficiary cost sharing is based at the point of sale, which is particularly relevant when enrollees face a coinsurance requirement. Under the change, plans are now required to pass along all price concessions they receive from pharmacies, which help to lower the plan’s total costs, to enrollees at the point of sale. Enrollees will benefit from this change in the form of lower out-of-pocket drug costs, but plans were expected to face higher costs and lower revenues.

What do Part D premiums look like in 2024?

While the impact of the Part D benefit redesign changes on the 2025 Part D market is currently unknown, premiums for individual Part D plans are likely to continue to vary in 2025, as they do in 2024 – ranging from $0 to $100 per month or more. This is in part why Part D enrollees are encouraged to shop for plans during the annual open enrollment period in the fall.

For 2024, the average monthly premium for Part D coverage is $25, including premiums for both Medicare Advantage drug plans (MA-PDs) and PDPs. The average monthly premium for drug coverage in MA-PDs ($9) is substantially lower than in PDPs ($43). In 2024, 57% of all Part D enrollees are in MA-PDs in 2024 and 43% are in stand-alone prescription drug plans (PDPs).

The lower MA-PD average premium is heavily weighted by the predominance of zero-premium plans in the MA-PD market, because, as noted above, MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums. For 2024, all Medicare beneficiaries had access to zero-premium MA-PD plans – 27 on average – whereas only 1 PDP was available for zero premium for non-LIS enrollees in only 14 out of 34 PDP regions.

Even with changes to the Part D benefit between 2023 and 2024 that increased plan liability, the average monthly premium for Part D coverage across both plan types combined was the same in both years ($25) (Figure 4). The average MA-PD premium decreased by $1 (from $10 to $9), while the average PDP premium increased by $3 (from $40 to $43).

The $43 average PDP premium is based on enrollment in March 2024 after the end of open enrollment. This amount is lower than the estimated $48 premium for 2024, which was calculated in the fall of 2023 before open enrollment for 2024 and did not account for plan switching by current enrollees or plan choices by new enrollees during the open enrollment period. The fact that the actual average PDP premium for 2024 is lower than the estimated premium indicates that some PDP enrollees opted for lower-premium plans during open enrollment.

Overall, nearly half of the 30.1 million Part D enrollees who are not receiving Part D low-income subsidies (LIS), or 14.3 million enrollees, pay no premium for their drug coverage in 2024 (Figure 5). The share of Part D enrollees paying no premium is heavily weighted by MA-PD enrollees. In 2024, three-quarters of MA-PD enrollees without LIS pay no premium for their drug coverage compared to 13% of PDP enrollees.

Nearly Half of Part D Enrollees Without Low-Income Subsidies Pay No Monthly Premium for Part D Coverage in 2024 - Predominantly MA-PD Enrollees

How does the Inflation Reduction Act premium stabilization provision help to limit growth in Part D premiums?

The premium for an individual plan is calculated as the base premium plus the difference between the plan’s bid and the national average bid (the NAMBA). Examples with two hypothetical plans illustrate how the 6% cap on growth in the base premium limits premium growth for an individual plan (Table 1).

For both plans, the 6% premium stabilization cap mitigates the increase in plan premiums between 2023 and 2024. For Plan A, with the 6% cap in effect, the premium increased by 10%, but without the 6% stabilization cap, the premium would have increased by 31%. Similarly, for Plan B, the 6% cap limits premium growth to 19%, compared to a 32% increase without the cap.

The Premium Stabilization Provision Helps to Limit Growth in Medicare Part D Premiums

This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Poll Finding

Well-being of Children and Parents: Highlights from the KFF Survey on Racism, Discrimination, and Health

Authors: Shannon Schumacher, Liz Hamel, Samantha Artiga, and Drishti Pillai

Published: Aug 1, 2024

Section:

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Findings

In recent years, there have been growing concerns about children’s mental health and well-being, particularly since the COVID-19 pandemic and with a rise in awareness and exposure to racism and discrimination amid instances of racial injustice, including the killings of George Floyd and Breonna Taylor, and growth in anti-Asian sentiment. Previous reporting from KFF’s Racism, Discrimination, and Health Survey examined experiences with and impacts of unfair treatment and discrimination, access to and use of mental health care, and loneliness and social support networks among adults. Based on responses from parents, this analysis examines parents’ assessments of their children’s mental health and well-being, children’s use of mental health care, children’s experiences with unfair treatment, and parents’ worries about their children as well as their hopes for their future.

The analysis reveals some areas of shared challenges across parents, as well as several areas where experiences differ across race and ethnicity. For example, while similar shares of parents across racial and ethnic groups say their children’s mental health is fair or poor, a larger share of White parents (32%) compared to Black (20%), Hispanic (23%), and Asian (14%) parents report that their children have received mental health care services in the past three years. Moreover, while about half of parents of school-aged children overall say any of their children have ever been treated differently or unfairly in one of several ways, larger shares of Black (40%), Hispanic (23%), and Asian parents (26%) say such treatment occurred specifically because of their child’s race or ethnicity compared to White parents (16%). The survey further shows a strong association between these negative experiences, and parent’s reported mental health status of their children. More broadly, Black, Hispanic, and Asian parents are more worried about their children and families compared to White parents, including worries about violence and experiences with racism and discrimination. At the same time, they remain more confident that life will be better for the next generation.

The findings highlight the importance of efforts to address racial disparities in mental health care use among children, as well as the importance of addressing other factors that influence children’s health and well-being, including unfair treatment and underlying structural inequities in social and economic factors.

Who are Parents?

For purposes of this brief, parents are defined as adults who say they are the parent or guardian of a child under age 18 living in their home. Parents as a group are somewhat more racially and ethnically diverse than the overall U.S. adult population, in part a reflection of the aging White population. Among adults who have a child under age 18 living with them, more than one in five (22%) are Hispanic, 15% identify as Black, and 8% are Asian. ¹ Parents face more financial challenges relative to those without a child in the home, including being more likely to say they are just able to afford their bills (37% vs. 30%) or have difficulty affording their bills each month (16% vs. 13%).

Parents’ Perceptions of Children’s Mental Health and Use of Mental Health Care

Black, Hispanic, and Asian parents are less likely than White parents to say their children received mental health services in the past three years. About nine in ten (88%) parents overall say their children’s mental health is excellent, very good, or good, while about one in ten (12%) report their children’s mental health as fair or poor, shares that do not differ significantly across racial and ethnic groups. White parents (32%) are more likely to say that any of their children have received mental health services in the past three years than are Hispanic (23%), Black (20%), and Asian parents (14%). Among parents overall, three-quarters (75%) of those who describe their children’s mental health as fair or poor say at least one of their children received mental health services compared to about one in five (21%) of those who say their children’s mental health is excellent, very good, or good.

One in Three White Parents Say Their Child Has Received Mental Health Care Services in the Past Three Years, Compared to Smaller Shares of Black, Hispanic, and Asian Parents

About one in seven parents (14%) say there was a time in the past three years when they thought their children might need mental health services or medication but did not receive them, a share that rises to more than four in ten (45%) among parents who say their children’s mental health is fair or poor. Similar shares of Hispanic, Black, Asian, and White parents say there was a time in the past three years when their children went without needed mental health services or medication. Among all parents who say their child went without needed care, seven in ten (70%) say they tried to find a provider for their children, while three in ten (30%) did not. Overall, adults identify scheduling delays, cost concerns, difficulty finding a provider who could understand their background and experiences, lack of information, and fear and embarrassment as challenges to getting mental health care for themselves or their children.²

One in Seven Parents Say Their Children Went Without Needed Mental Health Services in the Past Three Years, Rising to Four in Ten Among Parents With a Child in Fair or Poor Mental Health

Children’s Experiences with Unfair and Negative Treatment

About half of parents of school-aged children³ say any of their children have ever been treated unfairly or negatively, with larger shares of Black, Hispanic, and Asian parents than White parents attributing this treatment to their child’s race or ethnicity. The types of treatment asked about in the survey include being called names or racial slurs (32%), being treated unfairly by a teacher or other adult (31%), being hurt, threatened, or harassed in person or online (30%), or having a teacher or other adult assume something bad about them (25%). Over half of White (57%) and Black (52%) parents and nearly four in ten Asian (39%) and Hispanic (36%) parents say their children have ever had at least one of these negative experiences. Notably, four in ten Black parents (40%) and about a quarter of Asian (26%) and Hispanic (23%) parents say their child had at least one of these negative experiences and that their race or ethnicity was a major or minor reason for this treatment, compared to a smaller share of White parents (16%).

Half of Parents With School- Aged Children Say Their Children Have Ever Had a Negative Experience

There is a strong association between reported negative experiences among children and parents’ perceptions of their children’s mental health and well-being. Parents who say their child had at least one of the negative experiences asked about in the survey are more likely to say their children’s mental health is fair or poor compared with those who say their child did not have one of these experiences (20% vs. 6%), a pattern that is consistent across racial and ethnic groups.

Parents Whose Children Have Had At Least One Negative Experience Are More Likely To Say Their Children Are in Fair or Poor Mental Health

Many (45%) parents of school-aged children who had a negative experience say their child received mental health care in the past three years, but among these parents, Black parents are less likely than White parents to say their child received care. Perhaps reflecting greater health care access, White parents whose children who had at least one negative experience are more likely to report that their children have received mental health care services in the past three years compared to their Black counterparts (50% vs. 32%). While about four in ten (45%) parents of children who had a negative experience say their child saw a mental health care provider in the past three years, some also report unmet mental health care needs among their children. One-quarter (25%) of these parents say there was a time in the past three years when they thought their child might need mental health services or medication but didn’t get them, a share that is similar across racial and ethnic groups.

Black Parents of Children Who Have Had at Least One Negative Experience Are Less Likely Than White Parents To Say Their Children Received Needed Mental Health Treatment

Parents’ Worries, Challenges, and Optimism

While one in five parents across racial and ethnic backgrounds say they worry about their children’s health and well-being daily or almost daily, Black and Hispanic parents are more likely than White parents to say they worry about a range of other issues affecting their families. Black (18%) and Hispanic (18%) parents are more likely to say they experience worry or stress “every day” or “almost every day” about their child being the victim of violence at their school compared to White parents (11%). Similarly, Black (16%) and Hispanic (11%) parents are more likely to say they frequently worry about the possibility of them or someone in their family being the victim of gun violence than are White (3%) parents. In addition, larger shares of Black (15%), Asian (12%), and Hispanic (7%) parents worry about experiences with racism and discrimination than do White parents (2%).

Beyond these worries, parents also express financial concerns. Overall, parents’ top worries are about work and employment (23% worry daily or almost daily), followed by providing for their family’s basic needs (21%). Likely reflecting lower household incomes, three in ten (30%) Black parents say they frequently worry about providing for their family’s basic needs, higher than the shares of Asian (20%), White (20%), and Hispanic (18%) parents who say the same.

Parents' Top Worries Include Work, Providing for Their Families, and Their Children's Well-Being

Many parents report financial challenges that can have implications for their children’s well-being, including higher shares of Black parents. Overall, at least one in five parents across racial and ethnic backgrounds say they have had problems paying for necessities, health care, and childcare in the past year. Reflecting lower incomes and an array of underlying structural inequities, Black parents are more likely than White parents to report these challenges. For example, larger shares of Black parents (61%) say they had problems paying for food, housing, transportation, or other necessities in the past year compared to White parents (36%). Paying for health care also is a concern among parents, with at least one in four parents across racial and ethnic groups saying this has been a problem in the past year for them and their families. Moreover, at least one in five parents say they had problems finding or affording childcare, including larger shares of Black (31%) and Asian parents (29%) relative to White (21%) parents, and about one in five parents say they have had problems getting or keeping a job, with higher shares of Black (36%) and Hispanic (27%) parents reporting this than White parents (18%).

Black Parents More Likely to Say they have Had Problems Paying for Basic Necessities in the Past 12 Months Than White Parents

Black, Hispanic, and Asian parents are more confident than White parents that life for the next generation will be better. Six in ten or more Asian (71%), Black (64%), and Hispanic (60%) parents say they are either “very confident” or “somewhat confident” that life overall for the next generation will be better than it has been for their generation, compared to about one in three (34%) White parents who say the same. The differences in the shares of parents who say they are “very” confident are especially stark, with only 6% of White parents saying this, compared to about one in five Black (27%), Asian (26%) and Hispanic (22%) parents.

Black, Hispanic, and Asian Parents Are More Optimistic About the Future Than White Parents

Methodology

The Survey on Racism, Discrimination, and Health was designed and analyzed by researchers at KFF. The survey was conducted June 6 – August 14, 2023, online and by telephone among a nationally representative sample of 6,292 U.S. adults in English (5,706), Spanish (520), Chinese (37), Korean (16), and Vietnamese (13).

The sample includes 5,073 adults who were reached through an address-based sample (ABS) and completed the survey online (4,529) or over the phone (544). An additional 1,219 adults were reached through a random digit dial telephone (RDD) sample of prepaid (pay-as-you-go) cell phone numbers. Marketing Systems Groups (MSG) provided both the ABS and RDD sample. All fieldwork was managed by SSRS of Glen Mills, PA; sampling design and weighting was done in collaboration with KFF.

Sampling strategy:The project was designed to reach a large sample of Black adults, Hispanic adults, and Asian adults. To accomplish this, the sampling strategy included increased efforts to reach geographic areas with larger shares of the population having less than a college education and larger shares of households with a Hispanic, Black, and/or Asian resident within the ABS sample, and geographic areas with larger shares of Hispanic and non-Hispanic Black adults within the RDD sample.

The ABS was divided into areas (strata) based on the share of households with a Hispanic, Black, and/or Asian resident, as well as the share of the population with a college degree within each Census block group. To increase the likelihood of reaching the populations of interest, strata with higher incidence of Hispanic, Black, and Asian households, and with lower educational attainment, were oversampled in the ABS design. The RDD sample of prepaid (pay-as-you-go) cell phone numbers was disproportionately stratified to reach Hispanic and non-Hispanic Black respondents based on incidence of these populations at the county level.

Incentives:Respondents received a $10 incentive for their participation, with interviews completed by phone receiving a mailed check and web respondents receiving a $10 electronic gift card incentive to their choice of six companies, a Visa gift card, or a CharityChoice donation.

Community and expert input:Input from organizations and individuals that directly serve or have expertise in issues facing historically underserved or marginalized populations helped shape the questionnaire and reporting. These community representatives were offered a modest honorarium for their time and effort to provide input, attend meetings, and offer their expertise on dissemination of findings.

Translation:After the content of the questionnaire was largely finalized, SSRS conducted a telephone pretest in English and adjustments were made to the questionnaire. Following the English pretest, Cetra Language Solutions translated the survey instrument from English into the four languages outlined above and checked the CATI and web programming to ensure translations were properly overlayed. Additionally, phone interviewing supervisors fluent in each language reviewed the final programmed survey to ensure all translations were accurate and reflected the same meaning as the English version of the survey.

Data quality check:A series of data quality checks were run on the final data. The online questionnaire included two questions designed to establish that respondents were paying attention and cases were monitored for data quality including item non-response, mean length, and straight lining. Cases were removed from the data if they failed two or more of these quality checks. Based on this criterion, 4 cases were removed.

Weighting:The combined cell phone and ABS samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2021 Current Population Survey (CPS). The combined sample was divided into five groups based on race or ethnicity (White alone, non-Hispanic; Hispanic; Black alone, non-Hispanic; Asian alone, non-Hispanic; and other race or multi-racial, non-Hispanic) and each group was weighted separately. Within each group, the weighting parameters included sex, age, education, nativity, citizenship, census region, urbanicity, and household tenure. For the Hispanic and Asian groups, English language proficiency and country of origin were also included in the weighting adjustment. The general population weight combines the five groups and weights them proportionally to their population size.

A separate weight was created for the American Indian and Alaska Native (AIAN) sample using data from the Census Bureau’s 2022 American Community Survey (ACS). The weighting parameters for this group included sex, education, race and ethnicity, region, nativity, and citizenship. For more information on the AIAN sample including some limitations, adjustments made to make the sample more representative, and considerations for data interpretation, see Appendix 2.

All weights also take into account differences in the probability of selection for each sample type (ABS and prepaid cell phone). This includes adjustment for the sample design and geographic stratification of the samples, and within household probability of selection.

The margin of sampling error including the design effect for the full sample is plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. Appendix 1 provides more detail on how race and ethnicity was measured in this survey and the coding of the analysis groups. For results based on other subgroups, the margin of sampling error may be higher. All tests of statistical significance account for the design effect due to weighting. Dependent t-tests were used to test for statistical significance across the overlapping groups.

Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

Group	N (unweighted)	M.O.S.E.
Total	6,292	± 2 percentage points

Race/Ethnicity
White, non-Hispanic (alone)	1,725	± 3 percentage points
Black (alone or in combination)	1,991	± 3 percentage points
Hispanic	1,775	± 3 percentage points
Asian (alone or in combination)	693	± 5 percentage points
American Indian and Alaska Native (alone or in combination)	267	± 8 percentage points

Parents
Parent or guardian of a child under 18	1,919	± 4 percentage points

Endnotes

Many surveys and data analyses classify individuals into non-overlapping racial and ethnic categories using single-race and Hispanic ethnicity categories and grouping those who identify as more than one race into a “multiracial” or “other” category. To allow for better representation of experiences of the growing shares of people who identify as multiracial, this report uses an “alone or in combination” approach for classifying individuals so that they are represented within each racial and ethnic group with which they identify, resulting in overlapping racial and ethnic categories. For example, responses from someone who identifies as both Black and Asian are included in the results for both Black adults and Asian adults. The exception is reporting on White adults, who in this report are defined as those who identify as non-Hispanic and select White as their only race. ↩︎
This question was asked among those who thought they or their child needed mental health care services but did not try to find a mental health care provider. See topline for full question wording. ↩︎
Parents of school-aged children refers to adults who said they are the parent or guardian of any child under age 18 living with them and said that at least one of their children is between the ages of 5 and 17 and currently enrolled in school. See topline for full question wording. ↩︎

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