At the CNN town hall, Harris took the most aggressive position in the internal Democratic debate: Government should eliminate private health insurance and fund virtually all health-care services directly. “The idea is that everyone gets access to medical care and you don’t have to go through the process of going through an insurance company, having them give you the approval, going through the paperwork, all of the delay that may require,” she told the moderator, Jake Tapper. “Let’s eliminate all of that. Let’s move on.”

Those comments drew immediate criticism from Republicans, but Harris hasn’t retreated from her support for a single-payer system. In the Senate, she’s also endorsed Democratic legislation that would expand health-care coverage more incrementally, such as the bill from Senators Chris Murphy and Jeff Merkley that would create a robust public competitor to private insurance companies on the ACA’s exchanges. Lily Adams, the communications director for Harris’s campaign, says the senator still supports those ideas. But Adams reaffirmed that, as president, Harris would push as her own priority a Medicare for All plan that eliminates private health insurance (except for the small amount of supplemental coverage permitted in the single-payer legislation from Senator Bernie Sanders that Harris has endorsed).

“She believes we need to get profit making out of health care,” Adams said. “That’s a better way, a smarter way, to do this. That’s her bottom line.”

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But the idea of trying to completely eliminate private insurance unnerves many veterans of the health-care fights under former Presidents Bill Clinton and Barack Obama. After the ACA’s passage, Obama—who had famously promised that those who like their insurance plan could keep it—faced a huge backlash after only a few hundred thousand people in the individual insurance market were forced to give up coverage that did not meet the law’s standards. Ending private insurance would affect the 181 million Americans who today receive health insurance through their employers, according to census figures.

The share of Americans who receive coverage through work is significant: about two-thirds of adults with a high-school diploma, three-fourths of those with a two-year college degree, 87 percent of those with a four-year degree, and 90 percent of those with graduate education. Not surprisingly, that means extremely large percentages of adults receive health coverage through their employers in many of the affluent suburban districts that powered the Democratic takeover of the House last November.