Q&A: Experts discuss health care and the 2024 presidential election 

Health care has often taken a central role in political campaigns, and the 2024 presidential election is no different. But the debate around health care isn't just about policy. The issues at stake—such as health care coverage and affordability, reproductive health and substance use disorders—affect individuals and families in Pennsylvania and across the nation, making them a high priority among voters.

Penn State News spoke with four faculty experts about the pressing issues and how they may impact voters and their families.

How has political polarization changed the way government approaches policy making, especially when it comes to key issues like health care?

Daniel Mallinson, associate professor of public policy and administration at Penn State Harrisburg, studies why states adopt innovative policies and what we can learn from the individual and macro-level patterns of policy and is particularly interested in Pennsylvania state politics.

Mallinson says, "Our recent research has demonstrated that polarization is exaggerating the dynamics of policymaking in Congress. By that I mean that there are longer periods of relative stasis, where either nothing gets done or things change incrementally, but when change happens it tends to be bigger.

"Health care, specifically the Affordable Care Act (ACA), is a good example. Changes to national health care policy took a very long time, but when the political dynamics were right, it resulted in a major policy change. We also see that those big changes tend to be less bipartisan, which helps explain the exaggeration in stasis for many policy areas."

How has the Affordable Care Act affected health care coverage and access? If the ACA is repealed, how does that affect me and my family?

Dennis Scanlon, distinguished professor of health policy and administration, studies health policy and reform and can speak to health care affordability and efforts to fairly distribute funding resulting from opioid manufacturers and distributors.

Scanlon explains, "Overall, the Affordable Care Act has helped people get health insurance and increased the number of people with health insurance in the United States.

"It's highly unlikely that the ACA is going to be repealed. If anything were to be repealed, it's more likely to be pieces of the ACA that are dismantled. The impact would depend on what pieces are dismantled and one's individual circumstances. For example, if an individual currently receives subsidies to buy insurance on the health care exchange and if those subsidies are broken up, that may influence their choice in terms of whether or not they become or stay insured."

How has the Dobbs decision—the landmark Supreme Court decision in June 2022 that overturned the constitutional right to abortion—changed reproductive health care such as patient access to care?

Sarah Horvath, assistant professor of obstetrics and gynecology at Penn State College of Medicine, is available to discuss reproductive health care, including access to reproductive health services, contraceptive counseling, miscarriage management and the safety of mifepristone, one of two medications used in a medication abortion.

Horvath notes, "The impacts of the Dobbs decision are geographically dependent. Many of the total bans and early bans on abortion are clustered across a wide swath of the South. What we've seen is that in those states, there's been a huge drop in the overall volume of abortion care being provided. But if you look at the data from the whole country, we've actually seen an increase in the volume of abortion care being provided.

"What that means is that people must travel for care. It's really deepened the inequities in access to care because those who have the resources to travel will travel and the people who don't can't.

"It's also affecting access to ongoing pregnancy care because these policies have had a chilling effect on providers. Take Idaho, for example. It's a state that already had too few obstetricians and maternal-fetal medicine specialists, who care for high-risk pregnancies. There's been an exodus of providers from the state, which means that people toward the end of their pregnancies are now traveling to neighboring states just to access normal obstetrical care."

Have more restrictive reproductive health care policies had any surprising effects?

"We're seeing a lot of trickle-down effects. I provide care for complex miscarriage, stillbirth, ectopic pregnancy and other conditions, and we're seeing that the medications and techniques used to treat these conditions are affected too," says Horvath. "There are states where the medication mifepristone isn't available for miscarriage management, even though we know it improves outcomes. It makes care more efficient, safer and better for mom, but we're not giving people access to this medication because of its association with abortion. Similarly, some medications to treat cancer or conditions like rheumatoid arthritis are harder to access because of their historical association with abortion care. Women can no longer access these medications, but men can.

"We're also witnessing brain-drain in the profession. It's not just OBGYN, but it's also impacting family medicine doctors and, in one survey, even psychiatrists were considering leaving states because of the lack of ability to provide full care to their patients. Even among medical students, there's been a decrease in interest in residency programs in states with abortion bans across the board in all specialties."

How has the increase in substance use disorders, particularly opioid use, affected our society both nationally and in our communities?

Abeena Jones, Ann Atherton Hertzler Early Career Professor in health and human development and assistant professor of human development and family studies, has expertise in the social and structural determinants of substance use among vulnerable populations.

Jones says, "Substance use continues to be a pressing national concern as drug overdose deaths continue to climb. Substance use affects communities and the nation through the breakdown of families, particularly when the criminal legal system and child welfare are involved, increases health care costs and loss of productivity, impacts educational attainment and increases in infectious diseases such as HIV and Hepatitis C.

Are there populations that are disproportionately affected by substance use disorders?

"Populations most affected include vulnerable and marginalized groups who face a disproportionate burden of poverty and limited social mobility, and who live in under-resourced areas, such as rural communities or low-income urban areas," explains Jones.

"Moreover, available data suggests that soaring overdose deaths among racially/ethnically minoritized individuals are mainly attributed to poor quality drugs and fentanyl contamination often found in under-resourced areas and lack of access to quality substance use treatment, overdose reversal drugs and harm reduction services."