Healthcare in 2028
Health insurance coverage, drug prices, and the long-running debate over the structure of the American health system.
The United States spends far more per person on healthcare than other wealthy nations while leaving tens of millions uninsured or underinsured. The Affordable Care Act expanded coverage significantly but left major gaps, and debate over healthcare's structure has continued for decades.
Drug prices - particularly for insulin and other essential medications - became a flashpoint in the early 2020s, with Congress ultimately authorizing limited Medicare negotiation. Prescription drug affordability remains a cross-partisan concern.
The 2028 debate will center on whether to expand, modify, or shrink the existing insurance framework; whether to move toward a government-financed system; how to address hospital and insurer consolidation; and how to keep health costs manageable for families and employers.
Why it matters in 2028
Healthcare affects nearly every American directly, whether through insurance premiums, out-of-pocket costs, or access to care. The 2028 candidates will need to address a system that most voters consider broken or too expensive, while navigating deep disagreements over the role of government versus markets in delivering care.
How each party frames healthcare
A neutral summary of each party's general governing approach. Individual 2028 candidates will differ - no nominee has been chosen yet.
Democratic approach
Democrats broadly favor expanding public options and government-negotiated prices to increase coverage and lower costs. Many in the party support building on the ACA with a public insurance option or expanding Medicare eligibility. There is a significant faction that backs a single-payer system, though that position remains contested within the party. Across factions, Democrats emphasize protecting coverage for pre-existing conditions.
Republican approach
Republicans generally favor market-based approaches to healthcare - expanding competition, reducing regulation, and shifting more decision-making to states and individuals. Many in the party support repealing or scaling back the ACA and replacing it with mechanisms like health savings accounts. Republicans tend to oppose government negotiation of drug prices as interference in markets, though drug affordability has become a bipartisan pressure point.
What voters ask about healthcare
- What would candidates do about people who cannot afford health insurance?
- How would candidates lower prescription drug prices?
- Is Medicare for All or a public option on the table?
- What happens to people with pre-existing conditions under each candidate's plan?
- How would candidates address hospital and insurance company consolidation?
Other 2028 issues
How 2028 candidates plan to manage economic growth, consumer prices, and the cost of living.
Border enforcement, legal immigration pathways, and the future of undocumented immigrants already in the U.S.
Federal and state abortion policy after the Supreme Court returned the issue to state legislatures in 2022.
Federal tax policy, including the expiring provisions of the 2017 tax law and disputes over who pays what.
Employment levels, minimum wage, union rights, and the future of work in an era of automation and AI.
The future solvency and structure of the two largest federal entitlement programs for older Americans.