WASHINGTON — A Kamala Harris presidency could have far-reaching consequences for the U.S. health care system, from abortion rights to insurance coverage to drug pricing, according to policy experts and former advisers to the vice president.
For starters, Harris is expected to focus heavily on protecting abortion access, an issue she has been fluent in using against Donald Trump and the Republican Party.
“She will attack them repeatedly and mercilessly on reproductive rights,” said Drew Altman, the president and CEO of KFF, a nonpartisan research group. “I think it’s been a winning card for her so far, and I would expect to see her dial that up tremendously.”
Andy Slavitt, a top health care official in the Obama and Biden administrations who has informally advised Harris, said she has an advantage on abortion, an issue that resonates with voters.
“It’s awkward for President Biden to talk about it,” Slavitt said. “But I think she knows how to talk about it in ways that people relate to.”
In her vice presidency, Harris' goal has been to advance and promote Biden’s agenda. But if she secures the Democratic presidential nomination — as she is favored to — Harris would be free to cast her own vision to remake the health care system.
Her campaign didn't respond to a request for comment as the Harris campaign is in its early stages. But her record and her 2020 presidential campaign provide some clues about how she would govern.
“We can expect her to try to build on the Biden legacy of expanding coverage,” said Sabrina Corlette, a health policy expert and research professor at Georgetown University. “And she’s going to have to do something to bring down costs.”
Corlette predicted Harris would look to protect the Affordable Care Act and extend the enhanced subsidies designed to lower costs, which are set to expire at the end of 2025. She would also be likely to work with Congress to try to extend Medicaid coverage in the 10 states that haven’t expanded it under the Affordable Care Act. And she could carry on Biden’s attempts to expand Medicare to cover dental, vision and hearing benefits for seniors.
It’s still early for even close allies to know how Harris will seek to balance embracing Biden’s approach with carving out her own.
“I have no idea,” said Rep. James Clyburn, D-S.C., a powerful figure within the party, though he added that the Obama-Biden health care legacy would be in good hands with her. “She’s a part of it,” he said.
Beyond that, Harris showed more liberal instincts on health care in her 2020 campaign than Biden did, which could be a factor.
“She may be more willing to take on some of the sacred cows in health care than the Biden administration was,” Corlette said. “She obviously signed onto ‘Medicare for All.’ She also supported public option proposals in the Senate. You could see more backing of a government-supported plan option for people, which could have the power to bring down the costs of insurance.”
Harris signed on to the Medicare for All Act of 2019, led by Sen. Bernie Sanders, I-Vt., a few months into her presidential bid. The bill sought to expand Medicare to cover all Americans and effectively end private insurance. It divided the Democratic Party — progressives embraced it, but moderates, including Biden, feared it would go too far by effectively eliminating private coverage.
The issue tripped up Harris when she was quizzed about the bill's potential impact on the private insurance most Americans have. She later offered her own health care bill that leaned on Medicare Advantage to preserve a role for private coverage.
At the time, the episode raised questions among Democratic elites and voters about where she stood ideologically. Harris ended her campaign later that year, and by the time Biden chose her to be his running mate, she embraced his proposals.
“I don’t think she’s a disrupter. I don’t think she’s going to be pushing for some big, radical change,” said Slavitt, the former Obama and Biden administration official. “People will talk about how she signed on to Bernie’s bill. A lot of people signed on to Bernie’s bill for a variety of reasons — some to state the ideal is universal coverage … some because they believe in it literally. ... I read her as more pragmatic.”
Altman, of KFF, added that in this campaign, Democrats are highly unlikely to revive Medicare for All “because of their fear of Trump.”
Republicans are combing through Harris’ past statements about health care and looking for material to use against her.
A GOP strategist noted that in a June 2019 debate, Harris was among 10 Democratic candidates who raised their hands when they were asked whether the U.S. should insure undocumented immigrants. Harris didn’t discuss it, but others onstage argued that it was humane and fiscally wise to ensure broad coverage so people were less reliant on expensive emergency care when they got sick.
Altman expects that on the campaign trail, Harris will continue to promote existing initiatives from the Biden administration, particularly the ongoing rollout of the Inflation Reduction Act.
Among the provisions is a $35-per-month cap on the out-of-pocket cost of insulin for seniors on Medicare, which went into effect on Jan. 1, 2023. Starting next year, the law will also cap out-of-pocket spending on prescription drugs at $2,000 for people on Medicare. It also allows the federal government — for the first time — to negotiate prices for drugs that Medicare spends the most money on, a long-sought-after goal of Democrats and some Republicans.
The government is negotiating with drugmakers over the 10 costliest drugs under Medicare, which include popular heart medications and diabetes drugs. The new prices are expected to be published by September and go into effect in 2026.
A KFF poll published in May found that more independent voters trusted Biden over Trump when it came to many areas of health care, including health care costs. Harris will seek to carry that yearslong Democratic advantage.
Altman said he expects Harris to lean into protecting Medicare and Medicaid while highlighting GOP proposals that would partly privatize or cut the health care programs for elderly and lower-income Americans, respectively, a tactic Democrats have used against Republicans for years.
The GOP proposals include some recommendations in Project 2025, a sweeping collection of right-wing ideas to transform the U.S. government. Though it was written by former Trump officials in anticipation of a second term, Trump has said he knows “nothing” about it.
“I also suspect she will be the first to bring Medicaid into the picture,” he said, “arguing that the various Republican groups from [Project] 2025 to the Republican Study Committee are proposing to eviscerate the Medicaid program by capping and cutting it."
Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.
Yamiche Alcindor
contributed
.
