Holding Our Breath

The presidential election, pitting former President Donald Trump against Vice President Kamala Harris, has generated intense debate over the direction of healthcare policy.

Despite the prominence of this issue, there’s still little clarity on what healthcare might look like after the election. The legislative environment will also be shaped by the makeup of Congress, as the balance of power between the House and Senate will determine the feasibility of substantial healthcare reform. Compounding the uncertainties is the recent erosion of Chevron Deference, a judicial doctrine that has long guided how courts interpret ambiguous regulations set by federal agencies.

On the Republican side, Trump’s stance on healthcare has traditionally focused on reducing the federal government’s role in health insurance, promoting market-driven solutions and the notion of repealing or revising the Affordable Care Act (ACA). Although Trump was unable to fully dismantle the ACA during his first term, he remains critical of its regulatory framework, viewing it as a burden on the private insurance market. Instead, Trump advocates for expanding Health Savings Accounts (HSAs), encouraging cross-state insurance sales, and implementing measures that would give consumers more control over their healthcare choices. His approach is largely focused on deregulation and reducing federal oversight, potentially making healthcare less centralized, but also less universally accessible.

On the other hand, Kamala Harris represents a continuation of the Biden Administration’s incremental approach to expanding the ACA. She has voiced support for extending ACA subsidies, reducing out-of-pocket costs, and strengthening Medicaid, especially in states that have resisted expansion. Harris has also hinted at support for a Medicare buy-in option for certain age groups, though her stance stops short of endorsing a universal single-payer system. Her healthcare vision is more focused on affordability and access, emphasizing the government’s role in bridging healthcare disparities. However, Harris faces the difficult task of reconciling progressive demands for sweeping reforms with centrist calls for fiscal restraint, which could limit the extent of her initiatives.

The recent fall of Chevron Deference – a principle whereby courts historically have deferred to agency interpretations of ambiguous statutes – adds another layer of uncertainty to healthcare policy. Without this deference, courts now have greater latitude to interpret healthcare laws directly, rather than relying on agencies like the U.S. Department of Health and Human Services (HHS) to set regulatory standards. This shift could lead to more litigation over healthcare rules and policies, as courts are now more empowered to challenge agency interpretations. For instance, healthcare regulations regarding Medicaid work requirements, ACA subsidies, and other contentious issues may now face judicial challenges that reshape or even overturn current policies.

The fall of Chevron Deference could also put additional pressure on Congress to legislate more clearly on healthcare issues. With courts less likely to defer to agencies’ regulatory interpretations, ambiguous legislation may lead to a proliferation of court cases wherein judges, rather than healthcare professionals or policymakers, determine the application of healthcare law. This may result in a more fragmented and inconsistent healthcare landscape, where policies differ widely based on judicial interpretations in different jurisdictions.

In the absence of legislative clarity, the court system may become the de facto arbiter of healthcare policy, interpreting the law in ways that could reshape the healthcare system significantly. The uncertainty in the legislative and judicial landscapes means that the future of healthcare in the U.S. remains in flux, with millions of Americans awaiting answers that could fundamentally impact their access to care, insurance premiums, and overall health outcomes.

As the nation prepares to vote, it’s clear that the result will have lasting consequences for the healthcare system’s structure and accessibility, underscoring the critical intersection of politics, law, and public health.