Kamala Harris' Plan for Medicare for All

Why do we need Medicare for All?

Health care costs too much. Insurance companies and drug companies have been jacking up prices for so long that Americans now pay on average twice what people in other countries pay. Even though we spend more, we fail to cover 27 million Americans. The problem is getting worse: Millions of Americans have lost their health insurance under Donald Trump and many more are at risk with the fate of the Affordable Care Act under review in the courts.  

Meanwhile, those with insurance are waking up in the middle of the night worrying about staggering out-of-pocket costs. How am I going to afford a $5,000 deductible just for walking my child into the emergency room? How will I pay that surprise medical bill because the ambulance that carried me to the hospital was out of network? 

In America, health care should be a right, not a privilege. Families with pre-existing conditions should not fear that they will be denied care. It’s why we need Medicare for All.  

Imagine changing a job and not having to worry about your health care coverage. Imagine going to the pharmacy and not having to worry about an outrageous price increase on the prescription drug you need. Imagine walking through those sliding glass doors at the emergency room knowing that you have a Medicare card that will ensure you get the treatment you need without a bill you can’t pay.

Who will be covered under Medicare for All and what benefits will be offered? 

Medicare for All will provide every individual in America with access to comprehensive health care. It will cover all medically necessary services, including emergency room visits, doctor visits, hearing aids, vision, dental, mental health and substance use disorder treatment, and comprehensive reproductive health care services. These benefits will be covered — no deductibles, and no copays for high-quality care. The plan will also have strong caps on out-of-pocket costs. It will also empower the Secretary of Health to negotiate for lower prescription drug prices. My plan will give more Americans more options to gain access to the health care they need.

Under my Medicare for All plan, we will also expand the program to include other benefits Americans desperately need that will save money in the long run–for instance, an expanded mental health program including telehealth and easier access to early diagnosis and treatment, and innovative patient navigator programs to help people identify the right doctor and understand how to navigate the health system. It will provide a serious auditing of prescription drug costs to ensure Americans aren’t paying more for their prescription drugs than other comparable countries; a comprehensive maternal & child health program to dramatically reduce deaths, particularly among women and infants of color; and meaningful rural health care reforms, such as increasing residency slots for rural areas with workforce shortages and expanding loan forgiveness for rural health care professionals, to promote high-quality access to people regardless of their zip code. 

Will I be able to keep my doctor under Medicare for All?

Yes. 91% of eligible doctors participate in the Medicare program today. Envision a program where you can walk into a doctor’s office knowing that they are in-network and you can walk out without worrying about your out-of-pocket costs or a surprise medical bill. My plan recognizes that doctors, nurses, and your entire health care team who provide high-quality care will have a voice in their workplace and be paid at appropriate rates under my plan. 

How does this plan work and how will we transition to Medicare for All? 

Under my Medicare for All plan, we will immediately allow people to buy into a Medicare Transition Plan through an extended 10-year phase-in period. 

We will automatically enroll newborns (with an opt-out provision for families with employer-sponsored insurance) and the uninsured into a Medicare Transition Plan, and provide a commonsense path for employers, employees, the underinsured, children, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition into the Medicare Transition Plan. The Medicare Transition Plan will provide enhanced benefits with limited cost-sharing requirements and financial assistance for those who qualify based on income. During the transition, seniors will be able to keep their Medicare with immediate coverage of additional benefits such as dental, vision, and hearing aids. 

Second, after the 10-year transition period, we will have a new Medicare framework where most Americans will be in an expanded and improved public Medicare plan. In my Medicare for All system, similar to Medicare Advantage today, private insurance plans can contract through Medicare and compete with the public Medicare plan. However, these private Medicare plans will be subject to stricter consumer protection requirements than under current law, such as getting reimbursed by Medicare for less than the cost of the public Medicare plan to ensure taxpayers aren’t subsidizing insurance company profits. Americans can then choose whether to stay in the public Medicare plan or opt-into a private Medicare plan.

What about employer-based plans?

 During the transition period, employers can continue to provide private health coverage to employees. However, employers will also have the opportunity to provide health care for their employees through the Medicare Transition Plan, with a shared responsibility payment. Employees will also have the option on their own to buy into the Medicare Transition Plan during the transition period. 

Following the transition period, under my Medicare for All system, employers will have the option to provide a private Medicare plan for their employees that will be certified by the Medicare program, similar to how employers can offer Medicare Advantage plans today. Employees could choose to be in that employer Medicare plan, a different private Medicare plan, or the public Medicare plan. 

What about organized labor and union workers?

Under my Medicare for All plan, union workers will have the option to join Medicare and stop sacrificing wages for better health care. Unions could also continue working with employers to offer a private Medicare plan option or supplemental benefits in addition to the Medicare plan.

Workers should and will be guaranteed the opportunity to join together in a union or other worker organization and have a collective voice in discussions concerning the health care issues that affect them. They can and should be allowed to pay dues and be active in organizations without retaliation.

 Does your plan affect the VA Health System or the Indian Health Service?

No. Those programs will remain untouched, but my Administration will stay vigilant to ensure that Veterans and Native Americans receive high-quality health care.

How does your plan affect seniors?

Seniors will be able to keep their Medicare with immediate coverage of additional benefits such as dental, vision, and hearing aids, and the Secretary will have the authority to use market leverage to secure the best prices for these products and services. Medicare Advantage plans would continue uninterrupted during the transition. And employer-sponsored health insurance would continue to be an option until we meet these shared principles as all Americans gain access to better coverage over the next decade. My Medicare for All plan would also phase-in coverage of comprehensive long-term services and supports, with a focus on consumer-directed home and community-based services. 

How does your plan affect children?

Newborns will be automatically enrolled into the Medicare Transition Plan with an opt-out provision for parents who have employer-sponsored coverage. Children currently covered by the state Children’s Health Insurance Program (CHIP) and Medicaid will have a pathway to transition onto the Medicare Transition Plan and ultimately into my Medicare for All system. Comprehensive services including prevention, wellness, and services to assist children with developmental delays will be included. All currently available Medicaid supplemental benefits to children, such as EPSDT, will be provided under my Medicare for All plan.

How does your plan affect people with disabilities?

People with disabilities will also transition to the Medicare system and have access to comprehensive long-term services and supports, as well as necessary equipment and assistance devices. Under my Medicare for All plan, long-term services and supports will be consumer-directed and provided in home- and community-based settings, unless the individual chooses otherwise. 

How does your plan affect Americans living in rural areas?

By expanding high-quality health care coverage to the uninsured and underinsured, my plan will substantially increase patient access at rural hospitals and clinics. Rural Americans will have better access to care through telehealth services. We will work to redesign and prioritize delivery system reforms for rural areas to promote innovative solutions to deal with critical workforce shortages and a lack of reliable access to trauma, obstetrics, and other hospital services.

How does your plan affect Medicaid?

Medicaid will transition to the Medicare for All system, which will ensure that all current Medicaid benefits for low-income individuals will be covered. States will be required to make maintenance of effort payments to the Medicare program equal to the amounts they currently spend on Medicaid and CHIP, which will grow with inflation. 

Does your plan eliminate all private insurance?

No. Under my Medicare for All system, the power of big insurance companies will be greatly diminished. After the transition period, private insurance will only exist in two ways:

1) At the end of the day, Americans want to be able to choose their doctor and the care they receive, not the insurance company that provides it. Under my plan, private insurers can compete with the new public Medicare plan, as long as the plans they offer adhere to strict requirements like those laid out below. This would function similarly to how Medicare Advantage operates within the Medicare system today. Today, 35% of seniors are enrolled in private Medicare plans that get paid directly by Medicare and, in fact, 25% of current private Medicare insurance plans are already at or below 95% of Medicare costs. 

In my Medicare for All system, Medicare will continue to 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. But unlike under the current program, these private Medicare plans will be held to stricter consumer protection standards than they are today, such as getting reimbursed less than what the public Medicare plan will cost to operate, to ensure that they are delivering meaningful value and unable to profit off of gaming consumers or the government.

2) People will be able to purchase supplemental insurance covering services not included under Medicare for All, such as medical insurance for traveling abroad and cosmetic surgery. Employers will still be able to offer their employees retiree supplemental coverage through a private insurance plan. 

 How will we pay for Medicare for All? 

Right now, the US spends $3.5 trillion a year on health care. If we do nothing over the next decade, that number will skyrocket to an estimated $6 trillion a year. 

That’s why over 200 economists around the country have said we will dramatically save money over the long run if we expand the Medicare program to include everyone and limit profits for drug companies and insurance companies. We will also save money by accelerating delivery system reforms and value-based care that rewards meaningful outcomes instead of promoting performing unnecessary tests and procedures. 

Senator Sanders, for example, has put forward a number of ways to help pay for his Medicare for All plan, including an income based premium paid by employers, higher taxes on the top 1%, taxing capital gains at the same rate as ordinary income, among others.

I think these are good options, especially making the top 1% and corporations pay their fair share through a more progressive income, payroll, and estate tax.

However, one of Senator Sanders’ options is to tax households making above $29,000 an additional 4% income-based premium. I believe this hits the middle class too hard. That’s why I propose that we exempt households making below $100,000, along with a higher income threshold for middle-class families living in high-cost areas. 

To pay for this specific change, I would tax Wall Street stock trades at 0.2%, bond trades at 0.1%, and derivative transactions at 0.002%. Think of it like this: that’s a $2 fee on a $1,000 trade by investors and big banks. I would also end foreign tax shelters by taxing offshore corporate income at the same rate as domestic corporate income. Together, these proposals would raise well over $2 trillion over ten years, more than enough to make up the difference from raising the middle class income threshold.

In total, this plan will reduce our country’s health care costs and lower Americans’ out-of-pocket costs, all while extending health insurance coverage to every American.