Abby Goodnough and Astead W. Herndon

Harris’ announcement comes as the Democratic candidates are preparing for a fresh round of debates this week, and as she faces mounting pressure to clarify her stance on the issue after repeated missteps. It also comes as fellow candidates, such as Sanders and former Vice President Joe Biden, have sparred over health care in recent weeks.

The issue has become a litmus test among the 2020 Democrats, separating the candidates of the progressive left, who want to move rapidly toward a single-payer health care system, and the more moderate contenders, who favor other ways of expanding coverage and lowering costs.

Harris’ proposal seeks to straddle both camps, using the “Medicare for All” mantra as a long-term target while also seeking to keep a significant role for private insurers — which Sanders’ plan would eliminate.

Instead of completely replacing private coverage with a government-run, single-payer system based on traditional Medicare, Harris would allow people to choose plans modeled on Medicare Advantage, which would be run not by the government but by private insurers. More than one-third of the Medicare population already chooses Medicare Advantage, which offers extra benefits and limits out-of-pocket costs but is strict about which doctors and hospitals enrollees can use.

Her plan would also allow people to choose a somewhat expanded version of traditional, government-run Medicare. But by preserving a major role for private insurers — and calling for a 10-year phase-in period instead of the four-year transition that Sanders envisions — it could potentially draw less opposition than Sanders’ plan from insurance companies, many of which have profited handsomely from Medicare Advantage plans.

“Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services,” Harris wrote in a post on Medium. “If they want to play by our rules, they can be in the system. If not, they have to get out.”

At the Democratic debate this week in Detroit, Harris is likely to face questions about her previous statements on health care, in which she has oscillated between supporting Sanders’ more robust proposal and rejecting its most controversial parts, like tax increases on some middle-class families.

Harris’ advisers said she wanted a plan that more closely reflected her values to lay out on the debate stage. But while her proposal draws specific contrasts with Sanders’, the two candidates will debate on separate nights this week. Both are in the tier of candidates below Biden in current polling, along with Sen. Elizabeth Warren, D-Mass.

Harris’ plan also appears intended to put to rest confusion over her past statements on abolishing private health insurance. At a CNN town hall-style event in January, Harris responded to a question about private insurance by saying, “Let’s eliminate all of that.” And at the first debate last month, Harris raised her hand when asked if she favored getting rid of private insurance. In both cases, she attempted to clarify her position after the events.

But Harris’ proposal still leaves open questions, including how the longer transition period would play out. During those 10 years, newborns and the uninsured would be automatically enrolled into a “new and improved” Medicare system, according to the Harris campaign, and all Americans could buy into the public program.

Ian Sams, a spokesman for Harris, said in an email that her plan, like Sanders’, would limit everyone’s annual out-of-pocket costs to $200.

Sanders’ plan, by comparison, would allow everyone 55 and older to join Medicare in the first year, and would move everyone into Medicare by the fourth year.

Harris was also eager to draw a contrast with Sanders over the extent to which they would ask the middle class to help pay for their plans. Sanders has raised the possibility of imposing premiums equaling 4% of people’s income after the first $29,000 for a family of four. Critics have assailed that provision as politically unpalatable, but Sanders has said that families’ overall health costs would be significantly reduced.

Harris, on the other hand, would “exempt households making below $100,000, along with a higher income threshold for middle-class families living in high-cost areas,” according to her Medium post.

In the post, Harris made her version of Medicare for All sound similar to Sanders’ in terms of benefits. She said it would cover “all medically necessary services, including emergency room visits, doctor visits, vision, dental, hearing aids, mental health and substance use disorder treatment, and comprehensive reproductive health care services.”

Harris’ 10-year runway would “give all doctors time to get into the system, and provide a common-sense path for employers, employees, the underinsured, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition,” she wrote.

Sams said both Medicaid and the exchanges would be eliminated under Harris’ plan, but older Americans would continue to have the same coverage options they get now.

Like Sanders, Harris did not provide specific details of how she would pay for her plan but said she liked several of his ideas, especially imposing higher taxes on corporations and the top 1% of earners. She also said she liked the idea of modest increases in employer taxes to help pay for her plan; Sanders has suggested a 7.5% payroll tax on employers.

Sanders ran on the idea of a single-payer system in his 2016 presidential campaign, and his proposal has largely set the tone of the health care debate this time around, forcing rivals to establish their positions relative to his.

Warren, another liberal Democrat who co-sponsored Sanders’ bill, used the first debate as a moment to leave no doubt that she stood with him. “I’m with Bernie on Medicare for All,” she said.

Biden has moved in the opposite direction. In recent weeks, he has ramped up his criticisms of Medicare for All, seeking to contrast himself with the senators looking to supplant him atop the primary polls.

His plan would model itself after the Affordable Care Act and allow anyone to sign up for a new “public option,” or government-run health plan like Medicare. Most of the other Democratic candidates have also called for keeping private insurance while offering some kind of public option.

Biden has even veered into language that mirrors attacks Republicans have used to disparage the idea of a single-payer system. “Come on, what is this, a fantasy world?” he said at a campaign stop in Michigan, referring to Medicare for All. (He and Harris will stand next to each other on the debate stage Wednesday. Sanders and Warren will be onstage Tuesday.)

One criticism of Medicare Advantage plans is that the insurance companies that offer them manage to make big profits by luring the younger, healthier segment of the Medicare population and by doing things like requiring prior authorization for certain care to control costs.

Seemingly nodding to the concern that Medicare Advantage plans have earned some insurers fat profits, Harris said she would be tough on companies that wanted to offer such plans under her system, with stricter consumer protection rules than exist today. She even raised the possibility that insurers would be “reimbursed less than what the Medicare plan will cost to operate, to ensure they are delivering meaningful value and unable to profit off gaming consumers or the government.”

How that would work — and how many insurance companies would agree to be reimbursed less than what their plans cost to operate — remained unclear.

“My guess is it’s a nod to the fact that private plans in Medicare Advantage today are arguably overpaid for the services they deliver,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

Corlette was on a list of analysts the Harris campaign provided to reporters seeking reaction to the plan, along with several former Obama administration officials and others. She said that while she was not endorsing the plan or Harris, “I think it’s a great step forward that this campaign is putting some deeper policy thought into how to execute the senator’s vision and what it will take to get there.”

Corlette said she thought a 10-year transition period was much more realistic than the four-year phase-in proposed by Sanders. But she acknowledged that drawing out the transition to Medicare for All would raise the chances that it would never happen, given the number of presidential and congressional elections that would take place over that time.

“That is a significant issue,” she said. “On the other hand, to try to rush this I think raises more risks than benefits.”

This article originally appeared in <a href="https://www.nytimes.com/2019/07/29/us/politics/kamala-harris-medicare-for-all.html" id="1d9d1656-49db-3dfd-a1d2-c5515a6d4bf2">The New York Times</a>.

Harris Sets Up Debate Showdown on Health Care With New Plan

Sen. Kamala Harris, D-Calif., who is increasingly seeking to carve out an ideological lane separate from the most progressive Democrats running for president, laid out a new plan Monday for providing Medicare for all Americans, with a twist that stops short of the complete overhaul of the health insurance system that Sen. Bernie Sanders, I-Vt., has proposed.

Harris’ plan would also allow people to choose a somewhat expanded version of traditional, government-run Medicare. But by preserving a major role for private insurers — and calling for a 10-year phase-in period instead of the four-year transition that Sanders envisions — it could potentially draw less opposition than Sanders’ plan from insurance companies, many of which have profited handsomely from Medicare Advantage plans.

For now, though, the industry signaled it was not backing down.

“Like other plans, this proposal puts us on a slippery slope to Medicare for All and does nothing to address our top health care challenge: out-of-control costs,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans, a trade group for insurers. “People will have to pay more, to wait longer, for worse care. Our top health care priority needs to be making health care more affordable for all Americans.”

Tricia Neuman, who directs the Medicare policy program at the Kaiser Family Foundation, said a big question was whether the private plans Harris would offer under the Medicare imprimatur would appeal to consumers.

“The appeal of private Medicare Advantage-type plans may boil down to whether the plans offer better benefits, with lower costs, and what the provider networks look like,” Neuman said. “So, a key question is how insurers will be able to differentiate themselves from the public program.”

Though Harris called her proposal “Medicare for All” — the same title Sanders has used — the Sanders campaign quickly attacked her plan as unworthy of the name. “Call it anything you want, but you can’t call this plan Medicare for All,” Faiz Shakir, Sanders’ campaign manager, said Monday. “Folding to the interests of the health insurance industry is both bad policy and bad politics.”

Harris’ plan also appeared intended to put to rest confusion over her past statements on abolishing private health insurance. At a CNN town hall-style event in January, Harris responded to a question about private insurance by saying, “Let’s eliminate all of that.” And at the first debate last month, Harris raised her hand when asked if she favored getting rid of private insurance. In both cases, she attempted to clarify her position after the events.

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Abby Goodnough and Astead W. Herndon

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Harris Sets Up Debate Showdown on Health Care With New Plan

Harris Sets Up Debate Showdown on Health Care With New Plan