How Healthcare Has Improved Under the Biden-Harris Administration

In every election since 2018, voters have gone to the polls prioritizing better healthcare and lower healthcare costs.¹ Healthcare is a kitchen table issue, and policies to lower costs receive strong support from a majority of voters, whether they live in red or blue states or in rural, suburban, or urban zip codes.² This year, healthcare continues to dominate the national political conversation, as both presidential candidates have radically different visions for the future.

The state of US healthcare has improved substantially over the last four years. President Joe Biden, Vice President Kamala Harris, and Democrats in Congress have protected and strengthened the Affordable Care Act (ACA) and Medicaid, helping millions of families gain affordable coverage. Congress passed the Inflation Reduction Act,³ a landmark law that is lowering prescription drug and premium costs for millions of seniors and families. The Biden-Harris administration has also worked to improve children’s coverage, strengthen maternity care, and reduce racial, rural, and other disparities in health.

This year, a record 21.3 million Americans signed up for health insurance through ACA marketplaces—over nine million more than when President Biden took office.⁴ Seniors are saving on their prescriptions, paying no more than $35 a month for insulin, and gaining access to free vaccines.⁵ Starting in 2025, no one on Medicare will pay more than $2,000 for all their medications, a game-changer for people with serious conditions like cancer, arthritis, and heart disease.⁶ And for the first time in history, Medicare is negotiating with drug companies for lower prices on some of the most expensive drugs on the market.⁷ Together, these changes have increased financial security for families while making lifesaving healthcare more affordable.

From Crisis to Care

Four years ago, the US healthcare system was in crisis. The nation was in the throes of the COVID-19 pandemic, with healthcare workers fighting to save lives and economic uncertainty threatening families’ well-being. Former President Donald Trump’s response to the crisis undermined the health and safety of the American people and strained a healthcare system that his administration had already systematically compromised. During his time in office, Trump enacted policies that weakened protections for 135 million people with preexisting conditions,⁸ made it harder to enroll in affordable coverage, and raised healthcare costs for millions of people.⁹

One of Trump’s top goals while in office was to repeal the ACA, which roughly 27 million Americans relied on for healthcare coverage, and which more than 45 million Americans rely upon today.¹⁰ When his attempts to get Congress to repeal the law failed, Trump initiated a sabotage campaign targeting affordable healthcare. His administration made it easier to sell junk insurance: short-term and association health plans that can deny coverage for people with preexisting conditions.¹¹ As a result, ACA enrollment fell, and people were lured into subpar plans that didn’t cover essential care like hospital visits or prescription drugs. Trump also pushed work reporting requirements and other red tape to enroll in Medicaid,¹² which jeopardized healthcare coverage for millions of people. Millions more people became uninsured or underinsured, leaving families with staggering bills for uncovered care.¹³

Meanwhile, prescription drug prices skyrocketed, and Republicans in Congress continued to block reform.¹⁴ Rural hospital closures accelerated as a handful of states still refused to expand Medicaid under the ACA.¹⁵ And racial disparities in healthcare worsened with the growing Black maternal health crisis¹⁶ and policies that discouraged immigrants from enrolling in coverage.¹⁷

In early 2021, Biden took immediate action to lower costs and expand care. The Biden-Harris administration reopened HealthCare.gov for a special enrollment period to help Americans gain coverage as they continued to suffer from the health and economic impacts of the pandemic. Biden also issued executive orders to strengthen access to quality healthcare and to direct federal agencies to revise Trump-era policies that undermine affordable care.¹⁸

Crucially, the Biden-Harris administration also moved quickly to pass the American Rescue Plan. In addition to providing robust support to combat the pandemic, it lowered healthcare costs for millions of Americans by ensuring people purchasing coverage on the ACA marketplaces pay no more than 8.5 percent of their income for coverage,¹⁹ by eliminating premiums for those making 150 percent of the federal poverty level (about $46,000 for a family of four),²⁰ and by providing states with greater financial incentives to expand Medicaid. As a result of the American Rescue Plan, more than 40 million Americans had ACA coverage as of 2023,²¹ many at little or no cost, and a record number of children and families were able to gain access to Medicaid. The nation’s uninsured rate reached and has remained at a record low of 7.7 percent since early 2023,²² proving that policies to make coverage affordable and accessible help more people enroll.

In 2022, Biden signed the Inflation Reduction Act,²³ a landmark law that has lowered healthcare costs for millions of seniors and families²⁴ by extending the ACA premium savings under the American Rescue Plan through 2025. Under the Inflation Reduction Act, 80 percent of enrollees are able to find a health plan through the marketplaces for $10 or less per month.²⁵ For a family of four with an income of $120,000, the law saves $6,604 on their yearly premiums; for a married couple in their early 60s with an income of $75,000, the law saves $16,000 annually.²⁶

Access to health coverage is imperative to reducing coverage disparities. Historically, people of color and rural Americans have been disproportionately likely to be uninsured, which contributes to higher rates of chronic disease and poor health outcomes.²⁷ Lack of health insurance also increases financial instability, with an unexpected medical expense keeping people from paying rent or buying groceries.

The Inflation Reduction Act has led to coverage gains for these groups. Enrollment data show that 1.7 million Black people and 3.4 million Latinx people enrolled in marketplace coverage for 2024, an enrollment increase of 95 percent and 103 percent, respectively, since 2020—and the number of Asian American, Native American, and Pacific Islander (AANAPI) and rural enrollees increased as well.²⁸

By passing the Inflation Reduction Act, Biden, Harris, and Democrats in Congress won a decades-long battle against big drug companies. For too long, Americans have paid two to four times more than people in other countries for many drugs,²⁹ and older adults with complex health needs have paid up to 7.5 times as much.³⁰ The Inflation Reduction Act was a significant step toward ending the broken system that has allowed big drug companies to charge whatever they want for lifesaving medications while seniors cut pills and skip doses because of high costs. Now, seniors are saving money because the Inflation Reduction Act:

• Gave Medicare the power to negotiate lower drug prices. The Biden-Harris administration is implementing the Medicare Drug Price Negotiation Program, which will lower prices for some of the most popular and expensive prescription drugs while saving taxpayers and seniors billions of dollars. In August 2023, Medicare began negotiating lower prices for Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog, which treat conditions like cancer, diabetes, and blood clots.³¹ These drugs are taken by nearly nine million people on Medicare who spent $3.4 billion in out-of-pocket costs in 2022 alone.³² The negotiated prices for the first 10 drugs will take effect in 2026, and by 2030, 80 of the most expensive prescription drugs will have lower prices because of these negotiations.³³
• Lowered insulin costs. In 2020, more than 3.2 million people on Medicare used insulin;³⁴ those who did not receive financial assistance paid an average of $54 per month for this lifesaving medication. But many paid much more, with the top 10 percent of insulin users spending more than $111 per month.³⁵ Under the Inflation Reduction Act, monthly insulin copays for people on Medicare are capped at $35 per prescription.³⁶ Since the cap took effect, there has already been a substantial increase in the number of filled insulin prescriptions among Medicare beneficiaries.³⁷
• Capped out-of-pocket costs. Thanks to the new $2,000 per year cap on out-of-pocket costs, which begins in 2025,³⁸ over 38 million Americans enrolled in Medicare Part D will save an average of $462 per year.
• Ended outrageous price increases. The Inflation Reduction Act penalizes drug companies for raising drug prices faster than the rate of inflation.³⁹ Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation.⁴⁰ This provision will not only save the government billions of dollars but also drastically reduce out-of-pocket costs for Medicare beneficiaries.
• Provided free vaccinations. 50.5 million seniors are eligible for no-cost vaccinations, including RSV, DtaP, seasonal flu, and the usually costly shingles vaccine. With a single dose of Shingrix (just half of the recommended vaccine) costing more than $180 in some cases, seniors on Medicare Part D saved over $400 on average on vaccinations in 2023.⁴¹

The Inflation Reduction Act has also served as a catalyst for additional action to lower prescription drug costs for more patients. After its passage, the three largest insulin manufacturers announced $35 monthly out-of-pocket cost caps, lowering the cost of about 90 percent of the insulin on the market.⁴² And following pressure from Biden, Harris, and Democrats in Congress, two drugmakers have capped out-of-pocket costs for some top-selling inhalers at $35 per month.⁴³

Centering Access and Equity

In addition to making ACA coverage more affordable, the Biden-Harris administration boosted funding for marketing and education efforts to help people enroll in coverage, with a particular focus on outreach to historically marginalized racial and ethnic groups, people in rural areas, LGBTQIA+ people, and other underserved communities.⁴⁴ In a stark reversal from the previous administration, Biden also worked to limit short-term junk plans in order to protect people with preexisting conditions and prevent outrageous medical bills for uncovered care.⁴⁵

The Biden-Harris administration also fixed the “family glitch,” which previously blocked millions of families from accessing affordable coverage through the ACA. The family glitch occurred when workers added dependents onto their coverage, causing premiums to rise far beyond what the law intended.⁴⁶

Importantly, the Biden-Harris administration has pledged to protect the ACA from ongoing legislative and legal attacks. Republicans, including Trump, have reignited calls to “terminate” the ACA, which would jeopardize healthcare coverage for more than 40 million Americans and raise costs for millions more.⁴⁷ Extremists have also worked to undermine the ACA in the courts. One lawsuit (Braidwood Management Inc. v. Becerra) threatened to eliminate the ACA’s guaranteed access to free preventive care—including cancer screenings, prenatal care, and contraception—for 150 million Americans.⁴⁸ A recent decision by the Fifth Circuit Court of Appeals leaves free preventive services at risk as the case proceeds through the legal system and opens the door to further litigation.⁴⁹

Strengthening Medicaid has been one of the Biden-Harris administration’s most significant accomplishments. About one in four Americans are covered through Medicaid or the Children’s Health Insurance Program (CHIP), which serve various overlapping groups, including children, mothers, people of color, people with disabilities, working families, rural Americans, and seniors.⁵⁰

For years, Republican lawmakers in some states have blocked Medicaid expansion under the ACA despite research showing that Medicaid expansion improves health, increases financial security, supports rural hospitals, boosts local economies, and saves lives.⁵¹ Through the American Rescue Plan, Congress created multibillion-dollar incentives for Medicaid expansion. Under the Biden-Harris administration, North Carolina, Missouri, and South Dakota have finally expanded Medicaid, leaving just 10 states that continue to reject expansion.⁵²

Thanks to their focus on improving Medicaid, Biden, Harris, and Democrats in Congress have:

• Standardized enrollment and renewal processes nationwide. The Centers for Medicare and Medicaid Services made it easier for millions of eligible people to enroll in and retain their Medicaid coverage.⁵³
• Protected coverage for children. Biden signed legislation to guarantee kids can stay on Medicaid and CHIP for at least a full year before their parents must apply to renew their coverage.⁵⁴
• Extended coverage to new mothers. Under the Biden-Harris administration, 47 states have expanded Medicaid coverage to new moms for a full year postpartum.⁵⁵
• Blocked work reporting requirements. Biden stopped Republican efforts to rip Medicaid away from 21 million Americans with burdensome paperwork requirements designed to kick people off of coverage.⁵⁶
• Improved coverage and quality of care. Through executive action, the Biden-Harris administration banned lifetime limits and waiting periods for Medicaid and CHIP coverage and enacted a regulation to shorten wait times for primary care, behavioral health and substance use disorder services, and OB-GYN care.⁵⁷
• Strengthened the caregiving workforce. Biden enacted regulations to improve access to at-home care and staffing standards in nursing homes to promote safety, support the caregiving workforce, and deliver higher-quality care for seniors and people with disabilities.⁵⁸
• Provided maximum flexibility to protect enrollment. Congress passed legislation in 2020 ensuring no one could be disenrolled from Medicaid during the COVID-19 pandemic, but this provision expired on April 1, 2023. As of August 23, 2024, states had removed more than 25 million people⁵⁹ from Medicaid coverage, including more than four million children⁶⁰ who had been removed by December 2023.* The Biden-Harris administration has given states maximum flexibility to keep eligible people enrolled and stepped in to restore coverage for children and hold states accountable for disenrolling eligible people.⁶¹

In addition to the actions highlighted above, the Biden-Harris administration has worked to address health disparities and improve healthcare for people from all backgrounds, including people of color, LGBTQIA+ Americans, people with disabilities, and rural Americans. These groups have faced greater levels of poverty and worse health outcomes due to racism, discrimination, and other systemic barriers.⁶²

On his first day in office, Biden signed an executive order calling for the federal government to advance an ambitious, whole-of-government equity agenda.⁶³ As a result, agencies including the Department of Health and Human Services and the Centers for Medicare and Medicaid Services issued individual equity plans. These plans prioritize improving data collection and assessment of the root causes of disparities, reducing barriers to healthcare access, and expanding culturally competent care.⁶⁴

The Biden-Harris administration has worked to strengthen mental health care and treatment for substance use disorder, creating the first-ever Department of Health and Human Services Overdose Prevention Strategy.⁶⁵ In a reversal from Trump-era policies, the Biden-Harris administration expanded healthcare to Deferred Action for Childhood Arrivals program recipients and restored civil rights protections through Section 1557 of the ACA, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.⁶⁶

Protecting Reproductive Care

Reproductive care is under attack across the country. Between a growing maternal health crisis and a wave of laws restricting or banning abortion care following the US Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization (2022), which overturned Roe v. Wade, protecting the care of women and pregnant people is critical.

After the Dobbs decision, Biden signed an executive order building on previous actions to protect access to reproductive healthcare services.⁶⁷ In addition, the Biden-Harris administration has protected women’s healthcare through the following actions:

• Combating the maternal health crisis. As the nation faces an unacceptably high and worsening rate of pregnancy-related death, the Biden-Harris administration released a Blueprint for Addressing the Maternal Health Crisis, a whole-of-government approach to combating maternal mortality and morbidity.⁶⁸
• Defending care and privacy. The Biden-Harris administration rolled back Trump’s gag rule that barred family planning providers from mentioning abortion to patients.⁶⁹ Trump’s rule forced more than 1,000 clinics to lose essential federal funding and dramatically cut provider capacity.⁷⁰ The Biden-Harris rule restores funding for these providers, like Planned Parenthood, which offer essential healthcare, including sexually transmitted infection screenings and contraception. The administration also strengthened privacy laws around reproductive care.⁷¹
• Strengthening access to contraception. Biden issued an executive order on strengthening access to affordable contraception and family planning services.⁷² The Biden-Harris administration also approved the first over-the-counter birth control, which is available for purchase nationwide.⁷³
• Investing in women’s health research. The president signed an executive order directing federal agencies to prioritize women’s health research, including studying conditions like menopause, arthritis, and heart disease.⁷⁴

It is important to recognize and reflect on how far our country has come in the last four years in terms of lowering healthcare costs, boosting coverage, and improving the quality of care. This election will be pivotal for the future of healthcare. The last administration left millions of Americans without coverage and unsure whether they could afford care. In contrast, Harris wants to build on Biden’s legacy by extending the Inflation Reduction Act’s drug savings to more people, closing the Medicaid coverage gap, and defending recent gains for everyone in the United States.

Joi Chaney, JD, is the policy and health equity senior advisor at Protect Our Care and the founder of J.O.I. Strategies. Andrea Harris is the director of policy programs at Protect Our Care, where Anne Shoup is the communications director and Maddie Twomey is the deputy communications director.

*Republican-led states have exploited this process to clear the Medicaid rolls; by December 2023, more than one million of the children who had lost coverage were in Texas, and in several states the number of enrolled children was lower than before the pandemic. (return to article)

Endnotes

1. F. Newport, “Top Issues for Voters: Healthcare, Economy, Immigration,” Gallup News, November 2, 2018, news.gallup.com/poll/244367/top-issues-voters-healthcare-economy-immigration.aspx.

2. A. Kearney et al., “KFF Health Tracking Poll: Health Care Issues Emerge as Important Topics on 2024 Campaign Trail, Plus Concerns Loom Large Around Medicaid Unwinding,” KFF, December 1, 2023, kff.org/affordable-care-act/poll-finding/kff-health-tracking-poll-november-2023.

3. Inflation Reduction Act of 2022, H.R. 5376, Pub. L. No. 117-169, 136 Stat. 1818 (2022), congress.gov/bill/117th-congress/house-bill/5376/text/eas.

4. J. Biden, “Statement from President Joe Biden on the Record-Breaking 2024 Open Enrollment Period Under the Affordable Care Act,” White House, January 24, 2024, whitehouse.gov/briefing-room/statements-releases/2024/01/24/statement-from-president-joe-biden-on-the-record-breaking-2024-open-enrollment-period-under-the-affordable-care-act; and Centers for Medicare and Medicaid Services, Health Insurance Marketplaces 2024 Open Enrollment Report (Baltimore: 2024), cms.gov/files/document/health-insurance-exchanges-2024-open-enrollment-report-final.pdf.

5. Inflation Reduction Act of 2022, H.R. 5376; and B. Sayed et al., “Inflation Reduction Act Research Series: Medicare Part D Enrollee Vaccine Use After Elimination of Cost Sharing for Recommended Vaccines in 2023,” Data Point, May 3, 2024, US Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, aspe.hhs.gov/sites/default/files/documents/3854c8f172045f5e5a4e000d1928124d/part-d-covered-vaccines-no-cost-sharing.pdf.

6. Inflation Reduction Act of 2022, H.R. 5376; and J. Cubanski and T. Neuman, “The New Help for Medicare Beneficiaries with High Drug Costs That Few Seem to Know About,” KFF, December 12, 2023, kff.org/policy-watch/the-new-help-for-medicare-beneficiaries-with-high-drug-costs-that-few-seem-to-know-about.

7. US Department of Health and Human Services, “HHS Selects the First Drugs for Medicare Drug Price Negotiation,” press release, August 29, 2023, hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html.

8. E. Gee, “Number of Americans with Preexisting Conditions by District for the 116th Congress,” Center for American Progress, October 2, 2019, americanprogress.org/article/number-americans-preexisting-conditions-district-116th-congress.

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10. Office of the Assistant Secretary for Planning and Evaluation, “Health Coverage Under the Affordable Care Act: Current Enrollment Trends and State Estimates,” US Department of Health and Human Services, May 23, 2023, aspe.hhs.gov/reports/current-health-coverage-under-affordable-care-act.

11. D. Scott, “How Trump Gave Insurance Companies Free Rein to Sell Bad Health Plans,” Vox, June 30, 2020, vox.com/2020/6/30/21275498/trump-obamacare-repeal-short-term-health-care-insurance-scam.

12. A. Coleman and S. Federman, “Work Requirements for Medicaid Enrollees,” Commonwealth Fund, April 2, 2024, commonwealthfund.org/publications/explainer/2024/apr/work-requirements-medicaid-enrollees.

13. US Census Bureau, “Health Insurance Historical Tables - HHI Series,” US Department of Commerce, September 12, 2023, census.gov/data/tables/time-series/demo/health-insurance/historical-series/hic.html; and A. Gaffney, D. Himmelstein, and S. Woolhandler, “How Much Has the Number of Uninsured Risen Since 2016—and at What Cost to Health and Life?,” Health Affairs (blog), October 29, 2020, healthaffairs.org/content/forefront/much-has-number-uninsured-risen-since-2016-and-cost-health-and-life.

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15. D. Scott, “1 in 4 Rural Hospitals Is Vulnerable to Closure, a New Report Finds,” Vox, February 18, 2020, vox.com/policy-and-politics/2020/2/18/21142650/rural-hospitals-closing-medicaid-expansion-states.

16. L. Hill, S. Artiga, and U. Ranji, “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them,” KFF, November 1, 2022, kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them.

17. K. Whitener, How the New Public Charge Rule Impacts Children in Immigrant Communities (Washington, DC: Georgetown University McCourt School of Public Policy, Center for Children and Families, August 27, 2019), ccf.georgetown.edu/2019/08/27/how-the-new-public-charge-rule-impacts-children-in-immigrant-communities.

18. White House, “Fact Sheet: President Biden to Sign Executive Orders Strengthening Americans’ Access to Quality, Affordable Health Care,” January 28, 2021, whitehouse.gov/briefing-room/statements-releases/2021/01/28/fact-sheet-president-biden-to-sign-executive-orders-strengthening-americans-access-to-quality-affordable-health-care.

19. T. Straw et al., Health Provisions in American Rescue Plan Act Improve Access to Health Coverage During COVID Crisis (Washington, DC: Center on Budget and Policy Priorities, March 11, 2021), cbpp.org/research/health/health-provisions-in-american-rescue-plan-act-improve-access-to-health-coverage.

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21. Office of the Assistant Secretary for Planning and Evaluation, “Health Coverage Under the Affordable Care Act.”

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23. Inflation Reduction Act of 2022, H.R. 5376.

24. US Department of Health and Human Services, “On the First Anniversary of the Inflation Reduction Act, Millions of Medicare Enrollees See Savings on Health Care Costs,” press release, August 16, 2023, hhs.gov/about/news/2023/08/16/first-anniversary-inflation-reduction-act-millions-medicare-enrollees-savings-health-care-costs.html.

25. US Department of Health and Human Services, “More Than 4.5 Million Select Affordable Health Coverage in ACA Marketplace Coverage Since Start of Open Enrollment Period,” press release, November 21, 2023, hhs.gov/about/news/2023/11/21/more-than-4-million-select-affordable-health-coverage-aca-marketplace-coverage-start-open-enrollment-period.html.

26. G. Lukens, Health Premiums Will Rise Steeply for Millions If Rescue Plan Tax Credits Expire (Washington, DC: Center on Budget and Policy Priorities, May 26, 2022), cbpp.org/research/health/health-premiums-will-rise-steeply-for-millions-if-rescue-plan-tax-credits-expire.

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28. Assistant Secretary for Planning and Evaluation, “HealthCare.gov Enrollment by Race and Ethnicity, 2015–2023,” US Department of Health and Human Services, Office of Health Policy, March 22, 2024, aspe.hhs.gov/sites/default/files/documents/a1e8128c1b9996fd5a7eb98d0860d572/aspe-2023-race-ethnicity-marketplace.pdf.

29. US Government Accountability Office, “Prescription Drugs: U.S. Prices for Selected Brand Drugs Were Higher on Average Than Prices in Australia, Canada, and France,” March 29, 2021, gao.gov/products/gao-21-282.

30. C. Ramsay and R. Williams, “Medicare Patients Pay More for Drugs Than Older Adults in Other Countries; Congress Has an Opportunity to Move Forward,” blog, Commonwealth Fund, September 30, 2021, commonwealthfund.org/blog/2021/medicare-patients-pay-more-drugs-older-adults-other-countries-congress-has-opportunity.

31. White House, “Fact Sheet: Biden-Harris Administration Announces First Ten Drugs Selected for Medicare Price Negotiation,” August 29, 2023, whitehouse.gov/briefing-room/statements-releases/2023/08/29/fact-sheet-biden-harris-administration-announces-first-ten-drugs-selected-for-medicare-price-negotiation.

32. Assistant Secretary for Planning and Evaluation, “Inflation Reduction Act Research Series: Medicare Enrollees’ Use and Out-of-Pocket Expenditures for Drugs Selected for Negotiation Under the Medicare Drug Price Negotiation Program,” US Department of Health and Human Services, Office of Health Policy, September 13, 2023, aspe.hhs.gov/sites/default/files/documents/9a34d00483a47aee03703bfc565ffee9/ASPE-IRA-Drug-Negotiation-Fact-Sheet-9-13-2023.pdf.

33. J. Cubanski, T. Neuman, and M. Freed, “Explaining the Prescription Drug Provisions in the Inflation Reduction Act,” KFF, January 24, 2023, kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act.

34. J. Cubanski and A. Damico, “Insulin Out-of-Pocket Costs in Medicare Part D,” KFF, July 28, 2022, kff.org/medicare/issue-brief/insulin-out-of-pocket-costs-in-medicare-part-d.

35. Cubanski and Damico, “Insulin Out-of-Pocket Costs.”

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38. B. Sayed et al., “Inflation Reduction Act Research Series: Medicare Part D Enrollee Out-of-Pocket Spending: Recent Trends and Projected Impacts of the Inflation Reduction Act,” US Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Health Policy, July 7, 2023, aspe.hhs.gov/sites/default/files/documents/93a68f3c5ca949dcf331aa0ec24dd046/aspe-part-d-oop.pdf.

39. J. Cubanski et al., “How Will the Prescription Drug Provisions in the Inflation Reduction Act Affect Medicare Beneficiaries?,” KFF, January 24, 2023, kff.org/medicare/issue-brief/how-will-the-prescription-drug-provisions-in-the-inflation-reduction-act-affect-medicare-beneficiaries.

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41. K. Lankford, “Does Medicare Cover the Shingles Vaccine?,” AARP, October 31, 2023, aarp.org/health/medicare-qa-tool/does-medicare-cover-shingles-shot.

42. B. Lovelace, “Sanofi Announces Insulin Price Cap After Actions by Eli Lilly and Novo Nordisk,” NBC News, March 16, 2023, nbcnews.com/health/health-news/sanofi-insulin-price-cap-rcna75346.

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43. R. Pifer, “Biden Administration Makes Record-High Investment in ACA Navigators,” Health Care Dive, August 29, 2022, healthcaredive.com/news/biden-administration-record-aca-navigator-100-million-2023/630682.

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46. Z. Basu, “Trump Says He’s ‘Seriously Looking’ at Obamacare Alternatives,” Axios, November 26, 2023, axios.com/2023/11/26/trump-obamacare-affordable-care-act.

47. L. Sobel et al., “Explaining Litigation Challenging the ACA’s Preventive Services Requirements: Braidwood Management Inc. v. Becerra,” KFF, May 15, 2023, kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra; and Assistant Secretary for Planning and Evaluation, “Access to Preventive Services Without Cost-Sharing: Evidence from the Affordable Care Act,” US Department of Health and Human Services, Office of Health Policy, January 11, 2022, aspe.hhs.gov/sites/default/files/documents/786fa55a84e7e3833961933124d70dd2/preventive-services-ib-2022.pdf.

48. National Women’s Law Center, “Braidwood Management Inc. v. Becerra: The Latest Affordable Care Act Attack Threatens Access to Preventive Health Care Services for Over 150 Million People,” July 11, 2024, nwlc.org/resource/braidwood-management-inc-v-becerra-the-latest-affordable-care-act-attack-threatens-access-to-preventive-health-care-services-for-over-150-million-people.

49. Medicaid.gov, “March 2024 Medicaid & CHIP Enrollment Data Highlights,” Centers for Medicare and Medicaid Services, medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.

50. L. Harker and B. Sharer, “Medicaid Expansion: Frequently Asked Questions,” Center on Budget and Policy Priorities, June 14, 2024, cbpp.org/research/health/medicaid-expansion-frequently-asked-questions-0.

51. KFF, “Status of State Medicaid Expansion Decisions: Interactive Map,” May 8, 2024, kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map.

52. R. Pifer, “CMS Streamlines Medicaid, CHIP Renewal and Enrollment in Final Rule,” Health Care Dive, March 28, 2024, healthcaredive.com/news/cms-medicaid-eligibility-enrollment-final-rule/711513.

53. M. Sanger-Katz, “The December Omnibus Bill’s Little Secret: It Was Also a Giant Health Bill,” New York Times, January 22, 2023, nytimes.com/2023/01/22/upshot/new-health-policies-budget.html.

54. KFF, “Medicaid Postpartum Coverage Extension Tracker,” May 10, 2024, kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker.

55. D. Scott, “White House Warns 21 Million Americans at Risk of Losing Medicaid Under GOP Proposal,” Vox, April 25, 2023, vox.com/policy/2023/4/25/23697375/medicaid-eligibility-work-requirements-debt-limit-bill; and P. Minemyer, “Medicaid Work Requirements Dropped in Debt Ceiling Deal,” Fierce Healthcare, May 30, 2023, fiercehealthcare.com/regulatory/medicaid-work-requirements-dropped-debt-ceiling-deal.

56. A. Portalatin, “Biden Administration Issues Final Rule on Medicaid, CHIP Enrollment: 6 Notes for Dentists,” Becker’s Dental + DSO Review, March 28, 2024, beckersdental.com/dentists/43311-biden-administration-issues-final-rule-on-medicaid-chip-enrollment-6-notes-for-dentists.html; and S. Rosenbaum and M. Casoni, “The Medicaid Managed Care Rule Is a Blockbuster,” Health Affairs, May 13, 2024, healthaffairs.org/content/forefront/medicaid-managed-care-rule-blockbuster.

57. A. Gomez Licon, “Harris Announces Final Rules on Minimum Nursing Home Staffing Standards,” PBS News, April 22, 2024, pbs.org/newshour/politics/harris-announces-final-rules-on-minimum-nursing-home-staffing-standards.

58. KFF, “Medicaid Enrollment and Unwinding Tracker,” July 12, 2024, kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview.

59. J. Alker et al., Child Medicaid Disenrollment Data Shows Wide Variation in State Performance as Continuous Coverage Pandemic Protections Lifted (Washington, DC: Georgetown University McCourt School of Public Policy, Center for Children and Families, May 2, 2024), ccf.georgetown.edu/2024/05/02/child-medicaid-disenrollment-data-shows-wide-variation-in-state-performance-as-continuous-coverage-pandemic-protections-lifted/#heading-3.

60. Center on Budget and Policy Priorities, “Unwinding Watch: Tracking Medicaid Coverage as Pandemic Protections End,” July 8, 2024, cbpp.org/research/health/unwinding-watch-tracking-medicaid-coverage-as-pandemic-protections-end; and US Department of Health and Human Services, “HHS Takes Additional Actions to Help People Stay Covered During Medicaid and CHIP Renewals,” press release, March 28, 2024, hhs.gov/about/news/2024/03/28/hhs-takes-additional-actions-to-help-people-stay-covered-during-medicaid-and-chip-renewals.html.

61. Ndugga and Artiga, “Disparities in Health and Health Care.”

62. White House, “Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government,” January 20, 2021, whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government.

63. US Department of Health and Human Services, “Advancing Equity at HHS,” hhs.gov/equity/index.html; and CMS.gov, “CMS Framework for Health Equity,” Centers for Medicare and Medicaid Services, cms.gov/priorities/health-equity/minority-health/equity-programs/framework.

64. US Department of Health and Human Services, “Overdose Prevention Strategy,” hhs.gov/overdose-prevention.

65. R. Masitha, L. Haynes, and S. Collins, “Biden Administration Releases New Rule to Help Dreamers Access Affordable Health Insurance,” blog, Commonwealth Fund, May 10, 2024, commonwealthfund.org/blog/2024/biden-administration-releases-new-rule-help-dreamers-access-affordable-health-insurance; and N. Weiland, “Biden Administration Restores Health Protections for Gay and Transgender People,” New York Times, April 26, 2024, nytimes.com/2024/04/26/us/politics/biden-gay-transgender-health-care.html.

66. L. Testa and R. Nuzum, “President Biden’s Executive Order Protecting Access to Reproductive Health Services,” blog, Commonwealth Fund, August 2, 2022, commonwealthfund.org/blog/2022/president-bidens-executive-order-protecting-access-reproductive-health-services.

67. White House Blueprint for Addressing the Maternal Health Crisis (Washington, DC: White House, June 2022), whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf.

68. J. Rovner, “How Much of Trump’s Health Agenda Has Biden Undone?,” KFF Health News, May 6, 2024, kffhealthnews.org/news/article/trump-health-orders-undone.

69. S. McCammon, “Biden Administration Moves to Undo Trump Abortion Rules for Title X,” National Public Radio, April 14, 2021, npr.org/2021/04/14/987131269/biden-administration-moves-to-undo-trump-abortion-rules-for-title-x.

70. US Department of Health and Human Services, “HIPAA Privacy Rule Final Rule to Support Reproductive Health Care Privacy: Fact Sheet,” hhs.gov/hipaa/for-professionals/special-topics/reproductive-health/final-rule-fact-sheet/index.html.

71. White House, “Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services,” June 23, 2023, whitehouse.gov/briefing-room/presidential-actions/2023/06/23/executive-order-on-strengthening-access-to-affordable-high-quality-contraception-and-family-planning-services.

72. S. Lupkin, “First Over-the-Counter Birth Control Pill Now for Sale Online,” National Public Radio, March 18, 2024, npr.org/sections/health-shots/2024/03/04/1235404522/opill-over-counter-birth-control-pill-contraceptive-shop.

73. Z. Kanno-Youngs, “Biden Signs Executive Order to Expand Research on Women’s Health,” New York Times, March 18, 2024, nytimes.com/2024/03/18/us/politics/biden-executive-action-research-women-health.html?partner=slack&smid=sl-share.

[Photos, from top: Official White House Photo by Erin Scott; Brian Stukes / Stringer / Getty Images; Official White House Photo by Lawrence Jackson; and Anna Moneymaker / Staff / Getty Images]