Kamala Harris and the Evolving Landscape of Universal Healthcare

Kamala Harris's stance on universal healthcare has been a subject of considerable discussion and evolution throughout her political career. From her initial support for "Medicare for All" to her more nuanced approach as Vice President, her views reflect the complexities and challenges of healthcare reform in the United States.

Early Support for Medicare for All

In January 2019, during a CNN town hall in Des Moines, Iowa, then-Senator Kamala Harris unequivocally stated, "We need to have Medicare for All." She passionately criticized the existing system, decrying it as "inhumane" to allow insurance companies to dictate access to medical care based on profit motives. This declaration resonated with supporters of universal healthcare, particularly given Harris's co-sponsorship of Senator Bernie Sanders's Medicare for All bill in 2017. When pressed by CNN's Jake Tapper on whether this meant eliminating private insurance, Harris appeared resolute, highlighting the frustrations of dealing with insurance claims, paperwork, and coverage delays. She stated: “Let’s eliminate all of that."

However, this seemingly definitive stance soon faced clarification and adjustments. Campaign representatives issued statements suggesting that while Medicare for All was Harris's "preference," she remained open to multiple "paths" toward achieving universal coverage. This ambiguity marked the beginning of a series of shifts in her position on healthcare.

The 2019 Healthcare Plan: A Middle Ground

Throughout 2019, Harris struggled to articulate a consistent vision for Medicare for All. In a June debate, she initially raised her hand when candidates were asked if they would eliminate private health insurance, only to backtrack days later. This inconsistency drew criticism from advocates like Adam Gaffney, an ICU doctor and former president of Physicians for a National Health Program. While Gaffney acknowledged Harris's laudable goal of covering everyone, he pointed out that her plan maintained a central role for private insurers, which he argued drive up costs.

Harris's plan, unveiled during her presidential campaign, proposed a 10-year transition period to expand Medicare access to all Americans. Newborns and the uninsured would be automatically enrolled, and employers could choose from federally designated programs. Crucially, it preserved a role for private insurance companies, allowing individuals to opt for either a public Medicare plan or a Medicare plan offered by a private insurer. This approach differed significantly from a single-payer system, which would create a single government entity to oversee all healthcare spending.

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Michael Lighty, a Medicare for All advocate who worked for Senator Sanders’s 2020 presidential campaign, noted that Harris’s eventual retreat was influenced by the intense attacks on Sanders's Medicare for All proposal. According to Lighty, Harris “backed off the fundamental principle - a single, publicly administered plan that would eliminate the power of the commercial insurance companies.”

The Role of Medicare Advantage

A key component of the debate surrounding Harris's healthcare proposals involves Medicare Advantage, a privatized version of Medicare that has existed in various forms since the 1990s and was renamed in 2003. Medicare Advantage plans are often chosen for their low upfront premiums, averaging less than $20 a month. However, concerns have been raised about the quality of care provided under these plans. Studies, such as those published in the Journal of Clinical Oncology, have indicated higher mortality rates for cancer patients in Medicare Advantage compared to traditional Medicare enrollees, potentially due to inferior care options. Additionally, data from one large insurer revealed a significant increase in claim denials over a five-year period, with one in three Medicare Advantage enrollees experiencing at least one denied claim annually.

Critics like the American Prospect have argued that Harris's approach would expand the commercial part of the system, falsely branded as a variant of Medicare, and take the country further away from true seamless and universal coverage. From the GOP's perspective, Medicare Advantage should get even bigger.

The Biden-Harris Administration: Building on the ACA

Since becoming Vice President, Harris has focused on improving the implementation of existing laws, particularly the Affordable Care Act (ACA). This approach involves expanding subsidies for individuals purchasing coverage through the ACA exchanges, potentially reducing monthly premiums for those who would otherwise pay more than 8% of their annual income on coverage. Additionally, Harris supports efforts to extend Medicaid coverage in the states that have not yet expanded it under the ACA.

Alex Lawson, the executive director of Social Security Works, defends Harris's 2019 proposal, arguing that her goal is to allow private insurance to offer plans within the Medicare system, subject to strict requirements to lower costs and expand services. Lawson points to the Biden-Harris administration’s healthcare track record, including "the largest expansion of Medicare since the creation of Medicare," and the creation of price caps on a select handful of drugs for Medicare patients.

Read also: The Education of Kamala Harris

Lowering Prescription Drug Costs

Both Biden and Harris have prioritized lowering healthcare costs, particularly prescription drug prices. The Biden administration has already taken steps in this direction, including capping the cost of insulin at $35 per month for Medicare recipients and initiating direct price negotiations on 10 top-selling prescription drugs. Starting next year, Medicare beneficiaries will also have a $2,000 annual cap on out-of-pocket costs for outpatient prescription drugs.

Harris has expressed interest in expanding these measures to the commercial sector. As BioPharma Dive reports, Harris has previously endorsed the possible use of “march-in rights” to break the patents on “federally funded inventions” to assist in lowering the price when manufacturers are allegedly engaged in price-gouging. The Biden Administration released a framework in 2023 for when march-in-rights that could be used going forward.

Addressing Medical Debt

Another area of focus for Harris has been medical bills and debt. She supports using funds from the American Rescue Plan to purchase medical debt from healthcare providers, potentially leading to the forgiveness of $7 billion for three million Americans by 2026. Harris also aims to prohibit medical bills from being included on individuals’ credit reports.

Affordability as a Central Theme

More recently, Harris has been framing healthcare as a pocketbook economic issue. Harris's package focuses entirely on people’s out-of-pocket costs and their worries about the affordability of health care. Affordability is the central theme, not universal coverage, or health care as a right.

Evaluating the Impact of a Harris-Led Healthcare System

To fully understand the potential impact of Harris's healthcare proposals, it's essential to consider analyses from various organizations. The Center for Health and Economy (H&E) conducted a microsimulation analysis of Harris's Medicare for All plan, projecting its effects on health insurance coverage, provider access, medical productivity, and the federal budget.

H&E's analysis, which assumes the plan takes effect in 2026, estimates that it would achieve full coverage of the population, eliminating premiums, deductibles, and copays. However, the analysis also projects a decrease in medical productivity due to the influx of previously uninsured individuals and the dissolution of the network structure. While provider access is expected to increase due to global coverage, the overall budgetary impact is estimated to be a -$43.9 trillion dollars over the next decade.

The analysis also acknowledges several factors not considered in the Harris plan, such as the additional costs of adding dental, vision, and hearing benefits. Furthermore, the microsimulation model does not account for the over-65 population, requiring certain adjustments and assumptions.

Harris's Stance on Reproductive Rights

Outside of insurance coverage and drug pricing, healthcare policy experts expect Harris to focus heavily on protecting abortion access. Harris has forcefully called on Congress to restore the protections offered by Roe v. Wade with respect to women’s reproductive rights and has made women’s autonomy in deciding whether or not to end pregnancies a centerpiece of her campaign.

Additionally, Harris said during an MSNBC town hall in May 2019 that, if elected president, she would require any state-passed law limiting reproductive freedoms to undergo approval from the Department of Justice before being enacted.

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