Inside the health arguments at Biden and Trumps first debate

President Biden and former president Donald Trump began their first debate Thursday night arguing about their responses to the coronavirus pandemic. Each candidate closed the evening touting their respective health-care legislation — with Biden talking about his efforts to cut drug prices and Trump his program to expand access to experimental drugs for terminally ill people. During the roughly 90 minutes in between, the men wrestled over their stark differences on abortion access, the Affordable Care Act and other health-care priorities.

There’s a reason health care kept coming up: The issue has helped define elections for more than a decade. The animus toward the Affordable Care Act, President Barack Obama’s signature health law, gave birth to the tea party and a conservative wave that won Republicans the House in 2010, the Senate in 2014 and the White House in 2016.

But in recent years, the political advantage has flipped: Biden successfully attacked Trump’s coronavirus pandemic response ahead of the 2020 presidential election, and the fight over abortion access helped Democrats reclaim the House in 2022.

Polls show health care remains a key priority for the electorate this year. About 8 in 10 voters said that health-care affordability is a “very important” concern, according to a February poll by KFF, a nonpartisan health policy organization.

Here’s what Biden and Trump said about health care:

Abortion

When asked about abortion, arguably the Democratic Party’s strongest political advantage this year, Biden failed to give a coherent response. He did decry Trump’s efforts to strip the constitutional right to abortion, pointing to his appointment of three Supreme Court justices who helped overturn Roe v. Wade two years ago. Biden said that resulted in the suffering of women across the country seeking basic health care.

Trump countered that he had succeeded in pushing the abortion question to the states after his Supreme Court appointments helped overturn Roe.

But the former president had his own struggles when talking about the issue, such as inaccurately claiming that the Supreme Court had “approved the abortion pill.” The court did not rule on the legality of mifepristone; it instead threw out the case that would have limited the pills because it said that the challengers lacked standing.

Trump also accused Biden of supporting abortion up to the point of birth, to which Biden responded: “You’re lying. That is simply not true.” Trump made other claims that medical groups have said are false. “The problem [Democrats] have is they’re radical because they will take the life of a child in the eighth month, the ninth month, and even after birth, after birth,” Trump said. It is illegal to kill any person after birth.

Drug pricing

Biden was particularly eager to talk about his work to lower drug prices: he repeatedly raised the issue, at times without prompting. The White House believes this is an advantage for Biden, given years of polls showing that Americans are frustrated with the high cost of prescription drugs — and the series of drug-price changes contained within Democrats’ landmark 2022 law, the Inflation Reduction Act.

The law empowers Medicare to negotiate directly with drug companies, caps out-of-pocket spending for seniors and penalizes companies that raise the costs of their drugs faster than the rate of inflation, among other changes.

“Repealing the Inflation Reduction Act would mean increased costs on prescription drugs and a whole host of other areas,” Neera Tanden, the president’s domestic policy adviser, said on Wednesday in a speech at the left-leaning think tank Center for American Progress. She noted that Republicans have taken aim at the law.

But in the debate, Biden had difficulty communicating what his administration has actually done — claiming at one point, “we finally beat Medicare,” when he probably meant to say “we finally beat pharma,” a misstep that Trump used to mock Biden. The president at one point claimed he had lowered the cost of insulin to “$15” per shot; the administration actually oversaw an effort to cap out-of-pocket insulin spending at $35 per month for many Americans.

Trump appeared irritated by Biden’s drug-price remarks, with the former president insisting that the current president was wrongly taking credit. “I’m the one that got the insulin down for the seniors,” Trump said.

There’s some truth to Trump’s claim — his administration did pursue lower insulin costs, including in a Medicare pilot program — but Biden’s team has gone much further and got insulin cost-cuts into law.

Affordable Care Act

The KFF poll also found that the Affordable Care Act has risen in popularity since Trump and Republicans tried to repeal it in 2017, with 6 in 10 Americans now holding a positive view of the law. Biden seized on that goodwill during the debate when he invoked the tens of millions of people receiving health coverage because of the law.

As expected, Biden criticized Trump’s prior efforts to weaken or replace the Affordable Care Act, casting Trump as going after Americans’ health care. Across the country, 45 million people have access to health coverage through the ACA insurance marketplaces and Medicaid expansion, according to the U.S. Department of Health and Human Services — more than triple the number of people enrolled in 2014.

Biden has been credited for his expansion of enrollment assistance, which Trump had cut.

Trump did not directly respond to Biden’s comments. Trump has contradicted himself as a candidate, saying he would never give up on repealing the health-care law while simultaneously denying he’s running on ending the ACA.

Coronavirus

The first health topic of the debate was on the issue that animated the 2020 election: covid. Trump decried Biden’s vaccine mandates and pointed out more people died of covid under Biden’s watch. Biden highlighted how Trump told Americans to drink bleach, a mischaracterization of Trump’s suggestion to consider injecting disinfectant into the lungs.

The commentary comes as the United States grapples with the threat of a potential bird flu outbreak and rising dengue fever risks.

The candidates have vastly different outlooks on how to respond to national health crises, as evidenced during the coronavirus pandemic.

While Trump shifted responsibility to the states and publicly denounced the role of federal agencies, Biden entered office the following year by coordinating a government-wide response and enacting mask and vaccine requirements.

Trump told Time magazine in a recent interview that he probably would disband the White House Office of Pandemic Preparedness and Response Policy that Biden created.

Medicare

Current projections show Medicare running out of funds by 2036, and its solvency came up throughout the debate.

Biden made a point in his closing arguments to highlight the billions he has saved Medicare by reducing drug costs, and he tried to invoke his efforts to protect the program throughout the debate. Biden has previously stated a desire to raise taxes on high earners to fund the program that Americans over 65 rely on for health coverage, and he alluded to protecting health programs with such taxes during the debate.

Trump, in contrast, raised premiums for high earners but also signed into law tax reductions that depleted Medicare funds and repealed a board put into place to slow Medicare spending. During the debate, he argued that Biden was hurting Medicare by allowing migrants into the country; over time, lawfully present immigrants can qualify for Medicare.

Some Republicans have previously floated raising the Medicare eligibility age to improve the program’s chance of solvency — an unpopular idea that neither candidate has proposed.

Medicaid

While more than 1 in 5 Americans are enrolled in Medicaid, the health coverage program for those with low-incomes or a disability, the program hardly came up in the debate except when Trump argued that migrants were taking resources from the program. Most migrants must wait five years before they can enroll in Medicaid.

But the candidates’ approach to the program varies widely. Trump previously has supported adding work requirements for Medicaid enrollees and converting Medicaid funding into block grants for states. Biden rolled back Trump’s efforts to institute Medicaid work requirements and encouraged the expansion of coverage targeted at eliminating disparities.

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