Here’s where Trump and Biden stand on fixing Medicare, which could be insolvent by 2024

President Donald Trump and former Vice President Joe Biden, his Democratic challenger, have widely divergent views on healthcare, including their takes on Medicare — the federal program that insures more than 62.3 million Americans.

With the Medicare Hospital Insurance Trust Fund on a path toward insolvency by 2024, the financial health of the Medicare program is a challenge that whoever occupies the White House in January will face. But a president can’t fix it alone.

“You can’t alter much in healthcare coverage without involving Congress,” said Steve Ullmann, a professor of health management and policy at the University of Miami.

“To date, Congress has always jumped in to fix it,” said David Lipschutz, associate director of the Center for Medicare Advocacy. “I think this is something people need to pay attention to.”

Difficult decisions on Medicare after the election

“Whoever wins in the November election will face really difficult political decisions in terms of bolstering the Medicare Hospital Insurance Trust Fund,” said Tricia Neuman, senior vice president of KFF, which focuses on national health issues.

How successful the winner will be in pushing through his healthcare agenda and a fix for Medicare will depend on the makeup of the new Congress too.

“The three branches of government all have input,” Ullmann said.

Supreme Court to hear Affordable Care Act case after election

Just a week after the November election, the Supreme Court is scheduled to hear arguments on a case challenging the constitutionality of the Affordable Care Act, which also will have implications for Medicare. The Trump administration has filed a brief in support of the 18 Republican-led states challenging a portion of the ACA.

The recent death of liberal Supreme Court Justice Ruth Bader Ginsburg has added immediacy to the issues of healthcare and Medicare during this electoral cycle. If as anticipated, the court takes a more conservative turn when her replacement is sworn in, it could have a bearing on the Supreme Court’s decision on the Affordable Care Act.

Even if the states don’t prevail in the Supreme Court, Trump has vowed to seek ACA repeal legislation in 2021 if he wins. Repeal of ACA could increase Medicare’s budgetary challenges.

Biden has said he wants to keep the Affordable Care Act and build on it. He has outlined several proposals aimed at lowering the price of prescription drugs for Medicare participants, including repealing the law that bars Medicare from negotiating lower prices with drug companies.

Trump says he will have new health plan

Trump has said he wants to scrap ACA in its entirety and plans to introduce his own healthcare plan, but few details have emerged at this point.

“It’s hard to tell exactly where [Trump] stands on Medicare. There has been some discussion of cutting entitlements, but he also has said he wants to safeguard the Medicare system,” said Ullmann.

The president also has expressed support for measures aimed at lowering the price of prescription drugs and has reduced insulin co-pays for some Medicare beneficiaries beginning in 2021. He also has directed the Secretary of Health and Human Services to establish an independent review board to recommend reasonable pricing for new drugs entering the market.

Trump’s fiscal 2021 budget proposal called for about $450 billion in Medicare spending reductions over 10 years, a move the administration says is aimed at improving the solvency of the Hospital Insurance Trust Fund.

Biden supports lowering the age for Medicare eligibility to 60 from the current 65. “The way this has been described, it would be funded by a separate financial system that wouldn’t put more pressure on the trust fund,” Neuman said.

Biden wants to expand dental, vision and hearing

The former vice president also favors expanded dental, vision and hearing coverage for Medicare recipients to the extent it is financially viable. Under traditional Medicare, these areas aren’t covered, and they are discretionary for Medicare Advantage plans.

“In general, Biden favors expanding coverage and access to coverage,” Lipschutz said.

The hallmark of the Trump administration, on the other hand, has been easing regulations and the rollback of so-called “regulatory burdens,” Lipschutz said. “Oversight has diminished under Trump.”

Despite its importance, Neuman said Medicare may not get the attention it received in past elections.

“This election is so different from other elections,” she said. “In 2016, healthcare was a top issue and Medicare was an important issue, especially for elderly voters. But this isn’t a usual year. The top issue seems to be leadership. There are so many other issues vying for voters’ attention that Medicare may not rise to the top, but the pandemic is certainly a top issue.”

Mimi Whitefield can be reached at mimiwhitefield@gmail.com