Democratic proposals to overhaul health care: A 2020 primer

About 20 million Americans have gained coverage under ObamaCare since it was passed in 2010, but nearly 9 percent — 30 million people — still don’t have health insurance. 

All Democrats running for president say they want to provide universal health care coverage to Americans. But they have different ideas about how to get there. 

Here are the plans they keep talking about on the campaign trail and what they would do. 

 

Medicare for All 

Sponsors: Sen. Bernie SandersBernard (Bernie) SandersAndrew Cuomo: Biden has best chance at 'main goal' of beating Trump Poll: Buttigieg tops Harris, O'Rourke as momentum builds Buttigieg responds to accusation of pushing a 'hate hoax' about Pence MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalOvernight Health Care: How 2020 Dems want to overhaul health care | Brooklyn parents sue over measles vaccination mandate | Measles outbreak nears record Democratic proposals to overhaul health care: A 2020 primer Dems counter portrait of discord MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerHarris adds another to her list of endorsements in South Carolina The Hill's Morning Report - Dem candidates sell policy as smart politics 2020 Dems rebuke Trump on Iran, say they'd put US back in nuclear deal MORE (D-N.J.), Kirsten GillibrandKirsten Elizabeth GillibrandGillibrand pledges not to use 'stolen hacked' materials in 2020 campaign 2020 Dems rebuke Trump on Iran, say they'd put US back in nuclear deal Where 2020 Democratic candidates stand on impeachment MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisJulián Castro: Trump should be impeached for trying to obstruct justice 'in very concrete ways' Poll: Buttigieg tops Harris, O'Rourke as momentum builds Trump Jr. slams 2020 Dems as 'more concerned' about rights of murderers than legal gun owners MORE (D-Calif.) and Elizabeth WarrenElizabeth Ann WarrenJulián Castro: Trump should be impeached for trying to obstruct justice 'in very concrete ways' Poll: Biden tops Sanders nationally Pete Buttigieg: 'God doesn't have a political party' MORE (D-Mass.) and Rep. Tulsi GabbardTulsi Gabbard2020 Dems rebuke Trump on Iran, say they'd put US back in nuclear deal New 2020 candidate Moulton on hypothetical Mars invasion: 'I would not build a wall' Blockchain could spark renaissance economy MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegAndrew Cuomo: Biden has best chance at 'main goal' of beating Trump Poll: Buttigieg tops Harris, O'Rourke as momentum builds Buttigieg responds to accusation of pushing a 'hate hoax' about Pence MORE said he wants to work toward such a system.

What it would do: Of all the plans to expand Medicare, Sanders’s is the most ambitious.

Over a four-year period, it would transform Medicare, the nation’s health care program for those over 65, into a single-payer system that provides comprehensive health care coverage, including dental, vision and long-term care, to all Americans under one plan.

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It also would eliminate most other federal health programs, such as Medicaid, but keep the Indian Health Service and the Veterans Health Administration, though those could eventually be eliminated as well.

This would mean an end to private insurance plans as we know them, including those offered by employers and the plans people can buy individually, such as those sold on the ObamaCare marketplaces. 

That’s because under this proposal, private insurance companies would actually be banned from selling plans that cover the same services.

This is a sticking point for Democrats, many of whom are wary of getting rid of a multibillion-dollar industry that covers 67 percent of the population.

But that’s precisely the point, says Sanders, who argues that health care costs have skyrocketed because insurance companies are motivated by profits and not patients’ health. 

"The current debate over Medicare for All has nothing to do with health care; it has everything to do with greed and profiteering," Sanders said this week.

Even the 2020 presidential candidates who have signed on to the Sanders bill have waffled on whether such a plan should eliminate private insurance. It’s a point that is likely to come up when the candidates are asked about the plan at debates starting this summer.

Another sticking point is the cost. 

Sanders hasn’t said how much his plan would cost, though some estimates put it at around $32 trillion.

A national health care system could be paid for, he said, by reshuffling the money the U.S. currently spends on federal health programs while raising income taxes for the wealthy or creating taxes on employees and employers. 

Opponents of the plan typically point to increased taxes as a downside. But Sanders notes that it would eliminate virtually all cost-sharing, including premiums, deductibles and copays. 

 

Medicare for America  

Sponsors: Reps. Rosa DeLauroRosa Luisa DeLauroDemocratic proposals to overhaul health care: A 2020 primer Progressives threaten to derail major Dem spending proposal GOP on defensive over Dem votes on policies geared toward women MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyDemocratic proposals to overhaul health care: A 2020 primer Bipartisan group asks DHS, ICE to halt deportations of Iraqi nationals FTC has received 26,000 complaints about Facebook privacy violations since 2012 MORE (D-Ill.).

Who supports it: Former Rep. Beto O’Rourke (D-Texas). Gillibrand also has voiced support for making Medicare available to everybody while maintaining private insurance.

What it would do: Medicare for America aims for universal coverage while giving workers the option of keeping their employer-sponsored health plan or switching to a new expanded version of Medicare. 

All U.S. residents would be eligible for the plans, but newborns, the uninsured, and anyone receiving coverage through Medicaid, Medicare, ObamaCare or the Children’s Health Insurance Program would automatically be enrolled.

Large employers could continue offering coverage as long as it’s comparable to the new Medicare plans, or they could make contributions to the Medicare plans on behalf of their employees. 

“It responds to the fact that so many Americans have said, ‘I like my employer-based insurance. I want to keep it. I like the network I’m in. I like the doctor that I see,” O’Rourke told The Texas Tribune last month. 

“It complements what already exists with the need that we have for millions of Americans who do not have insurance and ensures that each of them can enroll in Medicare.” 

Unlike Sanders’s proposal, Medicare for America plans would have premiums and deductibles based on income, with the poorest individuals paying the least. 

It would also preserve Medicare Advantage, plans managed by private insurance companies, which would be eliminated under Sanders’s bill.

There’s no cost estimate for this legislation, but it would be financed by sunsetting that tax cuts Congress passed in 2017 and by raising taxes on the wealthy and increasing the Medicare payroll tax. State governments would also be required to contribute.

 

Medicare-X Choice Act 

Sponsors: Sens. Michael BennetMichael Farrand BennetMichael Bennet declared cancer-free, paving way for possible 2020 run License to discriminate: Religious exemption laws are trampling rights in rural America Only four Dem senators have endorsed 2020 candidates MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineOnly four Dem senators have endorsed 2020 candidates Democratic proposals to overhaul health care: A 2020 primer Dems ask Justice Dept to release findings of Acosta-Epstein investigation MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoFreshman House Dems surge past GOP in money race Democratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage MORE (D-N.Y.), John Larson John Barry LarsonDemocratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage Stop asking parents to sacrifice Social Security benefits for paid family leave MORE (D-Conn.) and Brian HigginsBrian HigginsDemocratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage US labor unions say NAFTA replacement doesn't go far enough for workers MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy Jean KlobucharStudent slams Klobuchar for trying to classify pizza sauce as vegetable Pete Buttigieg: 'God doesn't have a political party' The Hill's Morning Report - Dem candidates sell policy as smart politics MORE (D-Minn.), Buttigieg, Harris and Booker 

What it would do: This proposal, sponsored by moderate Democrats in the House and Senate, would leave the existing health care system intact and create a public option administered by Medicare, allowing individuals of any age and small businesses to purchase plans that include access to the program’s network of health care providers.

These plans would be made available across the country over a period of four years and would cover ObamaCare’s 10 required benefits, including maternity care and mental health services.

It would also expand access to tax credits that help people buy ObamaCare coverage and would allow those credits to be used for Medicare-X plans while boosting the size of those credits for people with lower incomes. 

Kaine and Bennet frame the proposal as more politically feasible than Medicare for All.

“We preserve everything about the existing system, and we just put one additional element into it,” said Kaine, who ran for vice president in 2016. 

The plan works, Kaine says, because it’s run by the government and doesn’t have to earn a profit. 

“I just think that this is a much more practical way of trying to achieve the objective, which is universal coverage,” Bennet said.

 

Medicare at 50 Act 

Sponsors: Sen. Debbie StabenowDeborah (Debbie) Ann StabenowDemocratic proposals to overhaul health care: A 2020 primer We can accelerate a cure for Alzheimer's Bipartisan senators offer bill to expand electric vehicle tax credit MORE (D-Mich.) and Rep. Brian Higgins (D-N.Y.) 

Who supports it: Booker, Harris, Klobuchar and Gillibrand. 

What it would do: Stabenow’s bill is likely one of the most politically tenable of all the proposals to expand Medicare. 

Under the plan, U.S. citizens between the ages of 50 and 64 would be allowed to buy a Medicare plan. 

Like the Kaine and Bennet plan, individuals could use ObamaCare subsidies to purchase plans. 

Supporters of the bill say it’s a step toward universal health care. 

“I’ve always supported universal health care, but we are not there yet,” said Sen. Tammy BaldwinTammy Suzanne BaldwinOnly four Dem senators have endorsed 2020 candidates Democratic proposals to overhaul health care: A 2020 primer More than 30 Senate Dems ask Trump to reconsider Central American aid cuts MORE (D-Wis.), a sponsor of the bill. 

“Medicare at 50 is a very bold step in the right direction.”