WASHINGTON — A potential Kamala Harris presidency holds the promise of substantial shifts within the U.S. health care system, with significant implications for abortion rights, insurance coverage, and drug pricing, as assessed by policy experts and former advisers to the vice president.

Abortion Rights: A Central Focus

Kamala Harris is expected to prioritize the protection of abortion access, a domain in which she has adeptly engaged with both Donald Trump and the Republican Party. Drew Altman, President and CEO of KFF, a nonpartisan research organization, predicts that Harris will substantially amplify her focus on reproductive rights. “She will attack them repeatedly and mercilessly on reproductive rights,” asserts Altman. “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 distinguished health care official who served in the Obama and Biden administrations and has informally advised Harris, supports this view. He notes that Harris’s adept handling of abortion issues resonates with voters in a way that President Biden finds challenging. “It’s awkward for President Biden to talk about it,” Slavitt remarks. “But I think she knows how to talk about it in ways that people relate to.”

Potential Policy Directions and Challenges

If Harris secures the Democratic presidential nomination — a prospect she is currently favored to achieve — she will have the opportunity to articulate a distinct vision for transforming the health care system, separate from the Biden administration’s policies. Harris’s role as vice president has largely been to advance and support Biden’s agenda. However, her forthcoming campaign could provide a platform for her to assert her own health care policies.

Sabrina Corlette, a health policy expert and research professor at Georgetown University, anticipates that Harris will build upon Biden’s legacy of expanding health coverage. “We can expect her to try to build on the Biden legacy of expanding coverage,” Corlette says. “And she’s going to have to do something to bring down costs.” Corlette predicts that Harris will seek to protect the Affordable Care Act (ACA) and work to extend the enhanced subsidies designed to lower health care costs, which are set to expire at the end of 2025. Additionally, she may pursue efforts to extend Medicaid coverage in the 10 states that have yet to expand it under the ACA. There is also the potential for Harris to continue Biden’s initiatives to expand Medicare to include dental, vision, and hearing benefits for seniors.

Navigating the Biden Legacy and Progressive Ambitions

Harris faces the challenge of balancing the continuation of Biden’s policies with her own progressive aspirations. Rep. James Clyburn, D-S.C., a prominent figure within the Democratic Party, admits uncertainty about how Harris will navigate this balance. “I have no idea,” Clyburn says, although he expresses confidence in Harris’s ability to uphold the Obama-Biden health care legacy. “She’s a part of it,” he adds.

During her 2020 presidential campaign, Harris demonstrated more liberal inclinations on health care compared to Biden, which may influence her approach as a potential president. “She may be more willing to take on some of the sacred cows in health care than the Biden administration was,” Corlette suggests. Harris’s endorsement of the Medicare for All Act of 2019, led by Sen. Bernie Sanders, I-Vt., highlighted her willingness to advocate for a significant expansion of Medicare that would cover all Americans and potentially phase out private insurance. While the proposal garnered substantial support from progressives, it faced resistance from moderates, including Biden, who feared it might undermine private coverage.

Harris’s stance on Medicare for All became a contentious issue during her 2020 presidential bid, particularly regarding its impact on private insurance. This controversy led Harris to propose her own health care plan, which included Medicare Advantage to preserve a role for private coverage. This episode raised questions among Democratic elites and voters about her ideological positioning. By the time Biden selected her as his running mate, Harris had aligned more closely with Biden’s proposals.

“I don’t think she’s a disrupter. I don’t think she’s going to be pushing for some big, radical change,” Slavitt observes. “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 adds that in the current political climate, Democrats are unlikely to revive Medicare for All due to concerns about its potential impact, particularly given the looming threat of Donald Trump.

Republican Criticisms and Policy Priorities

Republicans are scrutinizing Harris’s past health care statements for potential vulnerabilities. A GOP strategist recalls that during a June 2019 debate, Harris was among the Democratic candidates who supported providing insurance to undocumented immigrants. Although Harris did not elaborate on this position, other candidates on stage argued that it was both humane and fiscally prudent to ensure comprehensive coverage to reduce reliance on costly emergency care.

As the campaign progresses, Altman anticipates that Harris will focus on defending Medicare and Medicaid while highlighting Republican proposals that could privatize or cut these critical programs. GOP proposals, including those outlined in Project 2025 — a collection of conservative ideas crafted by former Trump officials — are expected to feature prominently in these discussions. Despite Trump’s claims of unfamiliarity with Project 2025, Harris is likely to argue against proposals that could significantly impact Medicaid by capping and reducing funding.

Altman expects Harris to leverage the Democratic advantage on health care issues, particularly with the ongoing rollout of the Inflation Reduction Act. This legislation includes key provisions such as a $35-per-month cap on insulin costs for Medicare recipients, which took effect on January 1, 2023. Starting next year, the law will also cap out-of-pocket spending on prescription drugs at $2,000 for Medicare beneficiaries and allow the federal government to negotiate drug prices for the costliest Medicare drugs — a long-sought goal for many Democrats.

The government’s negotiations with drugmakers over the 10 most expensive drugs under Medicare, including popular medications for heart disease and diabetes, are expected to yield new pricing by September, with changes taking effect in 2026. A KFF poll published in May indicates that independent voters have historically trusted Biden over Trump on health care issues, including costs. Harris is poised to build upon this Democratic advantage as she campaigns.

In summary, a potential Harris presidency could usher in transformative changes to the U.S. health care system, driven by her commitment to reproductive rights, her approach to expanding coverage and reducing costs, and her response to Republican criticisms and policy proposals.