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 SandersThe Hill's Morning Report - House prosecutes Trump as 'lawless,' 'corrupt' Tensions between McConnell and Schumer run high as trial gains momentum Sanders wants one-on-one fight with Biden MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalSanders wants one-on-one fight with Biden The Hill's Morning Report - Trump trial begins with clash over rules Jayapal: 'We will end up with another Donald Trump' if the US doesn't elect a progressive MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerThe Hill's 12:30 Report: House managers to begin opening arguments on day two Patrick backs reparations in unveiling 'Equity Agenda for Black Americans' Booker ahead of Trump impeachment trial: 'History has its eyes on us' MORE (D-N.J.), Kirsten GillibrandKirsten GillibrandSanders defends vote against USMCA: 'Not a single damn mention' of climate change The Hill's Morning Report — President Trump on trial Overnight Energy: Schumer votes against USMCA, citing climate impact | Republicans offer details on their environmental proposals | Microsoft aims to be carbon negative by 2030 MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisCalifornia Democrat Christy Smith launches first TV ad in bid for Katie Hill's former House seat Steyer spokesperson: 'I don't think necessarily that Tom has bought anything' Biden wins endorsement of Sacramento mayor MORE (D-Calif.) and Elizabeth WarrenElizabeth Ann WarrenTensions between McConnell and Schumer run high as trial gains momentum Sanders wants one-on-one fight with Biden Biden, Sanders tax plans would raise less revenue than claimed: studies MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardGabbard suing Clinton for defamation over 'Russian asset' comments Gabbard knocks Clinton's jab at Sanders: 'This isn't high school' The data is clear: A woman could win in 2020 MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegThe Hill's Morning Report - House prosecutes Trump as 'lawless,' 'corrupt' Sanders wants one-on-one fight with Biden Overnight Defense: Trump downplays troops' concussion injuries in Iran attack | Dems offer case against Trump on day two of trial | UN links Saudis to hack of Bezos' phone 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 DeLauroSome kids will spend Christmas in border cages On The Money: House approves Trump USMCA deal in bipartisan vote | Senate sends .4T spending bill to Trump's desk | Why budget watchdogs are howling over the spending deal House approves Trump's USMCA trade deal amid shadow of impeachment MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyHouse Democrats may call new impeachment witnesses if Senate doesn't Lawmaker calls for hearing into MLB cheating scandal Big Pharma looks to stem losses after trade deal defeat 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 BennetWarren ad claims Trump fears her most Sanders to headline Iowa event amid impeachment trial On The Money — Presented by Wells Fargo — Sanders defends vote against USMCA | China sees weakest growth in 29 years | Warren praises IRS move on student loans MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineIran resolution supporters fear impeachment will put it on back burner House war powers sponsor expects to take up Senate version of resolution Sens. Kaine, Lee: 'We should not be at war with Iran unless Congress authorizes it' MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon Delgado Democrats plot new approach to win over rural voters The most expensive congressional races of the last decade How the 31 Democrats in Trump districts voted on impeachment MORE (D-N.Y.), John Larson John Barry Larson Retirees should say 'no thanks' to Romney's Social Security plan The Hill's 12:30 Report: All eyes on Pelosi as calls for impeachment grow More Democrats threaten impeachment over Trump's dealings with Ukraine MORE (D-Conn.) and Brian HigginsBrian Higgins'Medicare for All' backers notch win with high-profile hearing Here are the 95 Democrats who voted to support impeachment On The Money: Sanders unveils plan to wipe .6T in student debt | How Sanders plan plays in rivalry with Warren | Treasury watchdog to probe delay of Harriet Tubman bills | Trump says Fed 'blew it' on rate decision MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy Jean KlobucharBiden leads Sanders by 7 in new national poll Sanders joins Biden atop 2020 Democratic field: poll The Hill's Morning Report - Trump trial begins with clashes, concessions 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 StabenowSenate fails to get deal to speed up fight over impeachment rules The Hill's Morning Report — President Trump on trial John Lewis to miss Martin Luther King Jr. Day event 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 BaldwinSenate fails to get deal to speed up fight over impeachment rules Lawmakers introduce bill to bolster artificial intelligence, quantum computing Trump's China deal is a gift to Wall Street and Beijing MORE (D-Wis.), a sponsor of the bill. 

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