Kamala Harris rolled out a new “Medicare for All” plan Monday that preserves a role for private insurers, positioning herself between rivals Bernie Sanders and Joe Biden on a contentious issue in the 2020 Democratic presidential race.

Under her proposal, Americans could opt for Medicare Advantage, a program that allows beneficiaries to get coverage from a private insurer. Harris’s plan would put all Americans into Medicare over a 10-year transition period while allowing the participation of private insurance plans under a set of rules.

The California senator said her plan wouldn’t raise taxes on households making less than $100,000 a year -- unlike Sanders’s proposal, which he has acknowledged would require middle-class tax hikes to eliminate out-of-pocket costs. Harris didn’t offer a cost estimate but proposed to help pay for her program with a 0.2% tax on Wall Street stock trades, a 0.1% tax on bond trades and a 0.002% tax on derivative transactions. She said she’d also tax offshore corporate income the same way domestic corporate income is taxed.

Health care consistently ranks as a top issue for voters, particularly Democrats, and the 2020 debate illustrates a broader fight within the party. Sanders, the Vermont senator and a 2016 presidential candidate, and Massachusetts Senator Elizabeth Warren want to upend the system and create a single government-run insurance system. Biden, the former vice president under Barack Obama, wants a more modest approach that builds on Obamacare. The Harris plan seeks to appeal to both sides.

“I would describe the Harris plan as an effort to balance idealism and pragmatism,” said Andy Slavitt, who oversaw health care programs under the Obama administration and provided input to the Harris campaign on the new plan. He said using Medicare Advantage was “a clever approach” to preserving a role for private insurance.

The health care proposal represents a shift from Harris’s earlier support for largely eliminating private insurance, a position many mainstream Democrats have suggested would be politically disastrous in an election against President Donald Trump.

Harris had co-sponsored Sanders’s Medicare for All legislation that would collapse all insurance into one government plan, though she has at times tripped up when asked to defend that position and has repeatedly expressed discomfort with the idea of ending private insurance. Warren has championed the Sanders plan, while front-runner Biden has attacked it as too disruptive.

“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,” Harris wrote on medium.com. “If they want to play by our rules, they can be in the system. If not, they have to get out.”

Slavitt said Harris faces two big political questions. First, would her support in the primary be more likely to come from the left-leaning Sanders and Warren wing, or from the Biden-friendly moderate wing? “And there’s something in this plan for Bernie and Warren voters to like a lot, and something for Biden voters to like a lot,” he said.

The other question, Slavitt said, is whether the plan would allow Harris to “pivot to a general election” and be more effective against Trump “without the criticisms that something like a Sanders plan would receive.”

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