On health policy, Biden and Trump both have records to run on — and stark contrasts

Health care in the U.S. is undeniably expensive. This is a point that President Biden and former President Donald Trump actually agree on. They've both talked about the problems of costly prescription drugs, surprise emergency room bills and the need for price transparency in health care.

But in general, their ideas on how to address these problems with the health care system are very different.

Here are some ways that the two presidential candidates differ in their approach to health policy.

Obamacare feast or famine

Trump talked about the "disaster" of Obamacare all the time as president and nearly succeeded in repealing the whole Affordable Care Act (ACA). Although that effort failed, he did pull back federal support for the state marketplaces — all accessed via Healthcare.gov — where people who don't get insurance through their job can go to buy a health plan.

A major way he did this was by slashing the budget for advertising and for navigators — staffers at nonprofits that get federal grants to walk people through the process of finding a plan and signing up.

"During the Trump administration, we went down to a budget of only $100,000 a year in those years," says Jeremy Smith, a navigator with First Choice Services, based in West Virginia. "It was only just a couple of us working on the program."

Then when Biden took office in 2021, Smith says, the change was dramatic. "Our funding increased by more than tenfold — we went from $100,000 a year to over a million dollars a year. So that was just huge — it just made our head swim," he says, adding that the money allowed him to create remote offices around West Virginia and add bilingual staff.

Biden announced Friday that there would be $500 million available over the