When Kamala Harris picked the Minnesota governor, Tim Walz, as veep for the Democratic presidential ticket, advocates for healthcare reform felt a jolt of electricity.
Here, they saw a man who proclaimed healthcare a “basic human right”, reformed medical debt collections, and who laid the groundwork for expanded government insurance and denied corporate health insurers contracts with Medicaid, a state-run health insurance program for the poor. Walz even once joined Harris at an abortion clinic in support of abortion rights.
It was a sense of possibility some had not felt since the Obama era, and hard for some to contain their excitement.
“We’re celebrating here at the cabin,” said the Democratic Minnesota state representative Liz Reyer, who helped Walz pass a medical debt collection reform bill in 2023. She was on vacation in northern Wisconsin, sipping coffee next to her sleeping dog – a quiet, midwestern kind of celebration. Reyer felt compelled to stress “how absolutely strongly I was pulling for Governor Walz to be the VP pick”.
“It feels really important and like a huge opportunity,” said Reyer, about the possibility of making such reforms nationally. “I share with Governor Walz the bedrock belief that healthcare is a human right. So, to me – yeah, let’s go.”
Since the Obama era, health reformers have had a tough run. After the passage of the Affordable Care Act (ACA) better known as “Obamacare”, in 2010, the Democratic party suffered heavy midterm losses to what would become known as the conservative Tea Party movement.
Perhaps worse, the ACA became a focal point of Republican rage well into the Trump administration. Republicans only abandoned calls to “repeal and replace” the ACA in 2017, after the now-deceased Republican senator John McCain stunned party leaders by casting the decisive vote against Trump’s plan, returning to Washington amid a brain cancer diagnosis.
Although Republicans were not able to repeal Obamacare, they were successful in another way: years of attacks left little room to expand coverage or rein in healthcare prices, essentially the unfinished work of Obamacare.
Republicans policy wonks have since retreated to time-worn proposals for a second Trump term, primarily fleshed out in the Project 2025 document. Among the early 2000s hits now on a nostalgia tour: Make healthcare shoppable! More privatization! Less regulation! Tax-free savings accounts!
The former president has disavowed Project 2025, though the official Republican platform does not look dissimilar. Notably, Trump’s current campaign and former administration has close ties to authors of the project.
The 2024 Republican platform focuses on “transparency”, “choice” and “competition” (read: shoppable prices and fewer regulations). It also promises “no cuts” to Medicare, a government program for the elderly, though Project 2025 promotes further privatizing the program.
Today, about 92% of Americans have health insurance. That still leaves about 26 million people out of the system – potentially vulnerable to the full force of market prices in the world’s most expensive health system. A catastrophic illness or ailment can easily lead to financial ruin.
What’s more, even for people who have health insurance, medical debt remains a persistent problem. Forty-one per cent of Americans owe money to a medical provider, credit card or family member for healthcare. Often, when people have or fear medical debt, they cut back on food, clothing and other household items, according to a widely cited Peterson-KFF Health System Tracker poll. People with medical debt tend to be sicker and die sooner.
At the same time, the cost of healthcare now eats up 17% of America’s gross domestic product, nearly double that of peer nations. That is in spite of the fact that Americans see the doctor less than peers in other wealthy nations and have worse health outcomes.
While not all of America’s health problems can be pegged to problems with the insurance industry, anecdotal reports show at least some can be – such as adults waiting until they reach Medicare eligibility age to get cataract surgery or Americans feeling reticent to smile for fear of revealing a mouth full of decay.
Exactly what Harris and Walz’s healthcare platform will be remains to be seen. The 2020 Democratic platform included a call for a public option, reining in pharmaceutical spending and strengthening Obamacare. The administration accomplished some of this.
Notably, the Biden administration just finished its first Medicare prescription drug price negotiation – a process common in peer nations but which was prohibited when Biden took office. The most recently released Democratic party platform came in July, before Biden dropped out of the race.
What is clear is the similarities in Harris’s and Walz’s records. The Biden administration capped insulin prices at $35 a month for Medicare beneficiaries. So did Walz for Minnesotans not on Medicare – an act he named after resident Alec Smith, a 26-year-old who died from rationing his $1,300-a-month insulin supply.
Walz worked closely with Reyer to pass a comprehensive package of reforms for medical debt collection, which included a prohibition on hospitals from denying care to patients with outstanding balances, and which stopped the automatic transfer of debt liability to spouses. Similarly, the Biden administration has sought medical debt restrictions through rule-making with the Consumer Financial Protection Bureau.
Walz said in his inaugural address as governor that he believed healthcare was a “human right”. That’s widely accepted wisdom outside the US, and all but the unofficial tagline for single-payer healthcare advocates – the kind of government-run universal healthcare that is a source of pride for the UK’s National Health Service.
Similarly, Harris co-sponsored 2019 legislation introduced by Senator Bernie Sanders that would have established single-payer healthcare nationally. The revolutionary proposal stood no chance of passing, and she has since sought to moderate from that moment. Her campaign has said she would “not push” single-payer as president. Still, it has got advocates excited.
“From our standpoint, this is fantastic,” said Dr Philip A Verhoef, a critical care doctor in Hawaii and president of Physicians for a National Health Program, the nation’s largest single-payer advocacy organization.
“Ten years ago, single-payer burst on to the scene,” with Sanders’s presidential run, said Verhoef. “Prior to that, nobody ever talked about this.” Similarly, single-payer advocates were “shut out” of Obamacare discussions, Verhoef added.
Walz also laid the groundwork for a “public option” health insurance plan in Minnesota, where the government would allow people to buy into Medicaid, and banned private health insurance companies, such as behemoth UnitedHealth, from contracting with Minnesota’s Medicaid plan.
How the Harris-Walz ticket will translate the excitement of reformers into action – and what exactly their proposals will be – remains to be seen. For the time being, activists are enjoying a sense of possibility, knowing difficult discussions lie ahead.
“So often, we see people in positions of political power are thinking, ‘Well, what can we get done without blowing up the system,’” said Verhoef. “I appreciate that attitude – in a way that’s what the ACA was. It helped a lot of people. But it still left 30 million people uninsured in this country and it hasn’t stopped people from going bankrupt from healthcare bills.”
