Vice President Harris has not proposed a sweeping or even medium-sized reform of the health system. Her proposals build on what the Biden-Harris administration did. The New York Times called it a “reboot.” But, what Vice President Harris has done that is new and notable is to reframe health as a pocketbook economic issue; a dimension of the public’s economic concerns and part of her economic plan. That matches how voters now see health and what they worry about most—their health care bills.
Vice President Harris proposed to cap out-of-pocket drug costs for everyone at $2,000 per year and insulin copays at $35 per month, extend enhanced Affordable Care Act (ACA) premium support, speed up Medicare drug price negotiation, and expand efforts to cancel medical debt working with states.
All of these policy proposals have the same political characteristics:
- They are simple and understandable, and voters can relate to them. It hasn’t always been this way. The ACA was complex, with many moving parts (part of why the public had a hard time grasping what it did for them). The paragon of complexity was the Clinton Health Security Act, infamous for the complicated graphics intended to describe how the plan would work.
- Because there is no big new health reform plan, there is no big target for former President Trump and Republicans to shoot at. Every proposal on the list is popular and difficult to oppose. While it is true that the policies Vice President Harris has proposed fall far short of touching every American, it’s not true that they are insignificant. Drug price negotiation is a precedent for negotiating more health care prices, that’s why its passage was so contentious. It and out-of-pocket caps and insulin price caps can be extended to the general population. Enhanced ACA subsidies affect almost 20 million people. For all of the hoopla surrounding it, the ACA itself fell far short of reforming health care too. It did a lot of things at once, primarily reforming the individual insurance market, protecting people with pre-existing health conditions, and expanding private and Medicaid coverage.
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But most of all, Vice President Harris’ package focuses entirely on people’s out-of-pocket costs and their worries about the affordability of health care. Affordability is the central theme, not universal coverage, or health care as a right (which also gets used), or value, quality, or access (favorite words in health care). And in a break from past practice, the health proposals were put forward in a speech in North Carolina along with a set of other economic proposals, including expanded tax credits and housing assistance and policies aimed at supermarket price gouging, not as a stand-alone health care plan. There was no “health care speech” announcing a new health plan—it was announced as part of an economic speech instead.
Vice President Harris once favored her own variant of a Medicare for All plan. But for now, the Democratic left in Congress has generally supported more moderate proposals from President Biden and Vice President Harris in order to counter the threat from former President Trump, easing pressure on Vice President Harris to put forward a big health plan, and generally favors economic and health policies viewed as putting Democrats more in touch with working people. More expansive proposals from the left can be expected to return, including the public option and Medicare for All, if Vice President Harris wins. Of note, at a time when Democrats are framing abortion as a health care issue, with poignant heart-wrenching individual stories of the consequences of state abortion restrictions told at the Democratic convention, health care itself is increasingly being framed as an economic issue.
All of our KFF polling suggests to me that this is how voters view health care: as one of their economic concerns. People worry more about paying for health care than paying for gas, or for the rent or their mortgage. In some polls, health care costs barely trail inflation as a worry for voters and it’s one of the main reasons voters say the economy is in bad shape. I have written often about how affordability, not quality and not access, is the health care issue of greatest concern to voters, and elsewhere about how candidates use policy proposals in campaigns to send signals to voters. In this case the message is: “I am the candidate who cares about your health care costs.” Campaigns are for political strategy and signaling to win votes; detailed policy proposals come later when candidates, if elected, work with Congress on legislation. And policy plans made in campaigns will morph mightily on the way to legislation, should that happen. All this is even more true in a shortened campaign like this one.
The news media and stakeholders clamor for policy details from candidates in campaigns. Tom Nichols recently commented in the Atlantic: “The Kamala Harris campaign seems to understand that it is pointless to run against Donald Trump on policy. Despite criticism from the press and demands for more policy details, Harris and Tim Walz have adopted a pragmatic strategy heading into their national convention.” Nichols lamented: “I wish that Americans cared more about policy, but they don’t.”
Health care, of course, is not just about bills—it’s about life and death and the burdens health care problems can impose on patients and families, which we have all experienced. The complexity of the system itself can be a nightmare for many people just when they need it most. But with 92% of the population covered, it’s understandable that people are more focused on affordability now. It is, as I have suggested before, health care’s “big tent” issue. Reframing health as an economic issue is a change polling suggested could have been made years ago; a case of politicians catching up with the public.
