EXCLUSIVE: Trump’s healthcare plan would be ‘catastrophic’ for North Carolinians, a new Harris-Walz report says 

Trump’s healthcare ‘concepts’ include repealing the Affordable Care Act, which would strip health insurance from more than 1.5 million North Carolinians, increase costs, and put people with preexisting conditions at risk of losing their coverage, the Harris-Walz report says.

During his debate with Kamala Harris last month, Donald Trump said that after nine years of running for president, being president, and running again, he finally had “concepts of a plan” to replace the Affordable Care Act (ACA) and improve healthcare access across the country.

But while Trump faced renewed criticism for his continued lack of specifics, a new detailed report from the Harris-Walz campaign says that though his “plan” may still be vague, his record is clear enough to reveal what his second term healthcare message would be: “You’re on your own.”

Repealing the ACA combined with Trump’s other healthcare “concepts,” the Harris-Walz report says, would strip health insurance from more than 1.5 million North Carolinians, drive up prices for most of the people who keep it, and put people with preexisting conditions at risk of either losing their coverage or paying astronomical premiums.

The Harris-Walz report draws on an array of independent studies, analyses, media reports, data, and a review of Trump’s statements, plans, details, and comments over the last eight years.

It also factors in comments from JD Vance, Trump’s running mate, and Project 2025, a vast policy document that Trump has tried to distance himself from, but was written by more than 140 members of his administration.

“After nearly a decade of endlessly promising to reveal his health care plan, Donald Trump claims he only has ‘concepts of a plan,’” the report says. 

“The truth is he does have a plan—he just doesn’t want voters to know about it.”

Trump repeatedly tried and failed to repeal the ACA during his first term and told his party just last year that they should “never give up,” and that he was “seriously looking at alternatives.”

Those alternatives, the report suggests, are not only repealing the Affordable Care Act, but also repealing the Inflation Reduction Act, which lowered drug costs for seniors. He would also restrict access to abortion nationwide, the report says.

How would these policies affect North Carolinians?

• The 1 million people who currently get coverage via the ACA insurance marketplace and the 539,000 low-income residents who gained access to insurance through Medicaid expansion last year would lose their coverage. 
• Health care premiums would increase for more than a million people in the state, the report says, with “a middle-class family potentially facing premiums over $12,000 more” than they pay now.
• More than 4.2 million people with preexisting conditions would be entered into “high-risk pools,” effectively forcing them to pay higher premiums. Such a move would ultimately cause higher risk individuals to lose their coverage outright or be charged thousands of dollars more.
• Seniors could see their premiums climb by up to $15,000 and pay more for insulin and other necessary medications. 
• More than 2.1 million women would see their reproductive rights threatened.

Since the ACA was largely funded by taxes on wealthy corporations and individuals, a repeal would also mean the country’s 100 wealthiest people would get a combined tax cut of more than $12 billion. 

But they are the only ones who would benefit, the report says.

“Trump’s concepts of a plan would be catastrophic,” the report says.

‘Every American … is at risk.’ 

Trump’s plans, the report says, would benefit the super-wealthy and pharmaceutical industry, even as they harm “almost all of America.”

It added: “Every American, no matter their connection to the health care system, is at risk.” 

• The plans would cause 4.2 million small-business owners and entrepreneurs to lose their health insurance, the report says.
• Ending the federal payments tied to the ACA’s Medicaid expansion could force hundreds of rural hospitals across the country to close, while allowing many drug companies to pay $0 in federal taxes. (North Carolina already has one of the highest numbers of health care deserts in the country.)
• Trump has suggested he would repeal the Biden administration’s Inflation Reduction Act, which capped insulin costs to $35 per month for seniors on Medicare, and, starting in 2025, will cap  out-of-pocket drug expenses at $2,000 per year for those on Medicare. He would also ease regulations requiring pharmaceutical companies to negotiate prescription drug prices with Medicare, causing prices to rise even higher. 

High-Risk Pools

Soon after the debate, Trump’s running mate JD Vance hinted that Trump favored a return to “high-risk pools,” a part of health care coverage before the Affordable Care Act when insurers were allowed to make coverage unattainable for those who needed it most. 

The pools meant that sick people paid nearly double the premiums of healthy people, and made it nearly impossible for people with many preexisting conditions to get coverage at all. 

The pools also often limited enrollment and capped how much insurers would pay across a person’s lifetime.

Those who were stuck in the high-risk pools in North Carolina often faced severe consequences. 

“Most people enrolled in North Carolina’s high-risk pool had to wait at least twelve months before they could get coverage for those conditions,” the report says, citing a 2015 report from the Duke University Health Justice Clinic and the Southern HIV/AIDS Strategy Initiative.

“As for affordability, one analysis found that some people in North Carolina would have to pay a

third of their income just on premiums—before even getting to other expenses,” the report continues, citing the same Duke analysis. 

Vance and Trump have said they would still prevent insurers from denying coverage to people with preexisting conditions, but a return to “high risk pools” would mean that insurers could still charge these patients a lot more, effectively denying them coverage in many cases without expressly denying them coverage. 

“If you get really sick or even pregnant, you will have to pay a lot more money for health care because you can no longer get health insurance at the same price,” the Harris-Walz report says.

If insurers are allowed to target preexisting conditions again, the report continues, then North Carolinians with cancer, alzheimer’s disease, multiple sclerosis, heart disease, epilepsy, kidney failure, a history of strokes, brain tumors, ALS, HIV, asthma, and more than 70 other serious ailments could find themselves without coverage. 

Abortion rights

Trump has tried to soften his image on the abortion rights issue, in part because he knows abortion bans are unpopular with most Americans. Trump said during the debate that by appointing the Supreme Court justices who ultimately struck down the abortion protections of Roe v. Wade, he helped bring the issues directly to the voters in each state.

But that’s not at all what happened. 

State legislatures control abortion policy now, and most Republican-controlled legislatures, including North Carolina’s, have refused to let voters decide.

And though Trump has dodged questions of whether he would sign or veto any national abortion ban that comes to his desk, Project 2025, which he once called the “groundwork” of “our movement,” wants to block nearly all access to medication abortion, the most common form of abortion in the United States.

“Donald Trump continues to brag about his role in overturning Roe v. Wade and unleashing these

cruel bans across the country,” the report says. “Yet if elected, he and Vance would go even further. The impacts of their anti-freedom agenda would be devastating.”

Here are some of those potential impacts:

• Repealing the ACA would end its requirements that insurers cover contraception.
• Project 2025 would allow emergency room doctors to refuse to treat women who need abortion care to save their lives.
• Project 2025 would also push states to track several aspects of abortion care, including the reason the patient sought an abortion and the “gestational age of the child.” It would also track the number of miscarriages and stillbirths, raising the possibility that states with severe abortion bans might use that data to pursue criminal charges against abortion providers.
• And it claims as a defining principle that life begins at conception, a belief that the Alabama Supreme Court used to block access to IVF, a fertility treatment that utilizes frozen embryos.

Nearly a decade of data

While many of Trump’s health care details have been bare bones, this is not the first analysis to show what kind of beast that skeleton forms.

Under his 2016 plan to repeal the ACA, up to 25 million people would have lost their insurance, a Commonwealth Fund analysis showed. And the plan would have added up  to $41 billion to the federal deficit.

While the Trump administration was unable to repeal the law, it did chip away at some of the provisions, like ending the mandate requiring most individuals to have insurance or pay a small tax penalty. These cuts weren’t always deep, but they still bled. 

The ACA reduced the number of non-elderly citizens without health insurance by nearly 50%, for example.  During the Trump administration, the number of uninsured nonelderly individuals rose again.

Trump also allowed insurance companies to sell cheaper, short-term plans (often derided as “junk insurance”) that didn’t cover preexisting conditions and offered only limited coverage. 

‘Peace of mind’

There are still serious challenges and problems to solve in the healthcare space, Harris has admitted.

Americans spend more on healthcare than any other country, by far, and even with insurance, health care leaves lots of Americans with exorbitant expenses and sometimes staggering medical debt.

Harris has vowed to eliminate medical debt for millions of Americans and has backed a proposed federal rule that  would remove medical debt from credit reports. 

Harris has also proposed expanding the $35 monthly insulin cap and the $2,000 annual cap on out-of-pocket drug costs so that they apply to all Americans, not just seniors on Medicare. 

She has additionally said she would build on efforts to reduce the country’s soaring maternal mortality rate, which disproportionately affects Black women, by incentivizing states to expand their Medicaid coverage to include postpartum care. North Carolina’s maternal death rate is higher than the national average. 

The differences between the candidates in healthcare policy, the Harris-Walz reports says, is why many health care groups are supporting Harris.

“A group of almost 50 former leaders of national health care and delivery organizations warned of Trump’s threat to public health,” the report says.

While there is still a partisan divide on the ACA its provisions remain popular with the general public.

And the longer it hangs around, the more its favorability grows.

“Americans want the Affordable Care Act, Medicare and Medicaid protected,” the report says.

“They want lower drug prices, capped insulin prices and out-of-pocket costs, and protections for people with preexisting conditions. They want to know that if they or a family member gets sick, they can see a doctor and get the medication they need without going bankrupt. They want to defend reproductive freedom. They want a health care system that treats them with dignity and gives them peace of mind,” it says.

“Trump and Vance,” the report concludes, “do none of this.”