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Kamala Harris' past health care positions could come under the spotlight in debate

Posted October 7, 2020 10:50 a.m. EDT

— California Sen. Kamala Harris could be forced into the uncomfortable position on Wednesday night of explaining her past support of "Medicare for All," a proposal the Trump campaign has described as a socialized takeover of American health care -- and Harris' running mate, Democratic nominee Joe Biden, has long opposed.

Biden's attempt to talk through his own plan, which would shore up the Affordable Care Act and add a public insurance option to the mix, set off one of the most contentious exchanges of last week's historically ill-tempered presidential debate.

President Donald Trump, interrupting repeatedly, insisted that the Democratic nominee backed Sen. Bernie Sanders' Medicare for All bill, which would create a national health insurance system -- a false claim that Biden frustratedly rejected over and over.

Vice President Mike Pence is widely expected to push a similar line against Harris in their own debate, attaching her -- and Biden, by connection -- to Sanders' vision. The difference: Pence won't, in tying Harris to Medicare for All, be totally off-base. The California senator was a co-sponsor of Sanders' bill and talked it up in 2017 as both a moral and fiscal imperative. Harris began her 2020 primary bid supporting the universal health insurance plan. But her discomfort with the issue showed and, by the summer of 2019, she introduced her own, more modest proposal.

As Biden's deputy, Harris is now charged with making the case not only for the nominee, but his policies. In most years, the vice presidential debate is little more than a clash of high-level surrogates. But in 2020, with Trump allies openly (and baselessly) speculating about Biden's age and health, and looking for ways to link him to views he doesn't hold, the Pence-Harris showdown could carry more weight.

Harris' health care arc was one of the Democratic primary's first and most persistent dramas. And though it might seem like a distant echo to many voters, her unsteady shifts on the issue will provide a tempting target for Pence. The Trump campaign's accusations that the "radical left" has its claws in Biden and Harris have largely fallen flat, but Harris is a less clearly defined figure than Biden -- who has been in the public sphere for nearly 50 years -- and could find it more difficult to brush by Pence if and when he makes reference to her own past positions.

When Harris finally landed on her own plan, she stepped into an ideological no-man's land. The proposal would have put the US on the path toward a government-backed system but stopped short of completely eliminating private insurance. Biden's campaign called it a "have-it-every-which-way approach," while Sanders said Harris' plan "is not Medicare for all."

The unveiling was a definitive break from the left, which had been skeptical of her commitment to the politically fraught overhaul. Harris had joined Sanders and other Senate Democrats, including a few other future primary rivals, in September of 2017 on Capitol Hill for the introduction of the Vermont Senator's bill.

"Everyone -- all -- should receive the health care they need regardless of where they live, their income where they live their zip code," Harris said then. "And that's what this bill is about and I'm proud to co-sponsor it. It's about saying this a right, not a privilege for a few."

But her discomfort with the Sanders bill became evident early on in her campaign. At a CNN town hall in January 2019, Harris strongly voiced her support of eliminating private insurers, saying their focus on profits was "inhumane," and said she backed Sanders' plan. By the next day, though, a Harris adviser signaled that she would also be open to more moderate paths, creating confusion over position and touching off attacks from the left, who questioned her dedication to Medicare for All.

"Medicare for All" is the plan that she believes will solve the problem and get all Americans covered. Period," a Harris spokesman said in the aftermath, affirming her support. "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."

The issue of private insurers' role would pop up again a few months later, at the first primary debate in Miami. When the candidates were asked to raise their hands if they supported eliminating it, Harris did. But the next morning, she seemed to back track, saying she misinterpreted the question.

"The question was, would you give up your private insurance for that option," Harris told NBC afterward, "and I said yes."

A month later, and just days before the second primary debate in Detroit, Harris officially broke off from the Sanders bill and spelled out a plan of her own.

The Harris concept retained a role for private insurance companies within the health care system, in a stark difference from the Medicare for All Act proposed by Sanders, which essentially eliminated such coverage. Harris called for a 10-year transition period -- longer than the four years laid out by Sanders -- though Americans could have bought into Medicare immediately if they wanted. Her plan also would not have raised middle class taxes, exempting households below $100,000, another distinction with Sanders. And she would place new taxes on Wall Street transactions to help pay for the proposal.

"This isn't about pursuing an ideology," Harris wrote in a Medium post unveiling her plan. "This is about delivering for the American people."

Harris would expand on the current Medicare system, which consists of the traditional Medicare program but also provides a private insurance option called Medicare Advantage. About one third of Medicare enrollees -- or about 22 million people -- were enrolled in these private plans in 2019, according to the Kaiser Family Foundation.

"We will allow private insurers to offer Medicare plans as part of this system that adhere to strict Medicare requirements on costs and benefits," Harris wrote. "Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around."

Harris' proposal could have changed the prevalence of employer-sponsored health plans, which cover more than 150 million Americans. Employers and unions would have had the option to provide a private Medicare plan that would have to be certified by the Medicare program.

A month on, Harris -- by then trailing in the polls -- had become a kind of cautionary tale for Democrats, in particular primary candidates. The lesson: Go all-in on Medicare for All, and all that comes with it, or stay away.

Despite their differences in the primary, Biden selected Harris in August to be his running mate. The former vice president wants to build on the Affordable Care Act by providing more generous federal subsidies and creating a government-run insurance policy, known as a "public option," with the goal of extending coverage to more Americans by making it more affordable.

After her own campaign ended and in the time she's been the Democratic vice presidential candidate, Harris has focused more on defending Obamacare, which could be struck down by the Supreme Court later this term.

Her response to Trump's nomination of Judge Amy Coney Barrett, to replace the late Justice Ruth Bader Ginsburg, likely provided some insight into how Harris will attack health care questions on Wednesday night.

"From day one, President Trump made clear that he had a litmus test for Supreme Court Justices -- destroy the Affordable Care Act's protections for people with preexisting conditions and overturn our right to make our own health care decisions," Harris said in a statement after the pick was made official late last month.

She also tied her criticism to the coronavirus pandemic, which had by then killed more than 200,000 Americans but not yet reached the Oval Office -- again offering a potential preview of the framing she will bring to the vice presidential debate stage.

"President Trump, Mitch McConnell and Senate Republicans will stop at nothing to destroy the Affordable Care Act's protections for 130 million Americans with preexisting health conditions," Harris said in the statement. "The devastating coronavirus pandemic has already killed more than 202,000 Americans, and sickened millions more, yet President Trump is fighting in the Supreme Court right now to strike down the only law guaranteeing Americans can access the health care they need."

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