In 2019, presidential candidate Kamala Harris designed a replacement for the Affordable Care Act using the template of Medicare for All. The replacement (“the Plan” or M4A) is a proposal for a single-payer health program managed by the federal government that has the goal of universal coverage. This report details the findings of the Center for Health and Economy’s (H&E) combined Under-65 and Over-65 microsimulation models on M4A’s impact on health insurance coverage, provider access, medical productivity, and the federal budget.

Key findings:

• Without the need to sign up for insurance and with the promise of all cost sharing and premiums being eliminated, H&E expects universal coverage.
• The health insurance coverage provisions under current law for the non-elderly are estimated to increase the federal spending by $43.9 trillion between 2026 and 2035.
• One significant difference in the Harris plan from previous M4A proposals is the explicit funding of health insurance for all undocumented and illegal aliens residing in the United States. The approximate cost of covering an additional 11 million individuals with M4A coverage is $1.8 trillion between 2026 and 2035.
• Under the Plan, medical productivity is projected to decrease by 22 percent for the year 2035 relative to the current baseline due to the massive increase of patients into the health system and the dissolution of network structure.
• Provider access is projected to increase by 19 percent as a result of universal coverage, along with the elimination of cost sharing.
• An additional analysis compares the projected cost with the revenue the Plan expects to see raised. The tax revenue is expected to be about $1.7 trillion; however, this is more than offset by $4.1 trillion in spending, leaving a net federal cost of $2.3 trillion for the year 2028. Over eight years of full operation between 2028 and 2035, the total net cost is $24.1 trillion.

Read the analysis