Harris skips Medicare for All and public option in her economic plan

Vice President Kamala Harris appears to be supporting the idea of keeping the current health benefits framework largely in place.

Harris, the Democratic nominee for president, unveiled an economic plan Friday that provides a brief summary of her health and labor proposals.

She left out any mention of creating a completely government-run, single-payer, “Medicare for all” health care system, and she also left out any mention of creating a government-run “public option” health care plan that would serve as an alternative to health coverage.

Instead, she notes that she supports keeping the current Affordable Care Act premium tax credit subsidy levels in place and that her opponent, former President Donald Trump, does not.

Harris said that she and her vice presidential running mate, Minnesota Gov. Tim Walz, support “empowering workers and their right to come together to bargain for higher wages,” and “asking the wealthiest Americans and largest corporations to pay their fair share.”

Harris and Walz also support “creating a stable environment with consistent and transparent rules” and want to “work with businesses, entrepreneurs, workers, and all stakeholders to drive an economy that creates opportunity and ensures stability and security for everyone,” according to the economic plan.

Related: Biden’s exit heats up federal health benefits policy debates

The other health care proposals listed include:

• Expanding the $35-per-month cap on Medicare drug plans’ out-of-pocket costs for insulin to apply to “everyone.”
• Expanding the $2,000-per-year cap on Medicare drug plan out-of-pocket costs for all covered drugs to apply to everyone.
• Speeding up the launch of the Medicare program’s efforts to negotiate for lower prescription drug prices.
• Cracking down on “pharmaceutical companies who block competition.”
• Cracking down on pharmacy benefits managers, which the plan describes as “pharmaceutical middlemen who squeeze small pharmacies’ profits and raise costs for consumers.”
• Working with states to reduce the odds that people will accumulate medical debt and to cancel existing medical debt.

The history

Harris has appeared to be moving toward the center on health policy issues for the past seven years.

In 2017, she supported a Sanders Medicare for All bill. The Sanders bill would have eliminated all existing major medical insurance arrangements, including the current version of Medicare, and most supplemental health insurance arrangements. The bill would have replaced the current version of Medicare and all private health insurance arrangements with a government-run program.

In 2019, Harris moved away from backing Sanders’ single-payer proposal. Instead, she favored letting consumers buy into the traditional Medicare program while continuing to allow the sale of private supplemental health insurance.

Walz, her running mate, served in the U.S. House from 2007 through 2019. He never sponsored or co-sponsored the House Medicare for all bills.

Extending the current Affordable Care Act subsidy levels

The ACA itself originally provided premium tax credit subsidies only for people with modified adjusted gross income under 400% of the federal poverty level. This year, that’s $60,240 for an individual and $124,800 for a family of four in most states.

Under emergency laws passed in response to the COVID-19 pandemic, premium tax credit subsidies can be available to people with a higher income if the cost of standard health coverage would exceed a “required contribute percentage” of their income. This year, the required contribution percentage is 8.39%.

Extending the current premium tax credit subsidy levels could cost about $400 billion over 10 years, or about $40 billion per year, according to the Committee for a Responsible Federal Budget.

The United States will spend about $6.9 trillion this year and run a deficit of about $1.9 trillion, according to White House budget analysts.

Extending the current ACA subsidy levels would amount to about 0.6% of 2024 federal spending and about 2.1% of the 2024 budget deficit.

What it means for employers and brokers

Harris does not say anything about health savings accounts or health reimbursement arrangements in her proposal, and it’s not clear how friendly a Harris-Walz administration would be to those.

But, at this point, she looks as if she might not be planning to campaign on proposals for major changes.

Health system stability could be a positive for employers and brokers who like the current system but frustrating for employers and brokers who are frustrated with the current system and want to see major changes.