Policy Experts Weigh Healthcare Elements of GOP Platform

Earlier this week, the Republican party released its 2024 policy platform, which provides a glimpse of what the nation’s healthcare agenda might look like during a second term for Donald Trump, the presumed Republican nominee.

While short on details, the 2024 GOP Platform speaks of protecting and strengthening Medicare, lowering healthcare costs, expanding choice and competition, and opposing late-term abortions, among other issues.

Grace-Marie Turner, founder and president of the Galen Institute, a conservative think tank based in Paeonian Springs, Virginia, acknowledged that the document was light on healthcare substance, suggesting that healthcare is “woven into” the discussion of the economy, and therefore, embedded into the overall vision of “getting families back into a position that they feel financially secure.”

In the past, Trump has focused on lowering prescription drug costs and increasing transparency, choice, and competition, which are all emphasized in the platform, she said. The party also pledges to protect Social Security and Medicare, and to support long-term care, chronic disease management, and homecare for the elderly.

What the party doesn’t say is “‘Okay, we’re going to tackle and reform the whole healthcare system,'” Turner said. “There’s no appetite for that.”

So rather than being prescriptive, this outline aims to broadly answer the question, “What would you do if you were the ones that they voted for, and that were elected,” Turner said.

Brian Blase, PhD, president of the nonpartisan Paragon Health Institute, said that a look at Trump’s first term suggests what he might do in a second.

As president, he expanded price transparency, increased healthcare options for small businesses, and sought to enact Medicare payment reforms — including reforming 340B payment policies, and site-neutral payment policies.

While there’s no mention of Medicaid in the platform, Blase argued Republicans still have “a lot of sympathy” for work requirements for able-bodied adults, and for equalizing reimbursement rates — i.e., ensuring that the federal government isn’t paying more for the Obamacare “expansion population” than for low-income children and people with disabilities, he said.

Joseph Antos, a senior fellow with the right-leaning American Enterprise Institute in Washington, also weighed in on the platform.

“These are really general ideas … ‘Healthcare and prescription drug costs are out of control.’ I don’t think you could find anybody, any politician, who would disagree with that,” he said.

As for increasing price transparency, “Trump actually has a track record on that,” he said.

His first administration “pushed through” regulations mandating detailed pricing information from hospitals and from insurers, he said.

As for the affordable healthcare options mentioned in the platform, the Trump administration supported having “strong alternatives” to standard insurance. For example, short-term, partial-coverage plans and other policies that don’t cover the full range of benefits required under the Affordable Care Act, as well as health reimbursement arrangements, Antos said.

Andrea Ducas, vice president of health policy at the left-leaning Center for the American Progress Action Fund, in New York City, said the substance of the platform is “very light” and she thinks that’s intentional.

“But if you actually look at what’s in, for example, Project 2025 [a wide-ranging conservative plan for government reform] … there you get a much more explicit look at what the actual plans are for healthcare.”

She said its goals include “eliminat[ing] the Inflation Reduction Act, which would overnight increased prescription drug costs for America’s seniors … potentially capping Medicaid benefits, [and] stripping women of their ability to access no-cost emergency contraception.”

Project 25 is a consortium that includes the Heritage Foundation and other conservative think tanks. Trump has attempted to distance himself from the group, despite the clear involvement of many of his former top advisers.

Wendell Primus, PhD, a visiting fellow at the Brookings Institution’s Center on Health Policy, called out the GOP for claiming Democrats planned to add millions of “illegal immigrants” to the Medicare rolls.

“We’re not doing what the rhetoric says we’re going to do, and if [immigrants] are added to Medicare, it means they’ve paid taxes and they’re legitimately coming on,” he said.

Abortion, In Vitro Fertilization

On the issue of abortion, the Republican party platform also underscores Republicans’ pledge to protect and defend states’ rights on the “issue of life,” citing the 14th Amendment’s “due process” clause. It stresses the party’s opposition to late-term abortions, “while supporting mothers and policies that advance Prenatal Care, access to Birth Control, and IVF (fertility treatments).”

Asked what she thought of the party’s stance, Turner, who is personally anti-abortion, said her organization sees abortion as “a politically fraught issue” more so than a healthcare issue. She said the Supreme Court left abortion up to the states and that appears to be Trump’s position as well.

“I think that it’s just unrealistic to think that you’re going to get national consensus on a federal law that’s going to prevail. So the most realistic, and I think that the most appropriate thing, from our perspective, or from [the perspective of] our Constitution, is to allow the states to make their own decisions,” Turner said.

Molly Meegan, JD, chief legal officer and general counsel for the American College of Obstetricians and Gynecologists (ACOG), argued that anyone who interprets the GOP platform as taking a softer stance on abortion and reproductive rights is misreading the document.

The GOP platform “takes personal credit for the reversal of Roe [v. Wade] and for the Dobbs decision…. At the same time, it’s basically claiming to support mothers and families.”

“We know from story after story that [ACOG members and staff] hear from our patients … that women across the country are not able to access basic reproductive health care right now… that protects their lives, their health, their families, their decisions. And it’s an odd thing, I think, for the party platform to be taking credit for that,” Meegan said.

Also, “the statement that they support the 14th Amendment means that they support personhood laws, which would provide all the rights of personhood to a fertilized egg, an embryo or a fetus. And when you do that, the rights of the pregnant person … are subordinated, and access to care gets worse,” she said.

Asked whether there’s a tension between supporting the 14th Amendment and supporting in vitro fertilization, Meegan said, “You can’t do both and … the anti-abortion movement doesn’t want to do both. They believe that IVF should be limited, that embryo destruction should not be permitted. That would have real impacts on the efficacy of IVF, the affordability of IVF, and, you know, the practice itself,” Meegan said.

Ducas agreed. “You’ve got a [Supreme] Court that is essentially opening the door for an executive to be able to enact a backdoor abortion ban, by withdrawing mifepristone from the market. If you wind up in a situation where fetal personhood is on the table, that undermines everything else … including access to birth control,” she said.

Ducas called the platform’s statement “a deliberate obfuscation of what the actual policy goals are … You have to essentially tone down the language in order to not alienate women. So I think the reason for the lack of clarity there, is ironically, pretty clear.”

While the Republican party platform is general and uses emotional language to appeal to voters, Meegan argued that it is “sort of a generalized summary” of Project 2025, which includes very specific details about the party’s approach to reproductive health.

That document, which is over 900 pages, advocates for removing the words “reproductive rights” and “reproductive health” from every federal law and rule, Meegan said. It also calls for complete removal of mifepristone from the marketplace, disregarding its role in miscarriage management and for an “abortion surveillance system” as well as the revival of the Comstock Act, an 1873 law that prohibits the mailing of any articles used to produce abortion, Meegan said.

Meegan argued that Project 2025 essentially provides a “road map” for policies to be enacted at the state and federal level wherever possible if Trump is elected.

Asked whether Trump could mention abortion at the Republican National Convention, Antos said, “I think he’s going to try to be as quiet about this as anybody possibly could be…. I think Trump’s best move or any Republican running for national office’s best move is to stay away from it.”

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