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 day-old Senate bid faces pushback from progressives Steyer calls on DNC to expand polling criteria for debates Andrew Yang: News coverage of Trump a 'microcosm' of issues facing country MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalLawmakers urge DNC to name Asian American debate moderator Medicare for all: fears and facts House Democrats urge Trump to end deportations of Iraqis after diabetic man's death MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerSteyer calls on DNC to expand polling criteria for debates Gabbard hits DNC over poll criteria for debates The Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch MORE (D-N.J.), Kirsten GillibrandKirsten Elizabeth GillibrandThe Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch Gabbard, Steyer inch toward making third Democratic debate Gillibrand unveils mental health plan MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisSteyer calls on DNC to expand polling criteria for debates Gabbard hits DNC over poll criteria for debates The Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch MORE (D-Calif.) and Elizabeth WarrenElizabeth Ann WarrenSteyer calls on DNC to expand polling criteria for debates Gabbard hits DNC over poll criteria for debates The Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardSteyer calls on DNC to expand polling criteria for debates Gabbard hits DNC over poll criteria for debates The Hill's Morning Report: How will Trump be received at G-7? MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegSteyer calls on DNC to expand polling criteria for debates The Hill's 12:30 Report: Stocks sink as Trump fights with Fed, China Gabbard hits DNC over poll criteria for debates 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 DeLauroMigrants in US border detention centers won't receive flu vaccine Lawmakers point to entitlements when asked about deficits House bill would make World Cup funds contingent on equal pay MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyLawmakers jump-start talks on privacy bill The Hill's Morning Report — Mueller testimony gives Trump a boost as Dems ponder next steps On The Money: House to vote on budget deal Thursday | US, China resuming trade talks next week | Mnuchin backs DOJ tech antitrust probe 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 BennetThe Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch The Hill's Morning Report - Trump hews to NRA on guns and eyes lower taxes The Hill's Morning Report - Trump searches for backstops amid recession worries MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineA lesson of the Trump, Tlaib, Omar, Netanyahu affair Warren's pledge to avoid first nuclear strike sparks intense pushback Almost three-quarters say minimum age to buy tobacco should be 21: Gallup MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoMueller report fades from political conversation Assault weapons ban picks up steam in Congress The 11 House Dems from Trump districts who support assault weapons ban MORE (D-N.Y.), John Larson John Barry LarsonTrump's latest plan to undermine Social Security The Social Security 2100 Act is critical for millennials and small business owners Warren introduces universal child care legislation MORE (D-Conn.) and Brian HigginsBrian HigginsHere 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 Democrats give Trump trade chief high marks MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy Jean KlobucharSteyer calls on DNC to expand polling criteria for debates Gabbard hits DNC over poll criteria for debates The Hill's Campaign Report: Democratic field begins to shrink ahead of critical stretch 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 StabenowUSDA cuts payments promised to researchers as agency uproots to Kansas City USDA eases relocation timeline as researchers flee agency USDA office move may have broken law, watchdog says 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 BaldwinRecessions happen when presidents overlook key problems Trade wars and the over-valued dollar Overnight Health Care: Senate panel advances drug pricing bill amid GOP blowback | House panel grills Juul executives | Trump gives boost to state drug import plans | Officials say new migrant kids' shelter to remain open but empty MORE (D-Wis.), a sponsor of the bill. 

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