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 SandersBernie SandersHickenlooper beats back progressive challenge in Colorado primary Progressive groups urge Biden to tap Warren as running mate Young Turks host says Elizabeth Warren should be Biden's VP pick MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalProgressive lawmakers call for conditions on Israel aid Hillicon Valley: Democrats introduce bill banning federal government use of facial recognition tech | House lawmakers roll out legislation to establish national cyber director | Top federal IT official to step down Democratic lawmakers introduce legislation banning government use of facial recognition technologies MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerGOP senators debate replacing Columbus Day with Juneteenth as a federal holiday House to pass sweeping police reform legislation Police reform in limbo after Senate setback MORE (D-N.J.), Kirsten GillibrandKirsten GillibrandDemocratic lawmakers call for expanding, enshrining LGBTQ rights The Hill's 12:30 Report: Fauci 'aspirationally hopeful' of a vaccine by winter The Hill's Morning Report - Officials crack down as COVID-19 cases soar MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisLiberal veterans group urges Biden to name Duckworth VP GOP senators debate replacing Columbus Day with Juneteenth as a federal holiday If only woke protesters knew how close they were to meaningful police reform MORE (D-Calif.) and Elizabeth WarrenElizabeth WarrenHouse Armed Services votes to make Pentagon rename Confederate-named bases in a year Overnight Defense: House panel votes to ban Confederate flag on all Pentagon property | DOD report says Russia working to speed US withdrawal from Afghanistan | 'Gang of Eight' to get briefing on bounties Thursday Liberal veterans group urges Biden to name Duckworth VP MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardFinancial firms facing serious hacking threat in COVID-19 era Gabbard drops defamation lawsuit against Clinton It's as if a Trump operative infiltrated the Democratic primary process MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegDemocratic lawmakers call for expanding, enshrining LGBTQ rights Democrats debate Biden effort to expand map against Trump The Hill's Morning Report - Presented by Facebook - Dems, GOP dig in on police reform ahead of House vote 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 DeLauroThe Hill's Morning Report - Presented by Facebook - Trump, GOP on defense as nationwide protests continue The coronavirus crisis has cut the child care sector COVID-19 workplace complaints surge; unions rip administration MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyDingell pushes provision to curtail drunk driving in House infrastructure package 189 House Democrats urge Israel to 'reconsider' annexation Partisan divide on annexation complicates US-Israel relationship 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 BennetHouse Democrats chart course to 'solving the climate crisis' by 2050 'The Senate could certainly use a pastor': Georgia Democrat seeks to seize 'moral moment' Some realistic solutions for income inequality MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineOvernight Defense: Lawmakers demand answers on reported Russian bounties for US troops deaths in Afghanistan | Defense bill amendments target Germany withdrawal, Pentagon program giving weapons to police Senators aim to limit Trump's ability to remove troops from Germany Filibuster reform gains steam with Democrats MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoThe Hill's Campaign Report: Buzz builds around Warren for VP Gun control group rolls out House endorsements Human Rights Campaign rolls out congressional endorsements on Equality Act anniversary MORE (D-N.Y.), John Larson John Barry LarsonEncouraging research and development can drive America's recovery House pays tribute to late Congressman Sam Johnson on the floor Donald Trump is proposing attacks on Social Security and seniors; here is what we should do instead MORE (D-Conn.) and Brian HigginsBrian HigginsBiden slams Trump for promoting conspiracy theory about man shoved by police Trump claims 75-year-old man shoved by Buffalo police could be part of 'set up' NY, NJ lawmakers call for more aid to help fight coronavirus MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy KlobucharThe Hill's Coronavirus Report: Stagwell President Mark Penn says Trump is losing on fighting the virus; Fauci says U.S. 'going in the wrong direction' in fight against virus Hillicon Valley: Facebook takes down 'boogaloo' network after pressure | Election security measure pulled from Senate bill | FCC officially designating Huawei, ZTE as threats Democrats, voting rights groups pressure Senate to approve mail-in voting resources 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 StabenowSenators press IRS chief on stimulus check pitfalls Democrats warn Biden against releasing SCOTUS list Sheldon Whitehouse leads Democrats into battle against Trump judiciary 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 BaldwinBiden campaign adds staff in three battleground states Clinton, Buttigieg among Democrats set to hold virtual events for Biden Warren top choice for VP for some Black progressives MORE (D-Wis.), a sponsor of the bill. 

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