The State of Health Insurance Coverage and the 2024 Election in the USA

Health insurance coverage policy has been a perennial concern in recent US elections. Between 2008 and 2018, the design and fate of the Affordable Care Act (ACA), and particularly its coverage provisions, dominated political debate. In this election cycle thus far, however, neither party has made health coverage a priority and that absence must end. Recent gains in health insurance coverage cannot be sustained, let alone improved upon, without future policy action.

In the last quarter of 2019, immediately before the COVID-19 pandemic, 10.7 of the US population lacked health insurance according to quarterly estimates from the National Health Interview Survey. The uninsurance rate reached a historic low of 9.1 in the first quarter of 2022 and continued to decline in 2023. Estimates of uninsurance rates during the of 2023 were below the corresponding 2024

As the United States gears up for the 2024 presidential election, one of the most pressing issues on the minds of voters is healthcare. At the center of this debate is the state of health insurance coverage in the country. Over the past several years, healthcare has been a hot-button topic, with discussions ranging from access and affordability to the quality of care provided. With the COVID-19 pandemic further highlighting the importance of accessible healthcare, the state of health insurance coverage has become a critical focal point in the upcoming election.

The Current Landscape

Prior to delving into the implications for the 2024 election, it’s crucial to understand the current landscape of health insurance coverage in the USA. Despite significant strides made with the Affordable Care Act (ACA) under the Obama administration, millions of Americans still lack adequate health insurance coverage. While the ACA expanded Medicaid coverage for low-income individuals and established marketplaces for purchasing insurance plans, coverage gaps persist, leaving many uninsured or underinsured.

Furthermore, the COVID-19 pandemic has exacerbated existing disparities in healthcare access and coverage. Unemployment surged as businesses shuttered their doors due to lockdown measures, resulting in millions losing their employer-sponsored health insurance. The pandemic highlighted the fragility of tying healthcare coverage to employment status and underscored the need for a more robust and inclusive system.

Election Implications

Against this backdrop, the state of health insurance coverage is poised to play a significant role in shaping the 2024 election. The competing visions put forth by political candidates will undoubtedly influence voters’ decisions at the ballot box.

For Democrats, expanding access to healthcare and strengthening the ACA remain top priorities. Candidates may advocate for measures such as a public option, allowing individuals to buy into a government-run insurance plan, or even advocating for a single-payer system, wherein the government provides healthcare coverage for all citizens. These proposals aim to reduce the number of uninsured Americans and lower healthcare costs by increasing competition and negotiating drug prices.

On the other hand, Republicans may push for a more market-driven approach to healthcare reform. This could involve rolling back certain provisions of the ACA, such as the individual mandate, and promoting health savings accounts as a means of empowering individuals to take control of their healthcare spending. Republicans may also emphasize the importance of state flexibility in designing healthcare programs, arguing that one-size-fits-all federal solutions are ineffective and burdensome.

Key Issues

Several key issues will likely dominate the discussion surrounding health insurance coverage leading up to the 2024 election:

Affordability: The rising cost of healthcare remains a significant concern for many Americans. Premiums, deductibles, and out-of-pocket expenses continue to strain household budgets, making it difficult for some individuals to afford necessary medical care.
Pre-existing Conditions: Protections for individuals with pre-existing conditions have been a cornerstone of the ACA. Any attempts to dismantle or weaken these protections could have far-reaching consequences for millions of Americans with chronic illnesses or past medical issues.
Medicaid Expansion: Medicaid expansion has been a point of contention between states, with some opting to expand coverage under the ACA and others choosing not to. The availability of Medicaid can have a significant impact on the uninsured rate within a state, particularly for low-income individuals and families.
Access to Mental Health Services: The importance of mental health services has gained increased recognition in recent years, yet access to these services remains limited for many Americans. Addressing mental health parity and expanding access to mental health resources will likely be important considerations for voters.
COVID-19 Response: The handling of the COVID-19 pandemic, including vaccine distribution and access to testing and treatment, will undoubtedly factor into voters’ perceptions of candidates’ abilities to manage healthcare crises effectively.
This election is shaping up to be the first in a long time when health insurance coverage policy is not a crisis. But the apparent stability hides serious underlying risks. As the parties begin to formulate their platforms, we should demand that candidates lay out their vision for maintaining affordable health coverage over the next decade. That means, at the very least, affirming continued support for Medicaid expansion (rather than supporting a shift in the level or nature of the federal contribution), pledging to extend the enhanced Inflation Reduction Act subsidies for ACA Marketplace enrollees, and committing to regulatory actions that expand coverage further. Better yet, candidates should be urged to articulate plans for extending coverage even more, including by encouraging holdout states to participate in Medicaid expansion.

The state of health insurance coverage in the USA is a complex and multifaceted issue that will undoubtedly influence the outcome of the 2024 election. With millions of Americans still lacking adequate coverage and healthcare costs continuing to rise, voters are looking to political candidates for solutions that address these pressing concerns.

As the election season unfolds, candidates from both parties will need to articulate their visions for healthcare reform and convince voters that their proposed policies will lead to better access, affordability, and quality of care for all Americans. Ultimately, the outcome of the election will shape the future of healthcare in the USA for years to come.

Scroll to Top