Democratic presidential contender Kamala Harris on Monday unveiled her plan to broaden health care coverage, creating a contrast with former Vice President Joe Biden that could play out during their debate Wednesday night.

The California senator’s plan comes after months of hedging her support for a single-payer, government-run system. Harris is staking out a position on the hot political issue between Biden, who wants to set up a voluntary public insurance option, and Vermont independent Sen. Bernie Sanders, the leading advocate for a single-payer system known as “Medicare for All.”

Harris’ plan would essentially build on the current Medicare program through a decadelong transition that would allow private insurers to offer plans that meet the program’s cost and benefit requirements. In the future, employers could use the new program for their workers.

“Right now, the American health care system is a patchwork of plans, providers and costs that have left people frustrated, powerless and insurance companies in charge. And the bottom line is that health care just costs too much,” Harris wrote in a Medium post. “We need comprehensive health insurance that covers every American.”

The plan would cover all “medically necessary services,” she said, similar to Sanders’ single-payer proposal, including emergency room and doctor visits; vision, dental and hearing services; mental health and substance abuse treatment; and reproductive care. She did not say whether patients would have to pay any cost sharing or premiums.

[‘Medicare for All’ keeps defining 2020 political landscape]

While Harris’ plan would maintain private insurance coverage, a key sticking point in the health care debate among primary candidates, it would eliminate employer-sponsored coverage as it exists now at the end of the transition.

“Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services,” she wrote in the Medium post. “If they want to play by our rules, they can be in the system. If not, they have to get out.”

That decadelong transition, which would outlast a Harris presidency if she won two terms, is much longer than the proposed transition to a single-payer system by Sanders. His bill proposes a four-year transition, while the leading House single-payer bill would make the change in just two years. Under Harris’ plan, consumers would be able to buy into Medicare at the outset of the transition and newborns and the uninsured would automatically be enrolled in the public program.

[Democrats face pressure in debates on overhauling health care]

During the transition, employers could continue to offer private coverage to employees, but could also shift to paying for a Medicare plan. Later, after the transition, employers could still offer a private Medicare plan, and employees could enroll in that, a different private plan or the public plan, according to Harris’ campaign website.

The longer phase-in would decrease the overall cost of the program compared to Sanders’ proposal, which economists estimated would cost upwards of $30 trillion over a decade, Harris said. She did not offer a detailed cost estimate of her plan.

Harris had previously said her plan would not eliminate private insurance because people would still be able to purchase supplemental coverage, which she said would be available for people to buy to access care during overseas travel or for cosmetic surgery.

While Harris did not detail how the private insurance plans would be reimbursed, she said the plans would be held to stricter standards such as being reimbursed less than what the Medicare plan would cost to operate. Currently, the Medicare program reimburses providers such as doctors at a lower rate than private insurers.

Reaction

The Biden campaign criticized the proposal, saying that Harris was going back-and-forth on her support for a single-payer plan and that she sought to unravel the 2010 health care law. Defending the law is the centerpiece of Biden’s health care plan.

“This new, have-it-every-which-way approach pushes the extremely challenging implementation of the Medicare for All part of this plan ten years into the future, meaning it would not occur on the watch of even a two-term administration,” Kate Bedingfield, Biden’s deputy campaign manager, said in a statement. “The result? A Bernie Sanders-lite Medicare for All and a refusal to be straight with the American middle class, who would have a large tax increase forced on them with this plan.”

Several Democratic health care experts, including former Obama administration Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare and Medicaid Services Administrator Andy Slavitt, praised Harris’ plan.

“Sen. Harris’ plan balances idealism and pragmatism,” Slavitt said in a statement released by her campaign. “It says in effect: We have a mandate to get everyone affordable health care and put people over profits — but we don’t need to tear down the things people have and they like in order to do it.”

Harris did not outline exactly how she would finance her plan, but pointed to several options such as an income-based premium paid by employers, higher taxes on the top 1 percent of earners and taxing capital gains at the same rate as ordinary income.

She said she would not raise taxes on families making less than $100,000 annually, in contrast to Sanders. Instead, she would add taxes on stock and bond trades as well as derivative transactions, and tax offshore corporate income at the same rate as domestic corporate income. She said those ideas would provide a total of over $2 trillion over 10 years.

Sanders’ campaign also immediately pushed back on Harris’ proposal. Faiz Shakir, his campaign manager, said Harris had “gradually” backed down from her support for a single-payer plan, which she has co-sponsored since the fall of 2017.

“Call it anything you want, but you can’t call this plan Medicare for All,” he said in a statement. “Folding to the interests of the health insurance industry is both bad policy and bad politics. This plan is centered around privatizing Medicare, enriching insurance executives and introducing more corporate greed and profiteering into the Medicare system.”

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Adam Gaffney, president of Physicians for a National Health Program, a pro-single-payer group, said that he was “heartened” that more Democrats were moving to favor a plan that would achieve universal coverage, but that the Harris plan “leaves a lot to be desired.”

“Effectively, this kind of plan would give private insurance companies the option of selling Medicare plans to everyone in the population,” he told CQ Roll Call. “While universal coverage is critical, this imposes a really high cost.”