If You Like Your Health Care Plan, Will Kamala Harris Let You Keep It?

In 2008, then-Senator Barack Obama launched the largest political advertising campaign of all time, spending over $100 million to attack GOP nominee John McCain’s proposal to replace employer-sponsored health insurance with individually purchased plans. Obama promised, in contrast, that under his proposal, “if you like your health care plan, you can keep your health care plan.” 16 years later, Democrats are poised to nominate a presidential candidate—Kamala Harris—who has called for the abolition of employer-sponsored health insurance, and, at times, for the abolition of private health insurance in its entirety.

We don’t yet know the specifics of what health reform policies Harris will campaign on, assuming she gains the Democratic nomination, but we can go through the timeline of what she has supported as a U.S. senator and as a presidential candidate in 2019.

Harris co-sponsored Bernie Sanders’ single-payer bill

In 2017, Harris was the first senator to co-sponsor Bernie Sanders’ bill, the Medicare for All Act of 2017. “Here, I’ll break some news,” she said that year at a town hall in Oakland, California. “I intend to co-sponsor the Medicare-for-all bill, because it’s just the right thing to do.” 15 other Democrats eventually joined her.

That bill, if enacted, would have abolished private health insurance for all age groups (including Medicare beneficiaries) and replaced it with a government-run single-payer system to benefit “every individual who is a resident of the United States,” including undocumented immigrants. (Bernie Sanders has popularized the term “Medicare for all” for a U.S. version of single-payer, government-run health insurance.)

On January 21, 2019, Harris announced that she was seeking the 2020 Democratic nomination for President. A few days later, at a CNN town hall in Iowa, she elaborated on why she sought to eliminate private insurance. In response to a questioner who asked her if her health care solution “involved cutting insurance companies as we know them out of the equation,” Harris agreed, saying, “I believe the solution—and I actually feel very strongly about this—is that we need to have Medicare for all. That’s just the bottom line…it is inhumane to make people go through a system where they cannot literally receive the benefit of what medical science can offer because some insurance company has decided it doesn’t meet their bottom line.”

CNN host Jake Tapper followed up, asking, “You’re also a co-sponsor onto [the Medicare for all bill]. I believe it will totally eliminate private insurance. So for people out there who like their insurance, they don’t get to keep it?” Harris responded:

“Well, listen, the idea is that everyone gets access to medical care, and you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require. Who of us has not had that situation, where you’ve got to wait for approval, and the doctor says, well, I don’t know if your insurance company is going to cover this? Let’s eliminate all of that. Let’s move on.” [Emphasis added.]

Harris reverses herself multiple times in 2019

Harris received immediate blowback from other Democrats and Republicans for those statements. “To replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time,” said Democratic presidential competitor Michael Bloomberg.

The next day, Harris’ campaign put out word that she was open to other approaches to reducing the role of private insurance, but that single-payer remained her ultimate goal. “Medicare-for-all is the plan that she believes will solve the problem and get all Americans covered. Period,” said her national press secretary, Ian Says, to CNN. “She has co-sponsored other pieces of legislation that she sees as a path to getting us there, but this is the plan she is running on.”

That didn’t calm the furor, so Harris held a subsequent interview with Tapper in which she claimed “that’s not what I meant” with regards to eliminating private insurance. “It was in the context of saying, ‘let’s get rid of all the bureaucracy, let’s get [rid of] all of the waste.’”

But then, at the second Democratic presidential debate in Miami on June 27, 2019, NBC’s Lester Holt asked the group, “Who here would abolish their private health insurance in favor of a government-run plan?” Sanders and Harris were the only Democrats to raise their hands; the other eight candidates did not.

Again, there was immediate blowback, and the next day Harris attempted to clarify her position, when asked by MSNBC’s Willie Geist if “private insurance should be eliminated in this country.” “No, I do not,” Harris responded, arguing that “the question was, ‘would you give up your private insurance for that option,’ and I said yes.”

In a mid-July interview with CNN’s Kyung Lah, Harris then said that she would allow private insurers to “cover what is not otherwise covered” by Medicare, which would be “very little, because almost everything will be covered” by Medicare. When asked how her plan differed from that of Sen. Sanders, she responded, “I think they’re very similar. I don’t know—I don’t think that—I’m supporting his bill, so to the extent he’s talking about his bill, I don’t know what else he’s talking about.”

Then, on July 29, 2019, Harris rolled out a detailed description of what she billed as “my plan for Medicare for all,” but which had significant differences with the Bernie Sanders version, and from the various versions she herself had previously endorsed. Obama Health & Human Services Secretary Kathleen Sebelius reportedly advised Harris on the plan.

Like the Sanders bill, Harris’ new plan would abolish employer-sponsored insurance, Affordable Care Act exchange plans, Medicaid, and the like, replacing them with Medicare-based coverage. But unlike Sanders’ bill, Harris’ July 2019 plan would allow private plans to continue to offer Medicare Advantage-style coverage, as they do today, but with lower reimbursement rates than those for traditional Medicare. Sanders’ bill allows for a four-year transition to single-payer health care; Harris’ plan envisioned a 10-year transition to the new system.

Bernie Sanders’ presidential campaign manager, Faiz Shakir, lacerated the new Harris plan in an interview with Politico, arguing that “Kamalacare” would introduce “more corporate greed and more profiteering within Medicare.”

Kamalacare: >11x the cost of Obamacare

Both versions of Medicare for All would increase federal spending by a gigantic amount: more than $30 trillion over the next ten years. By comparison, the Congressional Budget Office estimates that subsidies for Affordable Care Act-based plans will cost $2.75 trillion over the same period. In other words, Harris’ plan costs more than 11 times what Obamacare does.

Both Sanders’ and Harris’ versions raise taxes. Sanders has proposed a number of different ways to pay for his plan, including a 7.5% payroll tax, a 4% income tax, and other options. Harris argues that Sanders’ plan “hits the middle class too hard,” and that she can exempt households making less than $100,000 from these taxes by taxing financial transactions instead.

Will Harris run on a similar plan in 2024?

Given Harris’ sudden emergence as the likely Democratic nominee in a highly unusual process, it’s not yet clear what her health reform agenda would look like this time around. She benefits greatly from not having to navigate a competitive primary process. I reached out to her campaign team to ask if Harris would be running on her 2019 health reform plan, and they declined to comment—for now.

But health care remains one of the most important policy issues in America. Rising health care costs are arguably the single greatest threat to Americans’ living standards, and health care spending is the biggest driver of growth in the federal debt, outside of interest payments. Harris will no doubt be asked about her health reform views, and the country would be well served to know her answer.