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Rachel Feltman: For Science Quickly, this is Rachel Feltman. The 2024 election is approaching fast, and we’re here to help you prep for your trip to the polls. Over the last few months, Scientific American’s editors have been reporting on how Donald Trump and Kamala Harris approach the science-related policy issues that impact our everyday lives. They’ve been talking to experts on topics like gun violence, health care, immigration and more to help explain what a Trump or Harris presidency might mean for these issues in the years to come.
Today we’re going to be hearing from a few of those Scientific American editors about what they’ve learned. First up is Tanya Lewis, a senior editor who covers health and medicine, to give us a primer on how the 2024 election could impact reproductive rights.
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Tanya Lewis: Trump and Harris have pretty starkly different views and records on this topic.
Trump has had a pretty big impact on abortion access. He’s appointed three Supreme Court justices that helped overturn Roe v. Wade, and that led to abortion bans or [substantial] restrictions in about half of all U.S. states.
[CLIP: Donald Trump speaks at September’s presidential debate: “We’ve gotten what everybody wanted: Democrats, Republicans and everybody else, and every legal scholar, wanted it to be brought back into the states.”]
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Lewis: So Trump says that he wants to return abortion decisions to the states, and he has also said that he would veto a national ban if one were passed by Congress. But he’s also said, quote, “We’ll see [what happens].” And that’s not the only way that a national ban could happen; Trump could also just try to enforce the Comstock Act, which is a 19th-century obscenity law that [nominally] bans mailing of materials that are used for abortion. Trump’s VP pick, J. D. Vance, has previously stated publicly that he would support enforcing a national ban like the Comstock Act, but he’s since claimed that Trump wants the issue to be decided by states.
Project 2025 is the conservative agenda that Trump has distanced himself from but which was actually written by many of his former colleagues. And that project basically supports the use of the Comstock Act to roll back abortion rights. It also calls for reporting data on individual pregnancies and abortions to the U.S. government.
Abortion bans actually affect things like routine pregnancy care or emergency care. There are already women who are dying because of miscarriages or ectopic pregnancies. Doctors [in some states] are scared of actually acting in these cases because they are afraid that they’re gonna face criminal charges.
Trump has falsely claimed that Harris supports abortion “after birth,” but that’s actually a meaningless term because abortion is not a legal thing that can happen after birth anywhere in this country.
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Harris’s campaign has been much more focused on supporting reproductive rights, including abortion. The Biden-Harris administration actually signed several executive orders that protect abortion and abortion medication. The Biden-Harris administration has defended abortion access in a couple of different Supreme Court cases. One of them involved the approval of mifepristone, the abortion medication, by the [Food and Drug Administration], and another one involved emergency abortion care in Idaho.
The Biden-Harris administration expanded coverage of abortion-related travel and access to birth control under Medicaid, the government insurance program for low-income individuals. Harris has vowed to sign legislation that would protect abortion if she’s elected. Now, of course, this is dependent on whether or not Congress passes such legislation, which is somewhat unlikely in this environment.
[CLIP: Kamala Harris speaks at September’s presidential debate: “And I pledge to you, when Congress passes a bill to put back in place the protections of Roe v. Wade, as president of the United States, I will proudly sign it into law.”]
Lewis: In order to get around the roadblock of Congress, Harris has called for getting rid of the filibuster to help Democrats protect abortion access.
So coming back to Project 2025, that plan would strip away access to contraception by getting rid of the Affordable Care Act’s contraception mandate. Trump also weakened the Title X family-planning network, which provides low-cost contraception and reproductive health care. He did this by disqualifying clinics that provide abortions or abortion referrals.
The Biden-Harris administration supported birth control coverage under Medicaid, including from Planned Parenthood, which provides many reproductive health services in addition to abortion care.
With all this discussion of abortion and reproductive health, we should also talk about IVF; that’s in vitro fertilization. Once Roe was overturned the Alabama Supreme Court ruled that embryos [created through IVF] are considered children, so [several] IVF clinics paused or stopped treatment. Trump has said that he wants to make IVF free, but he doesn’t really have the power to do that without Congress. And it would be pretty unrealistic because Democrats in Congress actually introduced a bill to protect IVF, but Republicans blocked that bill both times.
Both Harris and her VP pick, Tim Walz, have said that they strongly support IVF. Walz himself said that his family used fertility treatment, although not IVF specifically, to conceive his children.
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So just to summarize: if elected, Donald Trump would likely continue to roll back reproductive rights, whereas Kamala Harris would likely protect them. The president has quite a lot of power to direct the Justice Department to enforce laws and to nominate Supreme Court justices, but the president can only do so much. I mean, the courts and state legislatures are also very important in this process, and there are actually 10 state-level ballot initiatives on abortion this year. So this election could have repercussions for years to come.
Feltman: Since Tanya recorded that explainer for us, the Biden-Harris administration has come out swinging with a proposal to expand coverage of over-the-counter contraception. If finalized, the proposed rule would allow people to access emergency contraception without prescriptions and for no additional cost. They’d also have free access to Opill, the daily oral contraceptive approved for over-the-counter sales in 2023.
That brings us to our next election issue, which is that health care in the U.S. is expensive—like, seriously. The U.S. famously pays more than other developed countries when it comes to prescription drugs and other medications. Both Trump and Harris claim to have solutions. Here’s Lauren Young, an associate editor for health and medicine at Scientific American, to walk us through their stances on affordable health care.
Lauren Young: The U.S. is facing many issues with affordable, accessible health care, and both presidential candidates say their agendas will improve it.
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Drug pricing has been a really big part of Harris’s campaign. She was very instrumental in the passing of the Inflation Reduction Act in 2022; she cast the tie-breaking vote in Congress. The Inflation Reduction Act is also called the IRA. This new legislation puts limits on drug price increases under Medicare; that’s the federal insurance program for adults age 65 and older.
So the IRA does a number of things. The most talked about in Harris’s campaign is this $35 monthly cap on insulin, which is a very important lifesaving drug for those with diabetes. It also made Medicare-covered vaccines free. Both of those things went into effect in 2023.
There are a couple things that will go into effect a little later. The IRA will put a $2,000 out-of-pocket annual spending cap on prescription drugs under Medicare starting in 2025. So to give a better understanding of what this will look like, cancer patients, for instance, who need those drugs, those medications can cost anywhere from $10,000 to $15,000 a year, but the IRA will drop that cap to $2,000.
The IRA also grants Medicare the ability to negotiate lower prices for certain medications. Ten drugs have already been selected for this, but people won’t start seeing those price changes at the pharmacy until January of 2026.
So Harris has said she plans on expanding the IRA as president. She would lower costs for even more drugs for those under Medicare. She’s also hoping to expand this out to other drugs that would be covered by private insurance and Medicaid.
But since those negotiations don’t go into effect until 2026, a Trump administration could theoretically try and block or undo this. They’d have to move super fast, but it’s not entirely impossible. My experts say that some Republican Party members worry that the new drug price negotiations might cause companies to lose incentive to innovate or produce new drugs, and many of the companies that produce those 10 drugs that have been selected have sued the government to stop those negotiations.
Trump tried to tackle prescription drug costs during his administration. In his final months in office he tried to enforce a couple executive orders. One of them was the “Most Favored Nation” pricing model, which would set certain clinician-prescribed drugs under Medicare at lower average costs that are closer to the price in other developed countries. The Biden administration pulled the plug on this order back in 2022. Trump originally supported bringing back the Most Favored Nation model if he were reelected, but he has recently walked back those statements.
Another big health care issue is access to affordable care. Trump has made a lot of false claims and exaggerations about his history with the Affordable Care Act—most famously was during the September debate with Harris, where he said he, quote, unquote, “saved” the ACA.
[CLIP: Donald Trump speaks at September’s presidential debate: “I had a choice to make: Do I save it and make it as good as it can be, or do I let it rot? And I saved it. I did the right thing.”]
Young: During his administration he repeatedly attempted to repeal the ACA. He failed to do so, but he made several legislative and budgetary decisions that weakened the act. For instance, he rolled back the ACA’s individual mandate tax penalty, which incentivizes people to enroll in health insurance. He also proposed budget plans that would have cut [about] $1 trillion from Medicaid.
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Trump’s exact plans for the ACA have been pretty ambiguous. During his campaign he’s implied he would keep it and make it stronger. Other times he’s promised to replace it with something better. Again, during that September debate he said he had “concepts of a plan” but then offered no details.
Trump’s running mate, J. D. Vance, gave some more details on what Trump’s plan could potentially look like. What he described was potentially drastic changes in insurance risk pools. Experts have said that his proposal could make coverage cheaper for those with fewer medical needs but way more expensive for those with higher ones. So this might undo the ACA’s protections that prevent insurers from discriminating against people with disabilities or preexisting conditions, as well as people who are pregnant.
Harris has made it pretty clear that she’d protect and strengthen the ACA. Harris has also strongly highlighted a proposal to waive medical debt from people’s credit reports. She also recently released plans to offer more funding support through Medicare for at-home health aides and long-term health care needs for seniors. If this passes, it would be the first time ever Medicare would cover these benefits.
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So there’s a lot on the table this election when it comes to health care. Ultimately, the next president is going to have a substantial influence on how you are able to receive health care and how much it’s going to cost you.
Feltman: Health care might be the most obvious issue where science policy and everyday life intersect, but it’s far from the only topic on the ballot this year. So let’s pivot to something completely different: nuclear proliferation.
Dan Vergano: My name is Dan Vergano. I’m a senior opinion editor at Scientific American. And I’ve been writing about the nuclear weapons policy aspects of the 2024 election.
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So among nuclear policy experts, the big surprise of this campaign has been how little discussion there has been of nuclear weapons. There’s a lot going on: Vladimir Putin has been waving the nuclear sword around for the last three years. We’re spending a lot of money on nuclear modernization in the U.S., and there’s been surprisingly little discussion of what is a pretty important matter.
Whoever wins this election faces real deadlines in terms of dealing with nuclear weapons. In 2025 the Iranian deal limiting them from developing nuclear weapons expires. We’ve already pulled out from that deal, but the Europeans and the Iranians have kept it going. And the fear is that unless we come up with something to replace that, that there’ll be a “nuclear breakout,” they call it, which means Iran getting the bomb, in the Middle East, and that will lead to everybody else there getting it, and the world becomes an exponentially more dangerous place.
After that, then 2026, they have to deal with the expiration of a deal between the U.S. and Russia to limit our nuclear warheads, which has kept the world safe for decades. And so the potential there is for the numbers of nuclear warheads that both of the two largest superpowers in the world, in terms of nuclear arms, possess to start ratcheting back up again and making the world an even more dangerous place—one of the triumphs of the Cold War ending. So these are gonna face whoever the winner of the election is.
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So going mostly off the Biden administration’s record, the expectation is that Harris would try to employ diplomacy first to continue these treaties, essentially to kick the can down the road to keep them in effect and to limit the number of warheads the U.S. and Russia have to build and pay for. On Iran, Harris recently said she would seek diplomacy first but that all options were on the table; that means the threat of military action to prevent Iran’s nuclear breakout.
With Trump his record is one of blustering, essentially, to try and get better deals with other countries and it not working out. He tried to engage China and Russia in an extension of the treaty limiting nuclear weapons deployments, and that didn’t work out at all. It was kind of a last-minute thing for the Biden administration, as soon as it came in, to keep that deal alive. [Trump] doesn’t seem interested in continuing it. With Iran he pulled out of the earlier deal and, again, doesn’t seem interested in making a deal with them, so that would seem to lead to Iran getting the bomb. There’s some hopes that we could somehow overawe them with our military power, but that hasn’t worked so far.
So the elephant in the room is Trump’s temperament. He talked about “fire and fury” with North Korea back in his administration and alarmed a lot of people, then had a rapprochement with North Korea that ended up yielding nothing in terms of a deal. North Korea has since increased its number of warheads. And the question is: Is he any more stable now than he was then? He seems genuinely concerned about nuclear war and has spoken at times about fears of “World War III.” He mentioned it in the debate.
[CLIP: Donald Trump speaks at September’s presidential debate: “We have wars going on in the Middle East. We have wars going on with Russia and Ukraine. We’re gonna end up in a third World War, and it’ll be a war like no other because of nuclear weapons, the power of weaponry.”]
Vergano: But, you know, he famously makes his decisions from the gut, is an impulsive leader. This typically isn’t what you want in a nuclear weapons setting; you want clear signaling and predictable responses that everyone can understand. That’s sort of been what we’ve been trying to do since 1953.
Voters should know that right now we’re spending a lot of money on nuclear modernization. It’s a $2 trillion planned program over 30 years, and that’s double the cost that it was initially promised for us back in the Obama and Trump administrations. So we’re spending a lot of money on nuclear weapons. No matter who wins, that seems bent on getting forward, and no one is discussing whether that’s a good idea or not.
Project 2025, which is seen as signaling the direction the Trump administration would take, calls for a much more aggressive program than the one we already have. It would increase the number of weapons, and it would resume testing of nuclear weapons, which we haven’t done since 1992, which was seen as a way of ratcheting down the nuclear threat. And it’s not clear what benefit there would be to that testing. It’s something that defense hawks have sort of called for for a while, but it’s not one that sort of would settle the temperature of the world.
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The take-home is that a lot is going on in nuclear weapons, and voters aren’t really thinking about it or hearing about it. You should know that a program is continuing that’s gonna spend a lot of money on this, and the question is a matter of degree: Do you want an aggressive program or do you want a merely busy one going on? There doesn’t seem to be a lot of questioning of the role of nuclear weapons in the world, which is pretty curious because they are very important.
Feltman: That’s all for today’s episode, but we’ve got more election coverage coming your way. Stay tuned for part two on Monday, which we’ll be airing in place of our usual news roundup. We’ll hear from a few more Scientific American editors to learn where Trump and Harris stand on climate, energy, gun violence, education and immigration. And, yes, all of those are science and health policy issues. So if you're not sure how, definitely tune in.
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Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Madison Goldberg and Jeff DelViscio. This episode was reported and co-hosted by Tanya Lewis, Lauren Young and Dan Vergano. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.
For Scientific American, this is Rachel Feltman. Have a great weekend, and don’t forget to vote!
