What a Harris presidency would mean for healthcare policy

Just like that, the race for the presidency was upended and now the American public must consider a new candidate: Vice President and Democratic nominee Kamala Harris. President Joe Biden's decision not to seek re-election certainly changed the contest, and perhaps the considerations, as the candidates sprint toward Election Day. 

Chief among them for employee benefit professionals: What would healthcare look like under a Harris-Walz administration? And how significantly would it diverge from Biden's efforts over the past four years given her limited lead time to develop a unique plan?

We can probably draw a few conclusions based on Harris' previous statements and her current stance on healthcare. What we know: a Harris presidency would have significant implications for employers in regard to ongoing compliance with the Affordable Care Act (ACA). 

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Here are six areas where I believe we'll see an impact. 

1. Making healthcare more affordable  
The cost of healthcare continues to be a struggle for many Americans. I expect Harris, like Biden, will continue to prioritize policies and actions that make healthcare more affordable for Americans. This includes reducing out-of-pocket costs and expanding coverage options. 

Participation in state and federal marketplaces reached a historic high last fall under the Biden Administration. Some 21 million people signed up for coverage, nearly doubling the number enrolled in 2020. Fifteen key states also saw ACA marketplace enrollment double between those same years. Why such substantial growth in coverage in four years? 

A few factors likely contributed to this increase. Special enrollment periods were introduced, beginning at the height of the COVID-19 pandemic, and people were also allowed a greater window of time to sign up during annual open enrollments. Customer service on the platforms also improved, and outreach initiatives were ramped up to include new omnichannel and multicultural advertising efforts, among others. 

Harris supported Biden's efforts during this time, and she almost certainly will continue to champion increased access to affordable care, including an expansion of the ACA to include dental benefits in medical coverage. Harris has repeatedly expressed the need for greater equity in healthcare, urging an expansion of Medicaid and advocating for the first-ever public health plan option.

2. Expansion of Medicare and Medicaid
Ten states have yet to adopt the ACA's expansion of Medicare and Medicaid. It's safe to say Harris will require them to do so if she becomes the 47th President of the United States. 

An expansion lets states offer residents more affordable coverage based on their income rather than a disability. In 2010, when the ACA first passed, most states adopted the measure. Others followed, embracing the amendment, including – most recently – South Dakota and North Carolina. The program has granted millions of Americans eligibility for government-subsidized healthcare.

When Harris first made a run at the Democratic candidacy in 2019, she seemed to express support for a single payer or "Medicare for All" healthcare system. Though she walked that notion back, she did introduce her own plan that featured a transition to expanded Medicare access. As president, she could move in that direction by requiring expansion in the remaining outlier states. 

3. Strengthening reproductive rights
Earlier this year, in a history-making visit, Harris toured a Planned Parenthood facility in Minnesota that performs abortions. She vocally and publicly objected to the Florida law that bars abortions after just six weeks. Championing reproductive rights isn't new for Harris. She was outwardly critical of the Supreme Court's decision to overturn the landmark Roe vs. Wade in 2022, and ever since then, she has actively campaigned for women's health care rights, including access to safe and affordable reproductive services.

As a candidate for the presidency in 2024, her support of reproductive rights will remain central to her healthcare stance and the policies she would likely pursue in office. Her position is one that could give her an advantage, according to a report by the Kaiser Family Foundation, which finds that 12% of voters say abortion is the most important issue for their vote this election. Harris will no doubt continue to focus on protecting and strengthening abortion rights.

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4. Keeping ACA benefits intact
Throughout Biden's presidency, certain key provisions of the ACA have come under attack. For instance, a Texas judge struck down the ACA's preventive care services, the ones that guarantee eligible people can receive services like COVID-19 vaccines, cancer screening and substance abuse counseling without having a co-payment. That same judge also applied his ruling across the country. Biden issued a stay to preserve the mandate and an appeals court ultimately upheld the preventative care services portion, ruling it should not apply to the U.S. at large, but only to the affected parties in the case.

Biden protected these benefits and ensured they remain intact. Harris is likely to follow suit in working to preserve and maintain these and other critical benefits like coverage for pre-existing conditions.

5. Extension of premium tax credits
Premium tax credits (PTCs), refundable credits that help eligible individuals and families cover the cost of health insurance premiums purchased through the marketplaces, were first introduced as part of President Biden's American Rescue Plan. An expansion of these credits allowed Americans with income up to 150% of the federal poverty level to get silver-level health plans for $0 monthly premiums and pay considerably reduced deductible costs. The PTC program also expanded ACA coverage to Americans who earn 400% and above the federal poverty level, capping their monthly costs to 8.5% of their household income. The Inflation Reduction Act renewed the PTC expansion through 2025.

Implementing PTC expansion enabled many people to obtain affordable, quality coverage through state and federal marketplaces. If the ACA subsidy expansion expires next year as it's currently set to do, it may trigger the loss of access to coverage for millions of Americans. If Vice President Harris wins the election in November, several healthcare policy experts believe she will extend PTC access once again. She may even seek to make it a permanent feature of U.S. healthcare policy as Biden tried to do in 2021. 

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6. What this means for employers 
A Harris win in November would most likely result in healthcare policy and ACA protections that resemble many of Biden's. The Biden-Harris administration recently announced lower prices for 10 common prescription drugs selected for price negotiation, which will help millions of seniors and other Medicare beneficiaries to save on out-of-pocket costs. I would expect Vice President Harris to continue to build on this effort, and work to speed negotiations to lower the costs on more prescription drugs if she becomes president. 

A Harris presidency would almost certainly mean more affordable healthcare and improved access. At the same time, employers may continue to grapple with compliance hurdles due to the complexities of these policies. The PTC expansion, for example, raises penalty risks for employers since PTCs are the trigger for the IRS in identifying instances of potential ACA non-compliance. 

There's a lot at stake this November when it comes to healthcare and the ACA. For now, organizations should remain diligent in keeping up with responsibilities of the ACA's employer mandate as the IRS expands its focus and attention to detail on non-compliance.