President Donald Trump and Democratic challenger Joe Biden have dramatically different visions for the future of healthcare policy in the United States.

Healthcare, and specifically access to affordable care, has been a topic of fierce debate in recent presidential elections, and remains top of mind for voters this year, in part, due to the COVID-19 pandemic.

In fact, 29 percent of Americans say healthcare, not the economy, is the most important issue to them, according to a recent Economist and YouGov poll.

With early voting already underway in some states, Healthline spoke with nonpartisan healthcare policy experts to compare where each presidential candidate stands on key healthcare issues so voters can make the most informed decision possible when casting their ballot in this crucial election.

1. The COVID-19 pandemic

Over the last 8 months, the COVID-19 pandemic has shaped the ongoing debate about how to reform the U.S. healthcare system.

President Trump’s handling of COVID-19 so far raises questions about how a Biden administration, if elected, would manage the virus and its toll on our country going forward.

“We cannot talk about healthcare without talking about COVID-19,” said Jamila Taylor, director of healthcare reform and senior fellow at The Century Foundation.

“Trump has disputed the science around COVID. He undermines public health experts, scientists, and physicians who have been trying to address this issue, and he refuses to call for a national mask requirement. He has focused on reopening states and schools prematurely, before we have had a handle on the virus, before testing,” she said.

Many critics have strongly disapproved of the president’s response to the pandemic, including journalist Bob Woodward, who asserted in his recently published book, “Rage,” that Trump knew the new coronavirus was deadly, and intentionally misled Americans by de-emphasizing the dangers.

While the United States represents only 4 percent of the global population, the country has had 21.7 percent of the world’s confirmed COVID-19 cases and 20.6 percent of the planet’s deaths from the virus.

Taylor adds that another stark difference between Trump and Biden’s stance on the pandemic is how they’ve discussed and dealt with its impact on underserved communities.

“We know that the same families disproportionately affected by COVID from a health standpoint are also affected from an economic standpoint. So, under the current administration’s leadership, we have this mix of really dire circumstances largely relating to Black and brown people,” she said.

In contrast, Taylor says the Biden-Harris campaign has talked about the disproportionate effect COVID-19 has had on communities of color.

The campaign has also addressed the need for “targeted testing, ensuring access to healthcare services for those communities, and equitable access to a vaccine once it becomes available.”

Though the Biden-Harris campaign has been clear in its response to COVID-19 would be very different than President Trump’s, Rosemarie Day, CEO of Day Health Strategies and author of “Marching Toward Coverage: How Women Can Lead the Fight for Universal Healthcare,” points out that they wouldn’t have to reinvent how to fight the pandemic on a basic level.

“There’s a playbook for how to deal with the pandemic. It was created by the Obama administration for Ebola,” she said.

However, she says it will also take “a depoliticization of COVID” for the United States to effectively combat the pandemic on a larger scale.

2. The Affordable Care Act

The president, and the Republican Party in general, opposes the Affordable Care Act (ACA), or “Obamacare.”

They’ve vowed to repeal it because they say it’s one step closer to socialized medicine, in that Americans who can afford higher premiums contribute to the premiums of those who can’t.

However, the COVID-19 pandemic has led to millions of Americans losing their jobs, and with them, their health insurance.

“We can’t look at where we are going without looking at the record. Trump has focused on taking away healthcare coverage for many Americans,” Taylor said.

“The list is endless, but first and foremost, his healthcare lawsuit to repeal the Affordable Care Act, as well as numerous efforts where he has used executive actions to roll back existing protections. And, unfortunately, the folks more likely to be underinsured are people of color,” she said.

The president’s attack on the ACA has also been criticized for how it jeopardizes Americans with preexisting conditions, a factor the ACA specifically protects.

On Thursday, the president announced that though he’s fighting to dissolve the ACA, he plans to sign a series of executive orders to force insurers to cover preexisting conditions — something many experts say he doesn’t have the power to do.

And on Saturday, Trump announced his intent to nominate Judge Amy Coney Barrett of the U.S. Court of Appeals for the Seventh Circuit, a vocal opponent of the ACA, to replace the late Justice Ruth Bader Ginsburg on the Supreme Court.

“The nomination of Judge Barrett increases the chances that the health law and its protections for people with preexisting conditions could be invalidated,” said Larry Levitt, Kaiser Family Foundation’s executive vice president for healthcare policy. “Preexisting condition protections will be front and center in the campaign.”

Biden hasn’t only vowed to make sure people with preexisting conditions remain covered, he’s also promised to restore aspects of the ACA that have been repealed under the Trump administration.

Nevertheless, he may have a difficult time undoing Trump’s healthcare changes.

While both leaders point to the goal of lowering out-of-pocket costs for Americans, Jay Wolfson, a University of South Florida distinguished service professor of public health medicine and pharmacy, notes that “as we transition back into Trump or into Biden, a long-term issue not resolved by anybody is, how are we going to pay for this?”

Biden plans to expand the ACA in numerous ways, ultimately ensuring medical coverage for more Americans, and lowering out-of-pocket costs overall. Photo by JIM WATSON/AFP via Getty Images

3. Lowering prescription drug prices

Both President Trump and former Vice President Biden see skyrocketing prescription drug prices as a crucial issue in need of reform, but Biden believes federal government intervention should play a bigger role in that reform process than Trump does.

4. Expanding Medicare and Medicaid

Medicare and Medicaid are two different healthcare programs run by combined efforts of the federal and the state governments.

Medicare helps U.S. citizens ages 65 and older pay for medical expenses, while Medicaid assists low-income groups with healthcare expenses.

“Trump has looked to make a number of administrative changes on Medicaid, giving states more authority, many of which have been criticized,” said Levitt. “The biggest one is work requirements for Medicaid enrollees.”

The president supports lowering prescription drug costs but hasn’t actively passed legislation on this yet, Levitt says.

Trump has broadened Medicare coverage of telehealth during the pandemic and expanded Medicare Advantage benefits.

Biden has said he aims to expand Medicare and Medicaid (both aspects of his plan to further expand the ACA) in an effort make healthcare coverage available to more than 97 percent of Americans.

Biden has said he would also offer premium tax credits for middle-class families.

5. Transparency for medical pricing and network coverage

Both candidates support greater transparency in medical pricing and network coverage.

Both also support halting surprise billing for out-of-network costs.

6. Healthcare equality for marginalized communities

Recognizing the needs of marginalized communities due to inequalities in healthcare is an area in which the two candidates vastly differ.

The president has focused on economic opportunity as a way to support the Black community.

On Friday, he announced the Platinum Plan, a $500 billion economic plan designed to increase opportunities for Black Americans.

The plan promises “better and cheaper healthcare” and investments in treatments for kidney disease, diabetes, and sickle cell anemia, conditions that disproportionately affect Black communities.

Taylor criticized the Platinum Plan as “a day late and a dollar short.”

“He is 4 years in and we have seen no comprehensive plan to address inequality for African Americans under the Trump administration. Furthermore, Trump policies have done nothing but deepen inequities for low-income people and people of color throughout this country,” she said.

Taylor said that Biden, in contrast, has been consistent and clear about “addressing health inequalities as well as ensuring coverage for those who have fallen into the gap.”

“Biden has talked about maternal mortality for women of color, ensuring mental health coverage regardless of sexual orientation, ensuring access to quality generics. The list goes on and on,” Taylor said. “All of these issues are essential to addressing disparities as well as the gap for folks of color.”

In fact, Trump has rolled back healthcare protections for LGBTQ people, actions Biden has pledged to reverse.

“You could characterize this election as Biden looking to roll back so much of what Trump has done, and protections for LGBTQ people is one of those areas,” Levitt said.

“If elected, the question is not which regs would he try to roll back, but which would he try to get to first, and how quickly he could work through the whole list,” he said.

7. Increase funding for community health programs

“We are at an important time in our country when racial injustice is threaded into all issues: criminal justice, economics, healthcare,” Taylor said.

She added that “racial justice is not a priority” for the current administration. Whereas, with the Biden campaign, “racial justice is built into their platform on all threads.”

Day believes the Biden-Harris ticket will address this issue in practical terms.

“I don’t think this duo is going to defund the police,” she said, “but I do think they are going to look at reallocating funding toward other things that activists find important. It’s radical incrementalism.”

8. Reproductive health

In the arena of reproductive and women’s health, Trump and Biden couldn’t be more polarized.

Future Supreme Court picks could affect women’s reproductive rights, potentially reversing a woman’s right to choose.

Under a Biden-Harris administration, Taylor said she believes “we would see pro-choice nominees, someone who supports expanding reproductive healthcare coverage.”

Before joining the Republican Party, Trump publicly supported abortion, but since running for president, he’s worked to chip away at abortion access, making it a primary platform of his campaign and administration.

Abortion is a key issue among Trump supporters, and the president has made personal and policy decisions accordingly, including being the first president to attend a national March for Life, and attacking funding for Planned Parenthood and reproductive health services.

He’s also appointed conservative-leaning judges to the Supreme Court, and on Saturday nominated Judge Amy Coney Barrett (whose judicial record favors restrictions on abortion access) to replace the late Justice Ruth Bader Ginsburg, a vocal defender of abortion rights and access.

“Reproductive rights and the future of the Affordable Care Act are on the line with this nomination,” Taylor said. “President Trump could not have picked a nominee more opposite to the values and legacy of the late Justice Ruth Bader Ginsburg.”

Biden, a Catholic, has also shifted his public views on abortion over the 50 years he’s been in public service, but for decades now he’s supported protecting the constitutional right to choose through every branch of government.

Trump launched a plan to end the HIV epidemic, aiming to reduce transmissions by 90 percent by 2030. However, he is actively fighting to repeal the ACA, thereby reducing coverage and access services for people who are living with HIV. Photo by MANDEL NGAN/AFP via Getty Images

9. HIV education, research, and treatment

Both Trump and Biden say they’re committed to effecting major change in the HIV epidemic by 2025 through funding of education and prevention, but their opposing approaches to the ACA yield different results in access to treatment and services.

10. Mental health

“It’s troubling that in the middle of a pandemic where mental health needs have increased dramatically, there has been little discussion of what to do about it [under the current administration],” Levitt said.

Levitt points out that there are also big differences between Trump and Biden on the issue of mental healthcare.

“Biden has pledged to enforce mental health [inclusion] with coverage. [That inclusion] would roll back dramatically if the ACA is repealed,” he said.

However, despite their different approaches, Wolfson says one issue on which President Trump and Biden are essentially on the same page is mental healthcare for U.S. military veterans.

“They are both looking to address veterans, help the folks in service and out, and, once they become vets, address the depression and suicide that has grown in epidemic proportions,” Wolfson said.

“Outside of that, the president doesn’t have an interest in behavioral health, whereas Biden thinks behavioral health issues are related to physical health and well-being,” he added.

Wolfson also points out that Biden has said he would support more resources for psychologists, psychiatric nurses, and counselors across the healthcare field.

11. The opioid crisis

The president and the former VP have both publicly declared opioids a national crisis, and already have or intend to allocate federal funding to the issue.

Illustrated by Ruth Basagoitia

You can download a printable copy of our Healthcare Comparison Guide here:

How Healthline determined these comparisons

The Healthline News team analyzed the healthcare policies and proposals of both presidential candidates to date.

We based our analysis on the published policy outlines on each candidate’s official website, as well as public statements made by the candidates and their administration and/or campaign.

From there, we worked with our independent panel of health policy experts and senior editorial team to present where each candidate stands on key healthcare issues.

Our panelists:

  • Rosemarie Day, CEO of Day Health Strategies and author of just-released “Marching Toward Coverage: How Women Can Lead the Fight for Universal Healthcare” (Beacon, 2020)
  • Larry Levitt, executive vice president for health policy at Kaiser Family Foundation
  • Dr. Jamila K. Taylor, director of healthcare reform and senior fellow at The Century Foundation
  • Dr. Jay Wolfson, senior associate dean of Morsani College of Medicine and associate vice president of University of South Florida Health

Elizabeth Wallace contributes to Healthline, CNN Underscored, Architectural Digest, Domino, and Us Weekly, and is the author of “The Ambition Decisions: What Women Know About Work, Family, and the Path to Building a Life” (Viking, 2018).