A Kamala Harris presidency won't make health care a right.
Campaign aide confirms Harris has abandoned past support for universal coverage models.
It’s no secret that I think consider the absence of universal health care to be the greatest shortcoming of the United States’ social contract. Frustrated with inaccurate coverage of Vice President Kamala Harris’ confusing evolution on the issue, I recently posted a piece correcting the record. Here’s a brief timeline, which will provide context for the discussion that follows:
In 2017, Kamala Harris co-sponsored Bernie Sanders’ single-payer bill, which would have enrolled all Americans in an improved version of traditional Medicare and eliminated most private health insurance coverage.
In 2019, while campaigning for the Democratic nomination, Harris abandoned her support for single-payer and introduced a new universal health care plan, which preserved a central role for private insurers where they would compete, alongside a public option, to sell Medicare Advantage-type plans to all citizens. This was not a single-payer plan — it could accurately be described as a hybrid or managed-competition approach.
In 2024, Kamala Harris has said nothing about universal health care, but her campaign has simultaneously, and confusingly, told reporters that she no longer supports single-payer health care and Medicare for All (i.e. her 2019 plan). Like many of the reporters and wonks analyzing Kamala’s complicated past, her campaign aides also seem confused about her 2019 proposal — sometimes erroneously referring to it as single-payer. What they want Americans and journalists to understand, I guess, is that she no longer supports major changes to the health care sector in order to achieve universal coverage. The official line1 seems to be that she will attempt to reduce the uninsured population by tweaking the Affordable Care Act.
Left unanswered until last week, though, was why Harris has abandoned her 2019 universal health care plan. Now it appears we have something close to an answer from an anonymous campaign aide:
A Harris campaign aide explained to Axios that she's no longer pushing Medicare for All because of what she learned during her four years of experience in the White House, and seeing how the Biden administration has expanded coverage through the Affordable Care Act.
Harris doesn't think the disruptive process of replacing the private health care system is necessary to reach her vision of making health care a right not a privilege, the aide said.
According to the aide, Harris abandoned her 2019 health care plan — an insurance-based managed-competition policy misleadingly labeled Medicare for All — because of “what she learned [about health care] in the White House, and seeing how the Biden administration has expanded coverage through the Affordable Care Act.” (Biden has encouraged states to expand Medicaid and provided more generous subsidies for the purchase of marketplace plans.)
This is an unsatisfying explanation for a few reasons:
As vice president, Harris has personally done very little work on health policy apart from abortion, so it’s unclear what she would have learned to shift her opinion so dramatically.
While Trump and Biden Covid-era policies did temporarily expand both Medicaid and marketplace enrollment, the number of Americans — including poor children losing Medicaid and not being enrolled in new coverage — without health insurance is rising again. The percent of adults skipping medical treatment due to cost has also increased during the Biden presidency. How can Harris square those negative trends with her contention that Biden’s ACA tweaks taught her wholesale change is no longer necessary? Is she not familiar with this data?
Harris’ anonymous campaign aide noted that she “doesn’t think the disruptive process of the replacing the private health care system is necessary to reach her vision of making health care a right not a privilege.” This is a bizarre explanation for abandoning her 2019 plan, which would have preserved both private insurance and private providers while achieving universal coverage over a decade. Indeed, even Bernie Sanders’ 2017 single-payer bill would have protected private providers with a government single-payer only replacing private payers.
Does Harris think that uninsurance is the only problem with U.S. health care? As hospitals and insurers are still financially exploiting both insured and uninsured Americans, why does she no longer believe they should be forcefully reorganized into a more humane universal system with less abusive bureaucracy and patients no longer directly exposed to mailboxes full of medical bills?
By abandoning prior support for two different universal coverage models and signaling that her health care agenda will only consist of modest measures, Harris seems to be saying that those will be enough to “reach her vision of making health care a right not a privilege.” But this thinking was actually rejected years ago by the Democratic Party’s leading think tank.
In 2018, the Center for American Progress released a German-style universal health care proposal — awkwardly labeled “Medicare Extra for All” — which effectively served as mainstream acknowledgement that another substantial piece of health care legislation would be necessary to “finish the job” on health care reform started by Barack Obama. Neera Tanden, the think tank’s former president and now Biden’s top domestic policy adviser, repeatedly advertised the proposal on her X feed from 2018 through 2020. A white paper introducing it said:
Costs and deductibles remain much too high: 28 percent of nonelderly adults, or 41 million Americans, remain underinsured, which means that out-of-pocket costs exceed 10 percent of income. In the wealthiest nation on earth, 28.8 million individuals remain uninsured.
To address these challenges, the Center for American Progress proposes a new system—“Medicare Extra for All.” Medicare Extra would include important enhancements to the current Medicare program: an out-of-pocket limit, coverage of dental care and hearing aids, and integrated drug benefits. Medicare Extra would be available to all Americans, regardless of income, health status, age, or insurance status.
Precisely because of widespread recognition, among both candidates and policy wonks, that building on the ACA was no path to universal coverage, Medicare for All became the most important policy debate during the 2020 Democratic primary — see here, here, here, and here. By design, the existing health care non-system2 propped up by the ACA contributes to non-elderly Americans constantly churning between periods of uninsurance, underinsurance (i.e. deductible or cost-sharing presents a barrier to accessing care or there are insufficient doctors in a plan’s network), and chaotic enrollment in a variety of different insurance plans ranging from employer-sponsored to Medicaid to marketplace coverage. Commendably, Kamala Harris’ 2019 campaign website demonstrated understanding of underinsurance with an example of parents struggling to decide if they could afford to pay down a $5,000 deductible “for walking [a feverish child] into the emergency room.” If you are underinsured or uninsured, your right to health care has not been guaranteed.
Perhaps surprisingly, as a result of Harris abandoning past support for true universal coverage, there’s no longer significant daylight between her and Donald Trump on health insurance policy. Both candidates are simply making vague promises to build on the status quo where most Americans receive private health insurance at work, but not articulating plans for anything close to the universal systems — public or insurance-based — found in peer nations. Trump has said he will preserve the ACA “unless we have something better” and frequently attacks Harris for supporting universal health care policies that she has systematically discarded over the past half decade. Though a majority of swing state voters have expressed support for single-payer health care, powerful insurance and hospital lobbyists are effective at convincing both elected Democrats and Republicans to oppose major reforms that would hit industry profits.
In short, absent action in Congress or a change in Kamala Harris’ policy preferences, tens of millions of Americans will likely remain uninsured or underinsured during a potential Harris presidency. Given the vice president has decided not to endorse a concrete plan that would achieve universal coverage and make health care a right as in other high-income countries, it may be a good idea for her aides to choose their words more carefully moving forward.
Impossible to say with certainty, because her campaign website does not have an official policy platform.
Echoing Walter Cronkite, I understand the U.S. health care system as a “non-system,” because there is no single universal health care policy like in other high-income countries.