Healthcare reform debate in the United States

The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.

Details During the presidency of Barack Obama, who campaigned heavily on accomplishing health care reform, the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010. In the 2016 administration, President Donald Trump said during the election that the healthcare system should work based on free market principles. He endorsed a seven-point plan for healthcare reform:

repeal Obamacare reduce barriers to the interstate sale of health insurance institute a full tax deduction for insurance premium payments for individuals make Health Saving Accounts inheritable require price transparency block-grant Medicaid to the states allow for more overseas drug providers through lowered regulatory barriers He also suggested that enforcing immigration laws could reduce healthcare costs. The Trump administration made efforts to repeal the ACA and replace it with a different healthcare policy (known as a "repeal and replace" approach), but it never succeeded in doing so through Congress. Next, the administration joined a lawsuit seeking to overturn the ACA, and the Supreme Court agreed at the beginning of March 2020 that it would hear the case. Under normal scheduling, the case would be heard in the fall of 2020 and decided in the spring of 2021. However, as the Supreme Court subsequently went on hiatus in response to the coronavirus pandemic, it is unclear when the case will be heard.

Cost debate

U.S. healthcare costs were approximately $3.2 trillion or nearly $10,000 per person on average in 2015. Major categories of expense include hospital care (32%), physician and clinical services (20%), and prescription drugs (10%). U.S. costs in 2016 were substantially higher than other OECD countries, at 17.2% GDP versus 12.4% GDP for the next most expensive country (Switzerland). For scale, a 5% GDP difference represents about $1 trillion or $3,000 per person. Some of the many reasons cited for the cost differential with other countries include: Higher administrative costs of a private system with multiple payment processes; higher costs for the same products and services; more expensive volume/mix of services with higher usage of more expensive specialists; aggressive treatment of very sick elderly versus palliative care; less use of government intervention in pricing; and higher income levels driving greater demand for healthcare. Healthcare costs are a fundamental driver of health insurance costs, which leads to coverage affordability challenges for millions of families. There is ongoing debate whether the current law (ACA/Obamacare) and the Republican alternatives (AHCA and BCRA) do enough to address the cost challenge. In 2009, the U.S. had the highest health care costs relative to the size of the economy (GDP) in the world, with an estimated 50.2 million citizens (approximately 16% of the September 2011 estimated population of 312 million) without insurance coverage. Some critics of reform counter that almost four out of ten of these uninsured come from a household with over $50,000 income per year, and thus might be uninsured voluntarily, or opting to pay for health care services on a "pay-as-you-go" basis. Further, an estimated 77 million Baby Boomers are reaching retirement age, which combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments. Maintaining the long-term fiscal health of the U.S. federal government is significantly dependent on healthcare costs being controlled.

Public opinion on prescription drug prices In the March 2026 KFF Health Tracking Poll, for example, more than half of respondents reported being worried “a great deal” about how they would pay for needed prescription drugs, and most supported allowing the government to negotiate lower prices with drug companies (KFF Health Tracking Poll, Question 8). Consistent attention to this issue over time underscores that it is not simply a one-time political issue. Public opinion can also matter because, at times, elected officials think about issues that matter deeply to voters. When huge numbers of Americans experience the burden of high healthcare costs, they expect elected officials to do something about the problem when they hit it. By continuing to cover the high cost of prescription drugs in the latest round of survey questions on healthcare affordability, NHPC projects Americans’ continued strong concern about this issue, which they perceive to need policy action.

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