In this Instagram Live interview, MedPage today editor-in-chief Jeremy Faust, MD, and Anand Parekh, MD, MPH, of the Bipartisan Policy Center in Washington, DC, discuss the upcoming election and what the results could mean for our health care system.

The following is a transcript of their remarks:

Faust: Actually, let’s get right to it and get to probably the most divisive issue, which is reproductive care and abortion rights and women’s issues. Tell me where the bipartisan light is.

Parekh: It’s tough. There’s not much light, and Vice President Harris wants to make sure that if she’s elected, she wants to code Roe v. Wade through Congress. It will be hard to do, but that is her goal.

President Trump wants to — he’s not talking about a national ban anymore, but he certainly seems okay with letting the states handle it. And more than 40 states have some restrictions on abortion. At least over a dozen have severe restrictions, and so this is absolutely a big gap.

There are also some questions about what the executive might do under the Trump administration versus Harris. There are other ways to restrict access to reproductive health services, such as abortion — look at mifepristone — which is the most common drug used for medical abortions, which account for about two-thirds of abortions in this country . The FDA may change their positions on this and their related issues Title 10 family planning clinics.

Then finally, Jeremy, from a state perspective, there are 10 states where abortion reproductive health services are on the ballot, including swing states like Arizona and Nevada. Since Dobbs’ decision to overturn Roe v. Wadeseven states held referendums, all seven enshrined reproductive health abortion options in their constitutions. So seven out of seven, we’ll see how these other 10 states fare on Tuesday.

Faust: In terms of an area that I would think would be bipartisan, but I’m not sure it is, it comes down to this, which is EMLATEthis is the Emergency Medicine Treatment and (Work) Act, a 1984 Reagan-era law that says hospitals must take everyone.

I am an emergency physician; we must see them all and stabilize them, life and limb and pain. But EMTALA kind of came into the conversation because it’s a place where some of these issues conflict with each other, right? So you have someone whose life may be in danger, but you don’t know if it’s today or tomorrow. And abortion could be a definitive care to keep them safe. EMTALA is a law that both parties support, is that correct?

Parekh: It is. It’s a federal law. And he’s been in the news lately because of a The Montana case which reached the Supreme Court.

The issue here is whether EMTALA, as a federal law, preempts state laws regarding restrictions on abortion care. And so it is, Jeremy, in states across the country. And I think just like you said, as doctors and clinicians we’ve been morally trained to believe that we have to do everything we can to take care of the patients in front of us and to save lives.

And so it is in states across the country — extraordinary legal ramifications. And I suspect the courts will continue to look at it and maybe it could go back to the Supreme Court, so we’ll just have to wait and see. Traditionally, this should be absolutely, you’re right, a bipartisan issue.

Faust: One more thing on this issue before we can go in another direction, which is what you said a moment ago about Vice President Harris’ kind of vision and agenda on this. She said she wanted to code roe in law and you rightly said, “Good luck,” because that requires legislation in a very, very polarized world. Not only polarized, there are just different opinions about it. And the Supreme Court basically made us talk about fair play.

So she goes for it, but what can she really do? Correct? She can’t do that. I’m pretty sure he can’t, and if he can, he’ll sign it. But what can she do if she’s president to somewhat push back some of the post-Dobbs efforts that have gone against what that side wants?

Parekh: Yes yes. Very hard to get anything done in Congress. States will likely continue to lead in this regard, and this is unfortunately somewhat chaotic. The legal system will continue to be involved.

As I said, I think the executive branch, no matter who wins, will have influence in terms of access to — mifepristone is one example at the FDA, Title 10 funding of family planning clinics is another example. So I think there are actions by the executive that can support choice or further restrict choice, and I think that’s where you’ll see the differentiation between administrations.

Faust: Okay. And do you think the Supreme Court is likely to decide these cases on merit or policy?

Parekh: Jeremy, that probably depends on your opinion of the Supreme Court. I think we all want it on the legal merits and want to give the Supreme Court the benefit of the doubt. I think we’ve seen the politicization of this issue, like many, many other health and public health issues, increase. So I guess we’ll just have to wait and see.

Faust: Okay, let’s talk about health care reform and access to care and affordability. It is interesting to me that the Affordable Care Act (ACA) is no longer called Obamacare. People like it now, as they call it the Affordable Care Act. I think it is a joke maybe even the former president (Obama) did it.

And there are certain things that are very popular. No one really wants to threaten this idea of ​​eliminating coverage for people with pre-existing conditions. But it seems that in the last Trump administration, they certainly tried.

Famously or infamously, former President Trump said (in a debate) “I have concepts of a plan.‘ Any idea what he would do on this issue on the ACA and access in general if re-elected?

Parekh: Yes. Very hard to predict there, I think you’d have to go back to his first term to see what he did. It certainly did not support the marketing and expansion of the current ACA exchanges. I think his administration has tried to increase the option and try to make what are called short-term plans or association plans of up to 12 months become more prevalent in that regard. But those plans don’t necessarily cover pre-existing conditions, for example, so they’re not as robust.

Faust: Can you tell more about it? Because I don’t think people, including me, really know that corner. And also why can’t it cover pre-existing conditions?

For more, watch the full video interview above.