When the Biden administration dropped the final version of its nursing home staffing mandate in April, it was Vice President Kamala Harris who suddenly became the face of the initiative.

After months of waiting for potentially harsh new rules, providers saw her become the first to reveal the mandate would increase required nursing hours compared to an initial federal proposal. And it was the vice president who touted the landmark rule in a high-profile media event featuring union leaders and rank-and-file later that same day.

A big question now is how Harris might carry the mantle of nursing home reformer if she’s officially chosen as the new Democratic presidential candidate following Joe Biden’s exit announcement this weekend.

No president before Biden had made improving America’s nursing homes so central to his platform — dropping mention of facilities into not one but two State of the Union addresses and pushing an ambitious reform agenda post-COVID.

But while Harris’ positions traditionally have been even more liberal than Biden when it comes to healthcare reform, she might not embrace all of the same issues, or at least might not embrace them all with the same intensity.

Long-term care providers and lobbyists who work on behalf of the sector are looking to Harris’ known priorities, and her past work in the Senate and as California’s attorney general to understand what her candidacy or potential administration could look like.

“All signs point to her prioritizing reproductive rights and maternal health over all else to start,” Brian  Perry, vice president of government affairs at Direct Supply, told McKnight’s Long-Term Care News Monday. “Those issues are driving the American electorate much more than senior care at this juncture, and she would be in position to potentially address them in historic fashion. I suspect all other healthcare matters will be side burner issues until the reproductive and maternal health debates are settled.”

Unions’ influence

But, he cautioned, the SEIU was one of the first organizations to endorse Harris on Sunday. In its endorsement, the union noted that the VP “has taken action to make home care and child care more accessible and affordable, championed new staffing standards for nursing homes, and has always prioritized all service and care workers and the essential work that they do.”

The SEIU was a key player in a Connecticut rally Monday, during which Sen. Richard Blumenthal (D) continued to push his colleagues to embrace the rule — ahead of what he called “upcoming” Senate action that could overturn the Centers for Medicare & Medicaid Services rule.

“I do believe that unions, as they have the last four years, will continue to write and inform healthcare policy for the foreseeable future,” Perry added. “When you look at the $1.8 billion spent by labor unions during the 2020 election, one can assume they will continue to have an impactful presence on healthcare policy under a potential Harris administration.”

Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit, agreed that Harris “would be the face of the drive to protect abortion rights.” 

But aside from taking a harder line on that than Biden sometimes had, others expect Harris to remain committed to ongoing healthcare priorities Democrats are already lined up behind.

“She deserves credit. She’s talked about them on the campaign trail,” Debbie Curtis, vice president at McDermott + Consulting, told KFF Health News. “I don’t see any change there in the priorities on what Democrats want to do on healthcare if she becomes the nominee.”

And that would mean she’s likely to follow in Biden’s footsteps in trying to tamp down private equity investments in healthcare, promote policies and rules that bring more transparency to ownership, and try to thwart healthcare consolidation as she did as an AG.

Staffing mandate wanted for Democratic platform

Regarding the nursing home staffing mandate, party officials continue to bolster the push for improvements. Last week, a key party committee agreed to an amendment making nursing home staffing standards a convention platform, regardless of the candidate who prevails.

The amendment reads: 

“Democrats will overhaul the quality of care and the quality of life for our nation’s 1.3 million nursing home residents by defending the administration’s regulations that require minimum staffing standards at nursing homes.”

That embrace of the Biden healthcare legacy could mean the continued challenges for healthcare providers, potentially causing access issues for America’s seniors, Perry said. Still, he thinks a Harris campaign or presidency might bring with it better traction for efforts to allow more foreign-born workers to help fill gaps in the healthcare workforce

“Everyone in healthcare and the entire economy has been utterly crippled by the policies blocking qualified foreign-born workers from entering our country to go to work legally,” he said. “I’m hopeful whoever the next president is makes this a Day One issue to be solved.”

And a new presidential nominee — which could still be someone other than Harris — might help unite constituents around a shared goal of improving care for America’s most frail and elderly.  That, said Perry, is “what our seniors, their families, and the healthcare workforce desperately deserve.”