Nixing private insurance divides 'Medicare for All' candidates

Some Democratic presidential candidates who say they support “Medicare for All” are walking a tightrope on whether to fully embrace a key portion of the proposal that calls for eliminating private insurance.

Only a few White House hopefuls raised their hands when asked at last week’s debates if they were willing to abolish private insurers, even though others who were on the stage have publicly backed legislation from Sen. Bernie SandersBernie Sanders2020 Dems slam Trump decision on West Bank settlements Sanders doubles down on Bolivia 'coup,' few follow suit Overnight Health Care: GOP senator says drug price action unlikely this year | House panel weighs ban on flavored e-cigs | New York sues Juul MORE (I-Vt.) which would do just that.

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Sen. Elizabeth WarrenElizabeth Ann Warren2020 Dems slam Trump decision on West Bank settlements Sanders doubles down on Bolivia 'coup,' few follow suit Overnight Health Care: GOP senator says drug price action unlikely this year | House panel weighs ban on flavored e-cigs | New York sues Juul MORE (Mass.), Sen. Kamala HarrisKamala Devi HarrisKamala Harris endorses Christy Smith in bid to fill Katie Hill's seat Poll: Biden holds 11-point lead over Warren in Arizona Poll: Biden and Warren are neck and neck in California MORE (Calif.) and Sanders all raised their hands, as did New York City Mayor Bill de BlasioBill de BlasioDe Blasio knocks Bloomberg over stop and frisk apology Deval Patrick enters 2020 race De Blasio slams Bloomberg run for president: He 'epitomizes the status quo' MORE. But Harris later said she misunderstood the question, and clarified that she does not support eliminating private insurance.

“I am supportive of Medicare for All, and under Medicare for All policy, private insurance would certainly exist for supplemental coverage,” she said Friday morning on CBS News.

Sanders’s plan would cover every medically necessary service, including dental, vision and long-term care for people with disabilities.

That leaves little room for private insurers to cover anything except cosmetic surgery, Sanders has said.

Harris has seized on that exception to argue Medicare for All wouldn't eliminate private insurance, and that “supplemental coverage” would still exist.

Her comments, along with the discrepancy between those who have supported the Sanders bill on and off the debate stage, illustrate the delicate balance some Democrats are trying to achieve: They want to highlight their progressive chops by talking about Medicare for All, even though much of the voting public isn’t ready to give up their private insurance.

Harris has waffled on the issue of private insurance for months, despite being a co-sponsor of Sanders’s legislation. But she isn’t the only candidate in this situation.

Among the 2020 Democratic candidates, Sens. Cory BookerCory Anthony BookerKrystal Ball issues warning to Biden supporters Sanders official predicts health care, climate change will be top issues in fifth Democratic debate 2020 Democrats seek investigation into 'toxic culture' at NBC ahead of debate MORE (N.J.) and Kirsten GillibrandKirsten GillibrandMaloney primary challenger calls on her to return, donate previous campaign donations from Trump Senate confirms controversial circuit court nominee She Should Run launches initiative to expand number of women in political process MORE (N.Y.) are co-sponsors of Sanders’s bill, while Reps. Tulsi GabbardTulsi Gabbard2020 Dems slam Trump decision on West Bank settlements Sanders reclaims second place in new 2020 poll New poll catapults Buttigieg to frontrunner position in Iowa MORE (Hawaii), Tim RyanTimothy (Tim) RyanThe Hill's Campaign Report: Late bids surprise 2020 Democratic field Tim Ryan endorses Biden for president Strategists say Warren 'Medicare for All' plan could appeal to centrists MORE (Ohio) and Eric SwalwellEric Michael SwalwellThe Hill's 12:30 Report — Presented by Johnson & Johnson — Vindman defends witnesses from 'cowardly' attacks at third day of hearings Swalwell on flatulence allegation: Total exoneration Trump attacks Pence aide who called Ukraine call 'inappropriate' MORE (Calif.) are co-sponsors of a similar House bill introduced by Rep. Pramila JayapalPramila JayapalJayapal hits back at Biden on marijuana 'prohibition' Progressive House Democrat unveils bill to allow state-based 'Medicare for All' Progressives press Democrats to rethink Israel policy MORE (D-Wash.), a co-chair of the Congressional Progressive Caucus.

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Booker said he thinks there is a role for private insurance, and told The New York Times in a recent candidate survey that he would pursue a public option.

During the debate, Booker was less clear about his plans.

“We have to do the things immediately that provide better care,” he said. “We can do this better, and every single day I will fight to give people more access and affordable cost until we get to every American having health care.”

In a statement after last week’s debates, Sanders said there can be no middle ground, and his campaign called on all the candidates to unequivocally say where they stand on Medicare for All. 

"If you support Medicare for All, you have to be willing to end the greed of the health insurance and pharmaceutical industries. That means boldly transforming our dysfunctional system by ending the use of private health insurance, except to cover non-essential care like cosmetic surgeries," Sanders said. "And it means guaranteeing health care to everyone through Medicare with no premiums, no deductibles and no copays."

Democrats are trying to coalesce around a single health care message, much like they did in 2018 to take back the House.

Some on the left maintain that backing Medicare for All legislation is a must for anyone who wants to secure the Democratic presidential nomination next year, but moderate candidates are wary of giving President TrumpDonald John TrumpDem senator says Zelensky was 'feeling the pressure' to probe Bidens 2020 Dems slam Trump decision on West Bank settlements Trump calls latest impeachment hearings 'a great day for Republicans' MORE and Republicans an opening to accuse Democrats of pushing for a “socialist” takeover of health care.

Polls show that voters like the idea of Medicare for All, though most don’t know that the legislation would eliminate private insurance.

June survey by the Kaiser Family Foundation found that despite what the authors of two Medicare for All bills in Congress have said, a majority of poll respondents thought they would still be paying premiums, deductibles and co-pays.

A similar Kaiser poll from January found that support for Medicare for All dropped from 56 percent to 37 percent when respondents were told it would eliminate private health insurance.

Robert Blendon, a health policy professor at Harvard University, said most candidates will be deliberately vague about Medicare for All, even the ones who are co-sponsors of the Sanders bill.

“I think many candidates signed onto the principle,” Blendon said. “They want a Medicare dominated system but didn’t fully understand that today’s Medicare … has a private alternative which is very popular. I just don’t think they are aware of that.”

Candidates like Sanders, who has been advocating for single-payer for years, understand the nuances, Blendon said, but most others are new to the debate.

“They wanted to show they are committed to moving the country … and now this issue has surfaced in the primary, and it will definitely surface in the general election about a private alternative if you want one,” Blendon said.

Before last week’s debate, Warren had drawn some criticism from the left for equivocating about her health care policy. But on Wednesday, she left no doubt about her position, and made an aggressive play for the progressive vote.

“I’m with Bernie on Medicare for All,” Warren said on the debate stage. She added that politicians who say Medicare for All isn’t feasible just aren’t willing to fight for it.

Warren’s shift puts pressure on Sanders, and was praised by progressive groups.

“When it mattered most, and with millions of people watching, she made the strongest case yet,” said Adam Green, co-founder of the Progressive Change Campaign Committee.

“There’s a huge difference between checking a box on a position, versus actually making the case for the public and persuading them you are right,” Green added. “If all you do is check a box, you aren’t prepared with strong rebuttals to the obvious Republican attacks.”

But Warren’s embrace of Medicare for All also makes her a prime target for attacks from Trump and his GOP allies. Trump has relished attacking Medicare for All, and brought it up again last week, unprompted, as he signed an executive order about health cost transparency.

“More than 120 Democrats in Congress support Bernie Sanders’s socialist takeover of American healthcare. It’s very dangerous,” Trump said. “The Democrat plan would terminate the private health insurance of over 180 million Americans who are really happy with what they have.”

Democratic candidate Sen. Amy KlobucharAmy Jean Klobuchar2020 Dems slam Trump decision on West Bank settlements Sanders official predicts health care, climate change will be top issues in fifth Democratic debate Key Republicans say Biden can break Washington gridlock MORE (Minn.) touched on those attacks during the debate. She supports a Medicare public option, but is not a co-sponsor of the Medicare for All bill.

“I am just simply concerned about kicking half of America off their health insurance in four years, which is what this bill says,” Klobuchar said.