Sen. Kamala Harris announced her version of Medicare-for-all Monday, and in so doing reshaped her stance on one of the more divisive issues of the Democratic presidential primary with a plan that would allow those who want to keep their private coverage to do so, provided those insurers offer plans that adhere to the same regulations as the government-offered Medicare option.
The plan represents a pivot for Harris, who has previously said she supported Sen. Bernie Sanders's Medicare-for-all bill, which would effectively eliminate the private health insurance market.
"This isn't about pursuing an ideology," Harris wrote in a Medium post she published Monday to outline the plan. "This is about delivering for the American people."
She previously suggested that private insurance should exist only to cover supplemental expenses, such as cosmetic surgery, foreign travel insurance and other things not covered under Medicare. But as she has throughout her campaign, Harris is arguing for a more expansive Medicare plan than many of her competitors have proposed previously, one that would reduce the need for supplemental insurance by extending coverage to vision, dental, hearing aids and mental health services. An aide to her campaign said Harris is trying to "respond to the concerns and anxieties" she has heard on the trail.
Many voters at Harris events have spoken about being forced to give up their private plans in favor of a public one. In Iowa, multiple voters asked Harris about the jobs that would be lost in the private insurance sector should Medicare-for-all mandate public coverage. Under the terms of her plan, voters would not have to give up their private insurer as long as that insurer offers a plan that meets Medicare regulations, like Medicare Advantage does for seniors now. The plan also would allay concerns about the loss of jobs in private insurance, which could continue to exist.
"Seniors will be able to keep their Medicare and have dental, vision, and hearing aids covered immediately. Medicare Advantage plans would continue uninterrupted by the transition," Harris wrote in the Medium post. "Under my plan, no one will lose access to insurance during a transition. Period."
Harris's plan is based on Sen. Bernie Sanders' Medicare-for-All Bill - a measure she has signed - which calls for a complete transition to a government-run insurance plan over four years, but differs in three major ways.
First, Harris' bill would not force a transition to a public Medicare-for-all option, but would allow private insurers to continue offering plans provided they adhere to "strict requirements to ensure it lowers costs and expands services."
"If [private insurers] want to play by our rules, they can be in the system," Harris wrote in the post. "If not, they have to get out."
As soon as the plan is passed, anyone who wants it would be able to buy in to Medicare, a similar setup to the immediate buy-in Sanders outlines. All newborns and uninsured Americans would be enrolled immediately. Harris also wrote that, after passing the bill, her administration would "provide a commonsense path for employers, employees, the underinsured, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition."
Second, Harris' bill would extend the transition period from four to 10 years, providing for what she says would be a less expensive transition than one carried out over a shorter period.
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Third, Harris' plan calls for a less-substantial middle-class tax increase than Sanders' does. Sanders' bill would fund Medicare-for-all with a 4 percent tax increase on all Americans making more than $29,000 annually. Harris would raise that threshold to $100,000, and pay for the difference with a 0.2 percent tax on all stock trades, a 0.1 percent tax on all bond trades, and a .002 percent tax on derivative transactions. She also would tax offshore corporate income at the same rate as domestic corporate income, proposals she says would raise more than $2 trillion over 10 years - enough to make up for the money lost by not raising taxes on those making $29,000 to $100,000.
Harris' "plans to ensure that Wall Street and multinational corporations are paying their fair share of taxes are both good ideas," said Michael Linden, a former policy adviser to Senate HELP and Budget Committees and economy policy director of the Center for American Progress, who agreed to speak on behalf of the plan for the campaign.
They "would generate enough revenue to offset her proposal's higher income threshold after which premium payments begin - $100,000 rather than $29,000 - which is intended to help the middle class."
While Harris has signed on to a variety of health-care reform bills over the years - including Sen. Michael Bennet's Medicare X bill, which would create a public option - she will now have to account for her shifting outlook about private insurance. In her first CNN town hall appearance, Harris was asked about the bureaucracy and shortcomings of private insurance and said, "Let's do away with all that." She later clarified her stance to explain that her vision of Medicare-for-all would allow private insurance for supplemental health concerns.
Later, at the first Democratic debates last month, Harris and Sanders were the only candidates to raise their hands when asked whether they would abolish private insurance. Harris later said she misheard the question, and thought she was answering the question of whether she would give up her own private insurance in favor of Medicare-for-all. Harris has often expressed frustration with questions suggesting that she has altered her positions, and the Medium post on Monday accounted for the notion that she has not always been able to articulate her position in an easy-to-digest format.
"One of the problems with our politics is that it often demands 60-second sound bites or slogans to answer complex questions," she wrote. "There is perhaps no more complicated or more personal issue for Americans than health care."
The timing of Harris' plan was calculated, giving her a distinct position on a so-far confounding issue just in time for the second Democratic debates, which will take place this week in Detroit. In recent weeks, former vice president Joe Biden, a Democratic presidential rival, accused Harris of wanting to do away with the Affordable Care Act as part of her support of Medicare-for-all. Harris has argued that she was a staunch defender of the Affordable Care Act in the face of Republican challenges, and that her plan is simply building on President Barack Obama's plan. Harris and Biden will stand next to each other in the center of the stage Wednesday night.
This article was written by Chelsea Janes, a reporter for The Washington Post.