Vice President Kamala Harris has a complicated past with Medicare for All, and she's distancing herself from the policy as she heads into her 2024 presidential campaign.
The Democrat campaigned on the policy during her 2020 presidential campaign, but her position has evolved since. Today, Ms. Harris' 2024 campaign is not pursuing a progressive Medicare for All plan and is closely aligned with President Joe Biden's centrist work to strengthen and support the Affordable Care Act.
At its core, Medicare for All aims to create a single-payer system, but the proposals for how to achieve that have changed over the last two decades and often look different depending on the lawmaker advocating for it. Here's a brief history into the policy and what we know about Ms. Harris' positions on it.
1. What is Medicare for All?
Medicare for All would create a universal health coverage system in the United States to replace the current mix of private and public health insurance programs. It was first introduced in Congress by Democratic Rep. John Conyers in 2003.
The policy has been most supported by Sen. Bernie Sanders, who reintroduced the Medicare for All Act in May 2023 with record support in Congress. Ms. Harris co-sponsored the 2017 version of the legislation.
Under Mr. Sanders' bill, the Medicare eligibility age would be lowered in stages over four years to eventually encompass all U.S. citizens. The program would begin covering dental, vision and hearing aids for those not eligible under current law, and Part A and B deductibles would be eliminated, as would premiums and copays, with some exceptions for prescription drugs.
It would be illegal for commercial payers and employers to sell or offer policies that duplicate benefits provided under a single-payer system, and individual states would be permitted to offer additional benefits.
Among U.S. adults, 57% believe the federal government should guarantee all Americans have health insurance, though 53% are supportive of private insurance rather than a public option, according to a January 2023 Gallup poll, which did not ask directly about a Medicare for All strategy.
2. Harris' past proposals
In January 2019 during her first run for president, Ms. Harris discussed her support for Medicare for All and eliminating private health insurance. Republicans and some moderate Democrats rebuked the idea for being financially unsustainable and counter to consumer preferences. Later, the Harris campaign said she would also be in favor of more moderate health insurance reform strategies.
In July 2019, Ms. Harris published an article in Medium clarifying her position on Medicare for All and laying out how she would implement it.
"Medicare works. It's popular," she wrote. "Now, let’s expand it to all Americans and give everyone access to comprehensive health care."
Unlike Mr. Sanders' proposal, Ms. Harris' new plan included a role for private health insurers, who would be allowed to offer coverage under a highly regulated system similar to Medicare Advantage. Instead of a four-year transition period, Ms. Harris proposed 10 years. Additionally, financing would partly come from taxes on households with annual incomes of $100,000 or more, in contrast to Mr. Sanders' plan, which proposed taxing households making $29,000 or more.
In 2019, Ms. Harris also sponsored legislation as a senator called "Medicare X," which would create a new public insurance option under the ACA and would not eliminate private plans. Democratic senators reintroduced the legislation in June 2024.
3. Biden's position
As Ms. Harris adopts a more centrist position on healthcare, her campaign increasingly aligns with the Biden administration’s stance. President Joe Biden has publicly opposed Medicare for All and has worked to support and strengthen the ACA during his term.
Since 2020, the Biden administration has enacted several ACA-focused policies, including renewing premium subsidies for individuals purchasing health coverage on the ACA marketplace, opening special ACA enrollment periods, encouraging states to expand Medicaid, and fixing a loophole in the law called the "family glitch" that left some families without affordable coverage.
4. Trump's response
Mr. Trump has begun to use Ms. Harris' evolved stance on insurance reform as a campaign attack strategy, pointing to her previous support for Medicare for All as a risk for those with private insurance today.
"She wants to outlaw private health insurance," Mr. Trump said in July, per CNN. "A lot of people have private health insurance. They want to keep it that way. It's phenomenal."
“Kamala Harris’ spokespeople are once again alleging she has flip flopped on her positions – this time saying she no longer supports socialist Medicare for All," a Trump campaign spokesperson told CNN on Aug. 14.
The Republican Party's official platform includes no mention of the ACA.
"We're going to keep the Affordable Care Act," Mr. Trump said Aug. 14 during a rally in Asheville, N.C. "Unless we can do something much better, we'll keep it."
5. Harris' current position
Currently, Ms. Harris is not proposing a Medicare for All system, CNN and Fox News reported in August. Ms. Harris has not recently discussed Medicare for All publicly and has instead emphasized her support for the Biden administration's efforts to strengthen the ACA and lower prescription drug costs.
On Aug. 6, Ms. Harris said former President Donald Trump would "end the Affordable Care Act and take us back to a time when insurance companies had the power to deny people with pre-existing conditions" if given the chance.
On Aug. 16, the vice president unveiled new economic policies she would look to enact during her first 100 days in office if elected president in November, including four healthcare policies:
ACA
Ms. Harris signaled that she does not want ACA premium tax credits to expire. The Biden-Harris administration passed the American Rescue Plan Act in 2021, which enhanced subsidies for individuals purchasing health coverage on ACA exchanges. These subsidies are set to expire at the end of 2025 unless Congress takes action.
Lowering prescription drug costs
Ms. Harris highlighted her role in passing the Inflation Reduction Act in 2022, which allows CMS to negotiate the price of prescription drugs without generic or biosimilar competition that heavily cost Medicare Parts B and D. Medicare enrollees will save an estimated $1.5 billion when the negotiated prices take effect in 2026, according to CMS. Ms. Harris is proposing accelerated negotiations in order to reduce some drug costs by up to 79% in 2026.
The IRA also caps the cost of insulin at $35 for enrollees and $2,000 for out-of-pocket drug costs — the new proposals would extend the two price caps to all Americans.
PBMs
Ms. Harris is advocating for more competition and transparency among pharmacy benefit managers, "starting by cracking down on pharmaceutical companies who block competition and abusive practices by pharmaceutical middlemen who squeeze small pharmacies' profits and raise costs for consumers." Several federal investigations and probes into the industry are currently underway.
Medical debt
A Harris administration would work with states to cancel medical debt and enact policies to prevent debt in the future. The campaign pointed to its support of removing medical debt from nearly all credit reports and canceling $7 billion of medical debt using American Rescue Plan funds.
In June, CMS approved North Carolina's plan to push hospitals to relieve $4 billion in medical debt for about 2 million low and middle-income people, which all 99 of the state's eligible hospitals have signed onto.