WASHINGTON — If Vice President Harris wins the presidency, in many ways, she’ll work to achieve health care ideas that Democrats couldn’t quite push across the finish line during President Biden’s tenure.
While Democrats achieved major health policy goals on drug pricing in the Inflation Reduction Act, many policies were left on the cutting room floor. The Medicare drug price negotiation program was weaker than progressives imagined, and an effort to add benefits such as home care to Medicare was dropped.
President Biden’s pro-Affordable Care Act stance was a marked turnaround from former President Trump’s attempts to repeal it. Harris has pitched continuing on that track by extending premium subsidies that have lowered monthly payments, and by figuring out some way to cover low-income people in states that haven’t implemented the law’s Medicaid expansion.
Many of her health policy goals are outside of her immediate control. New Medicare benefits to cover home care, drug pricing changes, surprise billing protections, and codifying abortion access would all require cooperation from Congress. Efforts to relieve medical debt could be foiled if state policymakers refuse to play along.
STAT rounded up the top health policy priorities Harris has run on during her campaign, and how a victory could affect Americans.
Tackling drug prices
Harris has proposed expanding on Democrats’ 2022 drug pricing reform package.
Her drug pricing policies encompass these main goals: expanding Medicare negotiations, capping insulin costs and pharmacy drug costs for people outside of the Medicare program, and penalizing companies further for hiking prices faster than inflation.
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Democrats in their platform propose expanding “the number of drugs subject to price caps and negotiation under the Inflation Reduction Act.” In practice, there are a couple of ways they could do that.
The most obvious would be to increase the number of drugs that Medicare could negotiate each year.
Another would be speeding up when drugs qualify for the program, from the current threshold of nine or 13 years, depending on the type of drug.
There’s also a chance that Democrats could pursue lower maximum prices for negotiations, said John Barkett, a former Biden White House staffer who is now a managing director at the Berkeley Research Group.
Harris also promised to cap the costs of insulin and pharmacy drug costs “for every American.” Seniors’ drug costs are now capped at $2,000 a year in Medicare prescription plans, while some insulins are available for $35 a month.
Limiting what patients with insurance through their employers pay for prescription drugs at the pharmacy to $2,000 per year would benefit a tiny fraction of people, the available data show. A KFF analysis showed that in 2018, 0.7% of people in employer plans had out-of-pocket retail drug costs higher than $2,000.
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“I don’t think it would change a lot in the commercial space,” said Jeromie Ballreich, an associate professor at Johns Hopkins. He said younger people usually are taking fewer expensive medications, and the ones they do take are usually administered in a physician’s office.
If such a policy applied to uninsured patients, it could have a more expansive impact, if patients’ costs could be reliably tracked.
It’s unclear how many people would benefit from Harris’ proposal limiting insulin costs to $35 per month. Some companies that make insulin have already expanded their patient assistance programs to ensure that even insured people can access $35 per month insulin. However, some patients fall through the cracks of assistance programs, and companies could choose to cancel or limit the voluntary programs at any time.
Right now, drugmakers have to pay Medicare a penalty if they raise prices faster than the rate of inflation. Harris proposes making that penalty apply to the commercial market as well, which could further disincentivize drugmakers from taking dramatic price hikes.
Expanding Medicare benefits
One of the Harris campaign’s last-minute proposals was to expand Medicare to cover some home care, vision, and hearing benefits.
During the debate over the Inflation Reduction Act that created the Medicare drug price negotiation, Democrats weighed adding billions of dollars for home care, but the policy was left on the cutting room floor. Harris’ home care plan would provide coverage on a sliding scale for seniors based on income, and support the home care workforce.
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Depending on how generous the benefits are and on seniors’ health situations, it’s possible additional home care benefits could help older adults in the Medicare program stay at home longer. According to a study published in 2023, 17% of older adults surveyed had difficulty performing tasks like getting dressed, bathing, eating, or using a toilet.
The policy was targeted to appeal to the adult children who often provide that care for their parents on an unpaid basis, as well. Pew Research data showed 23% of adults are both financially supporting their children and have parents older than age 65.
While many Medicare Advantage plans include at least some vision and hearing coverage already, beneficiaries in traditional Medicare don’t have coverage. In 2019, about one in six Medicare beneficiaries reported that they couldn’t get dental, hearing, or vision services, and that cost was a major barrier.
Strengthening the Affordable Care Act
For people with insurance plans through the Affordable Care Act, Harris wants to extend premium subsidies that Democrats implemented in 2021 after Biden was elected. Those subsidies make premiums cheaper for a broader range of people, and even make some policies free for low-income enrollees.
Whether the subsidies are actually extended will depend in large part on the makeup of Congress, as some Republicans may be skeptical of extending the subsidies. Some prominent GOP health policy experts argue the subsidies have led to increased levels of fraud.
The subsidies’ creation has led to massive gains in Affordable Care Act enrollment, and their termination would lead to some people losing health coverage, said Cynthia Cox, the director of the ACA program at KFF. Even if people don’t lose health coverage, the average enrollee could see their monthly premiums double, Cox said.
“People across the income spectrum would see their premiums rise,” Cox said.
Overall, Harris supports the Affordable Care Act and has advocated for preserving it. Democrats in their platform also called for expanding “Medicaid-like” coverage to patients whose states refused to expand Medicaid eligibility under the Affordable Care Act, though Democrats in Congress have so far not agreed on exactly how to do that.
Canceling medical debt
Harris has proposed working with states to help cancel medical debt, building on similar work during her time as vice president.
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Harris’ platform doesn’t provide details about how she’d implement nationwide medical debt relief. It states that her administration would “work with states to cancel medical debt for millions of Americans and to help them avoid accumulating such debt in the future.” During her tenure as vice president, Harris led a push to remove medical debt from patients’ credit reports.
About 8% of all adults carry medical debt, per a KFF analysis of 2021 data. Most state medical debt cancellation programs thus far have focused on low-income patients.
States have taken a variety of tactics to cancel medical debt, from using leftover Covid-19 relief funds to buy discounted debt to leveraging Medicaid funding to incentivize providers to cancel the debt on their own. The disadvantage of working with states is that relief could depend on states’ political dynamics.
Experts have said that measures to prevent patients from falling into debt in the future are essential to ensure that one-time debt cancellation has lasting impacts. North Carolina is an example of a state that attached such requirements to medical debt relief, though its program financially benefited hospitals.
Ending surprise bills for ground ambulances
While Congress banned surprise medical bills during emergency situations in 2020, a big loophole was that ground ambulances were exempt. Harris proposes changing that.
Roughly 85% of all ground ambulance rides are out-of-network, so a ban could provide significantly more protection for people who don’t have much choice about the ambulance they end up in.
An advisory committee formed under the No Surprises Act recommended banning surprise bills for patients for 911 calls and emergency transport between medical facilities, and capping patients’ copays. Insurers would pay out-of-network charges set by local governments, or some amount based on Medicare rates.
Codifying reproductive health rights
Following the Supreme Court’s decision to overturn Roe v. Wade and the resulting patchwork of state policies on abortion access, Harris has pledged to sign a law codifying abortion access if Congress sends it to her.
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The problem is, Congress probably won’t send her one, at least under its current rules. Senate Majority Leader Chuck Schumer (D-N.Y.), has floated the possibility of getting rid of the filibuster for reproductive rights legislation, but with the Senate appearing poised to shift to Republican control, his opinion won’t carry as much weight.
More than 21 million women of reproductive age live in states where abortions are banned after six weeks of pregnancy.
So on reproductive rights, the best Harris could do is largely maintain the status quo. There are some regulatory changes that could help people access contraception — for example, the Biden administration this week proposed new regulations that would force insurers to cover over-the-counter birth control pills without cost-sharing.
