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 SandersConfused by polls? Watch early primary states — not national numbers Confused by polls? Watch early primary states — not national numbers Biden leads in early voting states, followed by Warren, Sanders: poll MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalCentrist Democrats raise concerns over minimum wage push Centrist Democrats raise concerns over minimum wage push Overnight Health Care: Democratic bill would require insurance to cover OTC birth control | House Dems vote to overturn ban on fetal tissue research | New rule aims to expand health choices for small businesses MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerFox News poll shows Trump trailing Biden, Sanders, other Democrats Fox News poll shows Trump trailing Biden, Sanders, other Democrats Poll: Biden leads, Warren surges in South Carolina MORE (D-N.J.), Kirsten GillibrandKirsten Elizabeth GillibrandBiden calls for equal pay for US women's soccer team Biden calls for equal pay for US women's soccer team Trump steadfast in denials as support for impeachment grows MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisBiden calls for equal pay for US women's soccer team Biden calls for equal pay for US women's soccer team Confused by polls? Watch early primary states — not national numbers MORE (D-Calif.) and Elizabeth WarrenElizabeth Ann WarrenBiden calls for equal pay for US women's soccer team Biden calls for equal pay for US women's soccer team Trump steadfast in denials as support for impeachment grows MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardOvernight Defense: Trump doubles down on claim Iran attacked tankers | Iran calls accusations 'alarming' | Top nuke official quietly left Pentagon | Pelosi vows Congress will block Saudi arms sale Overnight Defense: Trump doubles down on claim Iran attacked tankers | Iran calls accusations 'alarming' | Top nuke official quietly left Pentagon | Pelosi vows Congress will block Saudi arms sale Democratic presidential hopefuls react to debate placement MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegButtigieg wouldn't reverse US embassy move to Jerusalem: 'What's done is done' Buttigieg wouldn't reverse US embassy move to Jerusalem: 'What's done is done' Buttigieg: Iran situation 'disturbingly reminiscent' of lead-up to Iraq War 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 DeLauroTrump admin ending legal aid, English classes for migrant children in US shelters Brazilian firm draws scrutiny on Trump farm aid Watchdog: DeVos used personal emails for work in 'limited' cases MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyOmar blasts Trump's comment about accepting foreign campaign dirt as 'un-American' House Dem cites transgender grandson in voting for Equality Act Dems plan 12-hour marathon Mueller report reading at Capitol 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 BennetDemocratic presidential hopefuls react to debate placement Democratic presidential hopefuls react to debate placement The Hill's 12:30 Report — Presented by MAPRx — Biden, Sanders to share stage at first DNC debate MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineTexas raises age to purchase tobacco to 21 Texas raises age to purchase tobacco to 21 Democrats push to make national security a 2020 wedge issue MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoFreshman Democrats call on McConnell to hold vote on election reform bill Democrats face voters clamoring for impeachment T.I., Charlamagne Tha God advocate for opportunity zones on Capitol Hill MORE (D-N.Y.), John Larson John Barry LarsonUnchain seniors from chained inflation index A tax increase is simply not the answer to fund Social Security Social Security is approaching crisis territory MORE (D-Conn.) and Brian HigginsBrian HigginsHas Congress lost the ability or the will to pass a unanimous bipartisan small business bill? Democratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy Jean KlobucharElection security bills face GOP buzzsaw Election security bills face GOP buzzsaw Julián Castro defends going on Fox: I'm focused on 'the people out there watching' 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 Stabenow It's time to let Medicare to negotiate drug prices Trump judicial nominee says he withdrew over 'gross mischaracterizations' of record Trump judicial nominee says he withdrew over 'gross mischaracterizations' of record 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 BaldwinValedictorian says he was not allowed to use graduation speech to come out as gay Valedictorian says he was not allowed to use graduation speech to come out as gay Democrats highlight history-making LGBTQ lawmakers for Pride month MORE (D-Wis.), a sponsor of the bill. 

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