Biden's exit heats up federal health benefits policy debates
In 2019, Kamala Harris backed a "single payer" proposal that allowed the sale of private insurance.
President Joe Biden’s move to end his presidential campaign could focus more attention on where the Democrats stand on federal health insurance benefits issues.
Biden announced Sunday that he would withdraw from the race. He endorsed making Vice President Kamala Harris the Democratic presidential nominee. Harris said in a statement that she intends to earn and win the nomination.
The Democrats will choose their nominee through a virtual vote set to take place from Aug. 1 through Aug. 7.
It was not yet certain at press time whether Democrats would coalesce around Harris as the party nominee or make the convention an open convention. But several officials identified as potential rivals, including California Gov. Gavin Newsom and Pennsylvania Gov. Josh Shapiro, said they would support Harris.
Former President Donald Trump is now the Republican Party’s official nominee.
Related: Does Biden have an edge over Trump on health care issues?
Here are three ways Harris’s new role, her efforts to choose a running mate, and any remaining uncertainty about who will get the Democratic nomination, could affect health benefits policy discussions this summer.
1. Drama at the Democratic Party may heighten interest in Trump’s health benefits proposals.
Trump campaigned for years based on promises to eliminate Obamacare, but he now seems to have defined “repeal” to mean eliminating the Affordable Care Act individual mandate — the requirement that individuals hold a minimum level of health coverage or else pay a penalty.
Congress zeroed out the ACA individual mandate penalty. It’s not clear how interested Trump is in repealing what’s left of the ACA, such as the parts that created the Affordable Care Act public health insurance exchange system and the ACA tax credit subsidies for health insurance premiums.
While Trump was president, from early 2017 through early 2021, his team fought ACA major medical insurance funding requirements but kept the ACA public exchange system, including the federal government’s HealthCare.gov multistate exchange program, going.
His administration also kept the traditional Medicare program more or less the same, and it began to let the private insurers that issue Medicare Advantage plans add benefits related to the “social determinants of health,” such as food discount subsidies and respite care benefits.
Trump supporters have developed many proposals for creating new types of personal health accounts and expanding the existing health savings account program.
2. The new Democratic gameboard could focus attention on the idea of making the current Affordable Care Act premium tax credit subsidy level permanent.
The ACA premium tax credit subsidies can help individuals and small employers buy health coverage through HealthCare.gov or state-based ACA exchange programs.
The original law limited access to people with modified adjusted gross income, or MAGI, under 400% of the federal poverty limit. That’s $60,240 this year for an individual and $124,480 for a family of four.
Congress responded to the COVID-19 pandemic by including a premium tax credit expansion provision in the American Rescue Plan Act of 2022. The provision can make premium tax credits available to anyone at any income level if standard exchange plan coverage would cost more than 8.5% of their MAGI.
The extra ACA subsidies are set to expire at the end of 2025.
If the temporary subsidy expansion expires, the number of people using the tax credits to pay for exchange plan coverage could fall below 14 million, from about 20 million today, according to the Congressional Budget Office.
Employer health plan enrollment could increase to 168 million, from 164 million, and the number of uninsured people could increase to 32 million, from 26 million today.
Harris and any other Democrats running for national office in the next few weeks may talk more about efforts to renew the current ACA premium tax credit subsidy rules.
3. New national Democratic races might highlight single-payer health care proposals.
In a single-payer health care system, one government program pays for care.
Different advocates of single-payer health care systems have had different ideas about what a U.S. single-payer health care system would look like.
Sen. Bernie Sanders, a Vermont independent who caucuses with the Democrats, has introduced a series of single-payer bills that would eliminate all private health insurance, including products like group health insurance, self-funded employer health plans, private dental insurance, private long-term care insurance, and the current version of Medicare.
Biden favored efforts to improve and expand the existing health insurance system. He opposed Sanders’ single-payer bills and other single-payer system proposals.
Harris supported a Sanders Medicare for All bill in 2017.
In 2019, she moved away from backing Sanders’ single-payer proposals. Instead, she favored letting consumers buy into the traditional Medicare program while continuing to allow the sale of private supplemental health insurance.
Now that Biden is no longer the presumptive Democratic nominee, discussions about what Harris, any rivals to her nomination and the vice presidential contenders think about single-payer health care proposals and other major health system change proposals could surge.