The U.S. economy is growing at a healthy clip, but working Americans continue to identify high prices and living costs as their chief economic worry in this crucial election year. According to a recent YouGov poll commissioned by PPI, soaring medical bills are a top financial concern for voters without college degrees. Asked specifically which health care costs hit them hardest, they say health insurance, hospitals and drugs.
According to a 2023 report from the Centers for Medicare & Medicaid Services (CMS), health care spending increased by 4.8% in 2022, outpacing the 3.2% rise in the Consumer Price Index (CPI), which measures inflation. This disparity underscores the worsening affordability crisis in health care, where the cost of medical services, including hospital visits, prescription drugs, and insurance premiums, is escalating more rapidly than general living costs. Consequently, households are feeling the pinch as a larger portion of their budgets is consumed by health care expenses, leaving less room for other essential needs.
Every dollar that is spent on out-of-pocket medical costs is a dollar less to pay for food, gas, and other household necessities. Three out of every four families report they are worried about being able to afford unexpected medical bills, which have left millions of households collectively shouldering more than $200 billion in medical debt. Anxiety about household expenses is especially acute in households making less than $40,000 annually, leading families to prioritize pressing financial needs over preventive or routine medical care.
Voters generally have greater trust in the Democratic Party than the Republican Party when it comes to managing high health care costs and ensuring access to abortion services. Surveys consistently indicate that a majority of voters trust Democrats more when it comes to reproductive health and reducing health care expenses.
During her debate with former President Donald Trump, Vice President Kamala Harris committed to capping insulin prices, limiting patient cost-sharing for generic drugs, and expanding Medicare’s authority to negotiate drug prices. She also vowed to protect and enhance the Affordable Care Act (ACA), promising to make permanent the Biden-Harris administration’s enhanced tax credits, which have lowered premiums by an average of $800 annually for millions of Americans.
Despite his repeated failures to convince Congress to repeal the ACA during his presidency, Trump in the debate vowed again to replace it with “something better.” When pressed for specifics, however, he could only reference a vague “concept of a plan,” nearly a decade after his initial promise to provide a viable alternative. Over that period, public support for the ACA has risen dramatically, from 38% to 62%, according to polling by KFF.6 Nonetheless, Congressional Republicans are still trying to weaken the law by pushing for the elimination of enhanced tax credits passed during the COVID-19 pandemic. This would mean higher premiums for working Americans with modest incomes.
Trump also is trying to distance himself from the public backlash against the Supreme Court’s decision striking down abortion rights. Since the Court overturned Roe v. Wade in June 2022, Republican-controlled states enacted laws that either ban abortion outright or impose strict restrictions on access to reproductive health care, affecting 25 million women. This shift has resulted in a patchwork of laws, with many states erecting significant barriers to abortion access. Consequently, millions of American women are at risk of not receiving timely reproductive health care.
Beyond restricting abortion access, the impact of the Roe decision has complicated life for women seeking maternal care services. Many hospitals in states with stringent abortion laws have closed their maternity wards or significantly reduced maternal health services in response to legal challenges from right-wing politicians and pressure groups. Tragically, this led to the death of Amber Thurman, a 28-year-old nursing assistant and mother of a six-year-old son who succumbed to an infection after medical providers delayed care for the effects of a medication abortion in a state with such a ban, according to an investigation by ProPublica.
Maternal mortality review committees, like the one in Georgia that examined this case, typically operate with a two-year delay in reviewing the cases they investigate. As a result, experts are only now beginning to assess deaths that occurred after the Supreme Court’s ruling. As this data is reviewed and released, more such stories are likely to emerge.
Having stacked the Supreme Court with antiabortion ideologues, Trump now offers the ludicrous defense that Americans — who strongly supported the national right to abortion established by Roe — were clamoring for states to decide whether abortion should be legal. He now claims to support exceptions to abortion bans for rape and incest, drawing fire from outraged Christian conservatives who’ve accused him of political opportunism. Trying to avoid another minefield, the former president has also declared himself a “leader in fertilization” and proposed mandating free access to in vitro fertilization (IVF). Congressional Republicans, however, have blocked the Right to IVF Act.
Harris has vowed to push for national legislation restoring Americans’ reproductive rights; assuring access to contraception; and safeguarding families’ rights to access IVF if they can’t have children on their own. She also promised to continue to advocate for access to FDA-approved abortion drugs and select judges who uphold reproductive freedom.
In addition, Harris’ proposals provide a promising foundation for lowering medical bills for working families. But Democrats should be thinking about a bolder, more comprehensive attack on the structural drivers of medical inflation, which makes the U.S. health care system by far the most expensive in the world. In this report, PPI offers a radically pragmatic slate of new ideas for assuring access to providers, driving down medical prices, and improving health care outcomes for working Americans.
