Trump vs. Harris on health care: ‘Maintain and grow’ the ACA, or develop ‘concepts of a plan’ to replace it?

ABC News posted this image from the Sept. 10, 2024, debate between presidential candidates former President Donald Trump, a Republican, and Vice President Kamala Harris, a Democrat. © Saul Loeb/AFP via Getty Images

America’s presidential candidates said they will work to “maintain and grow the Affordable Care Act” (ACA) or develop “concepts of a plan” to replace it with “something better and less expensive.”

The future of American health care also will involve deliberations on abortion access and reproductive rights, according to Republican hopeful former President Donald Trump and Democratic hopeful Vice President Kamala Harris. They took the stage Sept. 10 in what may be their only debate.

Trump and Harris split across a range of issues, but neither unveiled specific details for sweeping changes across major issues in American health care. ABC News hosted the 90-minute debate and it included questions on health care by newscasters Linsey Davis and David Muir.

‘Obamacare was lousy health care’

As a third-time presidential candidate, Trump “long vowed to repeal and replace the Affordable Care Act, also known as Obamacare. You have failed to accomplish that,” Davis said. She asked Trump about his plan.

“Obamacare was lousy health care. Always was. It's not very good today,” Trump said. “And what I said, that if we come up with something, we are working on things, we're going to do it and we're going to replace it.”

Trump said he inherited Obamacare, and better health care reforms would have been possible, but Democrats would not vote to change it.

“I had a choice to make when I was president, do I save it and make it as good as it can be? Never going to be great. Or do I let it rot?” Trump said. “And I felt I had an obligation, even though politically it would have been good to just let it rot and let it go away.”

He added he would let Obamacare run as good as it can be run.

“So just a yes or no, you still do not have a plan?” Davis asked.

“I have concepts of a plan,” Trump said. “I'm not president right now. But if we come up with something I would only change it if we come up with something better and less expensive. And there are concepts and options we have to do that. And you'll be hearing about it in the not-too-distant future.”

‘Heath care should be a right’

Turning to Harris, Davis noted she previously supported Sen. Bernie Sanders’ proposal to eliminate private insurance in favor of a government-run health care system. Two years later, Harris pitched plan with a private insurance option.

Harris said as vice president, she has supported private health care options, and said Trump tried to get rid of the ACA 60 times. She cited her experience with deliberations in the Senate, where the late Sen. John McCain, supported ACA.

Historically, ACA also eliminated the ability of insurance companies to deny coverage to people with pre-existing conditions, Harris said.

“I don't have to tell the people watching tonight, you remember what that was like? Remember when an insurance company could deny if a child had asthma, if someone was a breast cancer survivor, if a grandparent had diabetes?” Harris said. As vice president, she pointed to the President Joe Biden’s administration work to negotiate drug prices for Medicare and cap costs of insulin and prescription drugs for seniors.

“And when I am president we will do that for all people understanding that the value I bring to this is that access to health care should be a right and not just a privilege of those who can afford it,” Harris said.

‘We could do much better’

Trump countered that McCain fought Obamacare for 10 years, but Democrats kept it going.

“And you know what? We could do much better than Obamacare. Much less money,” Trump said. “But she won't improve private insurance for people. Private, medical insurance. That's another thing she doesn't want.

“She wants everybody to be on government insurance where you wait six months for an operation that you need immediately,” Trump said about Harris.

Abortion rights

Regarding reproductive rights, Harris called out Trump for hand-selecting three U.S. Supreme Court justices who would overturn the landmark Roe v. Wade abortion ruling, and they did so.

“And now in over 20 states there are Trump abortion bans which make it criminal for a doctor or nurse to provide health care. In one state it provides prison for life,” Harris said. She hammered Trump on the point and said as president she would sign into law a bill to put back in place the protections of Roe v. Wade, while Trump would support a national abortion ban.

Trump called that “an absolute lie,” saying he is not in favor of an abortion ban.

“It's a lie. I'm not signing a ban. And there's no reason to sign a ban,” Trump said. “Because we've gotten what everybody wanted. Democrats, Republicans and everybody else and every legal scholar wanted it to be brought back into the states. And the states are voting. And it may take a little time, but for 52 years this issue has torn our country apart. And they've wanted it back in the states. And I did something that nobody thought was possible. The states are now voting.”

Quotations from the debate were taken from the full transcript posted online by ABC News.