In her ill-fated 2020 presidential primary campaign, then-senator Harris followed Senator Bernie Sanders of Vermont, the pied piper of progressives, down the political primrose path to an endorsement of a single-payer system. She did so without a thorough consideration of all it entailed, such as the elimination of private insurance, at least if her subsequent damage-control efforts were any indication. That rash decision hurt her straight from the gate.
In this campaign, her staff has let it be known that Harris has backed off single-payer and is now a firm supporter of the Affordable Care Act, a.k.a. Obamacare, which provides tax subsidies to make private health insurance plans affordable and matches customers with companies on the health care exchanges.
Under regular and ridiculous assault as socialism or communism during its early years, the ACA, or at least certain aspects of it, were unpopular with the public. But that has now changed. More than 60 percent of Americans now approve of the law.
That support was partly crystallized by Trump’s dogged effort to repeal that law, seemingly because it was a signal accomplishment of his predecessor. That effort failed because Republican Senators Lisa Murkowski of Alaska, Susan Collins of Maine, and, most dramatically of all, John McCain of Arizona broke with their party and voted against repeal.
A second reason for the strong public support is that the premium tax credits that aid in the purchase of health insurance have become considerably more generous under President Biden, making health insurance more affordable.
So backing the ACA is currently a politically smart place to be. Now, it would be too politically expedient for Harris simply to say that since the ACA is now popular, she’s for it.
But there are several plausible ways to explain her transition.
One is to note that, as the higher tax credits have demonstrated, when properly supported, the law works well and engenders high levels of public satisfaction. That is, to offer an if-it-ain’t-broke-don’t-fix-it rationale.
She could add that, during her nearly four years as Biden’s understudy, she learned that important public policy initiatives are best received when disruption is minimized, and as the nation has now seen with the ACA, the best way to pursue the goal of near-universal health care is by building on our existing systems.
Such an explanation would amount to a recognition that Harris got out over her skis in her 2020 campaign and has grown more politically pragmatic since then. She’d be using her flip-flop to demonstrate she is not an inflexible ideologue. That would prove reassuring to moderate voters. It would also provide a shield against the already incoming health care attacks.
Further, it would let her put Trump on the spot when it comes to health care. In his drive to repeal the ACA, Trump repeatedly promised he would soon release a plan that would make health care coverage “much less expensive and much better.” In his telling, that plan was always ready to be released in a few weeks or months.
He never unveiled such a proposal, of course. The replacement plan the GOP eventually offered would have seen 22 million fewer Americans with health insurance coverage after a decade, the Congressional Budget Office found.
As the ACA has climbed in popularity, Trump and the Republicans have gone quiet about repealing it. He now talks about making the ACA “MUCH, MUCH, MUCH BETTER FOR FAR LESS MONEY.” Hmm. Have we heard that before?
His previous dishonesty on the subject should serve as a great campaign cudgel for Harris. That’s all the more true because the expanded subsidies, which cost about $33 billion a year, expire at the end of 2025. If that’s allowed to happen, health insurance costs will spike for many who buy their plans on the exchanges.
Trump should be pressed hard on whether he would extend them. With her pro-ACA stand explained and fortified, Harris could contrast the plan she backs with the empty promises Trump has offered — and come out the winner on this issue.
Scot Lehigh is a Globe columnist. He can be reached at [email protected]. Follow him @GlobeScotLehigh.
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