Kamala Harris says she supports “Medicare for All,” and she has cosponsored legislation with Bernie Sanders. But unlike her Democratic presidential rival, she says the plan wouldn’t end private insurance.
That’s misleading. The measure would outlaw all private insurance for medically necessary services but allow a sliver to remain for supplemental coverage. It would force the roughly 150 million Americans who are insured through their employer to switch to a government-run program.
Harris is trying to find a narrow path between two competing constituencies in the Democratic Party. On one side are progressives who passionately support so-called single-payer insurance and are pushing the party to the left. On the other is the party establishment, which believes that calling for an end to private insurance for millions would be political suicide against President Donald Trump in 2020.
Her attempts to please both camps could become a vulnerability for a campaign that is surging after a strong performance in last week’s debates, though allies say her rhetoric about a role for private insurance would be more politically viable in a general election.
The issue has tripped up the California senator almost from the moment she began her candidacy. During the debates in Miami last week, Harris and Sanders raised their hands when NBC’s Lester Holt asked which candidates would “abolish their private health insurance in favor of a government-run plan.” She retreated the next day, saying she thought Holt was referring to her personal insurance plan and answered “no” when asked if private coverage insurance should end.
She ran into a similar problem in January, when her campaign walked back a comment she made at a CNN town hall calling for getting “rid of” private insurance structures.
Larry Levitt, a health-policy expert at the nonpartisan Kaiser Family Foundation, said the intent of the Sanders bill is clear.
“As a practical matter, Senator Sanders’ Medicare for all bill would mean the end of private health insurance,” he said. “Employer health benefits would no longer exist, and private insurance would be prohibited from duplicating the coverage under Medicare.”
Sanders last week criticized Harris for splitting hairs, without mentioning her by name.
“If you support Medicare for All, you have to be willing to end the greed of the health insurance and pharmaceutical industries,” he said. “That means boldly transforming our dysfunctional system by ending the use of private health insurance, except to cover non-essential care like cosmetic surgeries.”
In an email, Harris spokesman Ian Sams responded: “Kamala’s position is and has always been every American would get insurance through the single payer plan, and private insurance would exist to cover anything supplemental, as is expressly outlined in the Medicare for All bill. Seems like Bernie is saying that, too.”
Other 2020 candidates – Elizabeth Warren, Cory Booker and Kirsten Gillibrand – also cosponsored Sanders’ bill.
Warren has given a far more direct endorsement than Harris of the idea of eliminating private insurance.
“I’m with Bernie on Medicare for All,” she said on the first night of the Democratic debates. “There are a lot of politicians who say, oh, it’s just not possible, we just can’t do it, have a lot of political reasons for this. What they’re really telling you is they just won’t fight for it.”
At the other end of the spectrum is former vice president Joe Biden, who said he wants to build on Obamacare by adding a government-run plan to the menu of options, a provision that progressives tried and failed to add in 2009 amid opposition from centrist Democrats.
“Everyone, whether they have private insurance or employer insurance and no insurance, they, in fact, can buy in the exchange to a Medicare-like plan,” Biden said in the debate.
Hedging her position, Harris has also cosponsored “Medicare X” legislation by Sen. Michael Bennet of Colorado, another Democratic presidential candidate who’s running as a moderate. That measure would preserve private coverage while allowing Americans to buy into a government-run plan. But she said Friday on MSNBC she favors single payer with only supplemental private insurance.
Harris continued to defend that position in West Des Moines, Iowa, on Wednesday, saying that losing one’s private insurance doesn’t mean losing one’s doctor.
“I am for Medicare for All,” she told reporters. “I think that that if you talk with people extensively enough, nobody’s in the position of really trying to defend their insurance company. What they want to know is that they’re going to be able to keep their doctor under Medicare for All. They will be.”
Single-payer proponents argue that a “public option” isn’t feasible as it would attract only the sickest people and drive up costs; they say a national program that covers everybody is necessary to pool risk and keep prices down. But Democrats who prefer a government option argue that it’s the most pragmatic way to extend coverage.
At a campaign stop in Waterloo, Iowa, on Wednesday, Biden seemed to take aim at Harris and others who he said wanted to “start over” on health care.
“I fundamentally disagree with anyone who says scrap Obamacare,” he said. “I’m against any Republican who wants to scrap it, I’m against any Democrat who wants to scrap it.”
To some degree, Americans seem ambivalent or misinformed about what Medicare for All would actually entail. In a CNN poll released Monday, 56% of respondents said the government should provide a national health insurance program for all Americans, even if it requires higher taxes. At the same time, 57% said it should not completely replace private health insurance.
A Morning Consult/Politico survey released Tuesday found that public opinion on Medicare for All fluctuates based on what information voters receive: 53% support the idea, though that number that falls to 46% when respondents are told the program would diminish private insurers. But it rises to 55% when voters are told that losing their existing private insurance doesn’t mean they’ll also lose their doctors or hospitals.
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Jennifer Epstein contributed to this article