Kamala Harris’ complicated history with Medicare for All becomes a Trump campaign attack line

(CNN) — Kamala Harris may be done with Medicare for All, but Medicare for All – with a new nudge from former President Donald Trump – isn’t done with her.

The Trump campaign on Wednesday attacked Harris over her past support for a move to the single-payer, government-run health care system long championed by Vermont Sen. Bernie Sanders. Medicare for All gained broad support among progressive Democrats, especially those with eyes on the White House, before and during the early stages of the party’s 2020 presidential primary.

Harris’ team said recently that she no longer backs the plan, which fell out of vogue with Democrats as Joe Biden surged to the nomination four years ago as one of the few candidates to vocally oppose it. Instead, he campaigned on improving and expanding the Affordable Care Act, which he has focused on during his term and Harris has supported as his vice president.

But Harris has not addressed the question herself, touting the Biden administration’s record while trying avoid any relitigation of the years-old fight, and putting out word now only through campaign aides. Now, Trump is reviving the debate as he seeks to paint Harris as both a radical liberal and a flip flopper.

“Kamala Harris’ spokespeople are once again alleging she has flip flopped on her positions – this time saying she no longer supports socialist Medicare for All,” Trump campaign spokeswoman Karoline Leavitt said on Wednesday, calling on Harris “to explain why she is running from every liberal policy she has ever supported.”

The Trump camp’s focus on Medicare for All is emerging as the centerpiece of a wider strategy to use Harris’ 2020 primary positions against her now, less than 90 days before the general election. Harris dropped out of the Democratic primary before the first votes were cast, but her campaign that year frequently jousted with Sanders and reporters trying to pin down her position on the plan, which would eliminate private insurance plans and replace them with a government-funded and operated single-payer system.

That debate quieted when Biden consolidated the party on his way to winning the nomination and, eventually, the presidency with Harris as his running mate. Trump – who repeatedly attempted to repeal ACA, also known as Obamacare, without success and to significant electoral backlash – has never spelled out a clear plan of his own.

“She wants to outlaw private health insurance,” Trump said in late July at the conservative Turning Point Action’s Believers’ Summit in West Palm Beach. “A lot of people have private health insurance. They want to keep it that way. It’s phenomenal.”

Harris responded the next day at a fundraiser in Massachusetts, raising Trump’s 2017 campaign to end Obamacare.

“He intends to end the Affordable Care Act and take us back to a time when insurance companies had the power to deny people with preexisting conditions,” Harris said. “You guys remember what that was? It was real. Children with asthma. Breast cancer survivors. Grandparents with diabetes.”

The Harris campaign, in response to CNN, pointed to the record high number of Americans now enrolled in Obamacare and other initiatives, including moves to lower prescription drug prices.

“Vice President Harris believes real leadership means bringing all sides together to build consensus. It is that approach that made it possible for the Biden-Harris administration to achieve bipartisan breakthroughs on everything from infrastructure to gun violence prevention,” campaign spokesperson Sarafina Chitika said. “As President, she will take that same pragmatic approach, focusing on common-sense solutions for the sake of progress.”

Stances on Medicare for All

Harris’ relationship with Medicare for All was always tinged with a certain skepticism. As a US senator in September 2017, Harris signed on as a co-sponsor to Sanders’ Medicare for All legislation. Speaking at the unveiling of the bill on Capitol Hill, she made the business-friendly case for change.

“Let’s give the taxpayer of the United States a better return on their investment,” Harris said. “Why? Because Medicare for All stands for the proposition that all Americans from the day of birth, throughout their lives, will have access to health care.”

At a January 2019 CNN town hall, Harris appeared to fully embrace the system, telling a questioner from the audience she would be willing to cut out private insurers as part of the transition. She argued that insurers are motivated by profit, dump paperwork on patients and delay care, saying, “Let’s eliminate all of that. Let’s move on.”

“We need to have Medicare for All,” Harris said, adding that it was an issue she felt “very strongly” about. Her remarks drew immediate criticism from Republicans and sidelong glances from Sanders allies who repeatedly questioned her fidelity to what would be, even its most ardent supporters acknowledge, a radical remaking of the US health care system.

Harris’ campaign responded clumsily to the backlash. One Harris adviser, a day after the town hall, told CNN that, despite what she had said, Harris was open to a variety of plans being drafted by congressional Democrats, including those that kept some role for the industry.

Both the adviser and her spokesman at the time, Ian Sams, insisted that her interest in different legislation, all of it moving to a more progressive system, should not be described as a flip-flop.

“Medicare for All is the plan that she believes will solve the problem and get all Americans covered. Period,” Sams told CNN at the time. “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.”

Harris’s words at the town hall, followed by her adviser’s subsequent effort to pump the brakes, focused the spotlight on long-simmering internal Democratic tensions over the future of American health care, an issue they had successfully united over in defense of Obamacare during Trump’s first year in office.

The back-and-forth between Harris’ team and more staunchly progressive campaigns, including Sanders’ and that of Massachusetts Sen. Elizabeth Warren, dominated stretches of the primary. By the summer, though, with lingering questions about her position undermining her campaign, Harris released her own health care plan.

The Harris plan

Made public shortly before the second debate of the primary cycle, the Harris proposal kept a role for private insurance companies within the health care system – a significant departure from Sanders’ Medicare for All bill. Harris called for transitioning to a Medicare for All-type system over a decade – longer than the four-year transition period favored by Sanders.

“This isn’t about pursuing an ideology,” Harris said. “This is about delivering for the American people.”

The Harris plan would have expanded the existing Medicare system, which consists of the traditional Medicare program but also provides a private insurance option called Medicare Advantage.

“We will allow private insurers to offer Medicare plans as a part of this system that adhere to strict Medicare requirements on costs and benefits,” Harris wrote in a Medium post about her plan. “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.”

The shift came, in part, due to increasing pressure from labor leaders who did not want to forfeit the desirable plans they had fought for and won from employers at the bargaining table. It also allowed Harris to make the pitch for a new system without, as she explained it then, raising taxes – another sore spot with parts of the electorate.

Sanders immediately challenged Harris’ description of her plan as proper Medicare for All.

“I like Kamala. She’s a friend of mine, but her plan is not Medicare for All,” Sanders told CNN ahead of the debates. “What Medicare for All understands is that health care is a human right and the function of a sane health care system is not to make sure that insurance companies and drug companies make tens of billions of dollars in profit.”

A senior policy adviser to Sanders called Harris’ rejiggered plan “bad policy” and “bad politics,” warning it “vastly expands the ability for private insurance corporations to profit from over-billing and denying care to vulnerable patients who need it the most.”

For all the political drama, the debate over health care in the Democratic primary petered out over the course of 2019, as the 2020 Iowa caucuses approached and the crowded field of candidates jockeyed for position.

Harris, though, never quite found out what Democrats made of her proposal. She dropped out of the race in December 2019, citing diminished “financial resources,” about two months before the caucuses took place.

This story has been updated with additional reporting.

CNN’s Kate Sullivan contributed to this report.

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