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 SandersSupport drops for Medicare for All but increases for public option Hillicon Valley: Warren takes on Facebook over political ads | Zuckerberg defends meetings with conservatives | Civil liberties groups sound alarm over online extremism bill On The Money: Trump touts China trade deal | Wall Street, Washington see signs for caution | Trump threatens sanctions on Turkey | Sanders proposes sharp hike to corporate taxes MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalDemocrats see whistleblower report as smoking gun House Democrats say memo of Trump call bolsters impeachment case State Dept: Trump travel ban denied more than 31K people entry to US MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerHillicon Valley: Warren takes on Facebook over political ads | Zuckerberg defends meetings with conservatives | Civil liberties groups sound alarm over online extremism bill O'Rourke hits back at Buttigieg over criticism of his gun buyback proposal Progressives fume at Buttigieg, warn him not to attack Warren at debate MORE (D-N.J.), Kirsten GillibrandKirsten Gillibrand2020 Presidential Candidates Krystal Ball: Yang campaign a 'triumph of substance over the theatre' Three 2020 candidates have missed about half of Senate votes MORE (D-N.Y.), Kamala HarrisKamala Devi HarrisO'Rourke hits back at Buttigieg over criticism of his gun buyback proposal Warren leads Democratic field by 3 points in new national poll Analysis: Warren and Booker most cyber-aware 2020 candidates MORE (D-Calif.) and Elizabeth WarrenElizabeth Ann WarrenSupport drops for Medicare for All but increases for public option Hillicon Valley: Warren takes on Facebook over political ads | Zuckerberg defends meetings with conservatives | Civil liberties groups sound alarm over online extremism bill Feehery: Trump may be down, but he's not out yet MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardSaagar Enjeti: Tuesday's Democratic debate already 'rigged' against Gabbard, Sanders Former 2020 candidate Mike Gravel: 'No question' Sanders is physically fit to be president So many issues, too many candidates and so little time to debate MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegO'Rourke hits back at Buttigieg over criticism of his gun buyback proposal Chasten Buttigieg fundraising for husband Pete overseas Progressives fume at Buttigieg, warn him not to attack Warren at debate 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 DeLauroOvernight Health Care — Presented by Coalition Against Surprise Medical Billing — Planned Parenthood charges into 2020 | PhRMA CEO warns against Pelosi drug pricing bill | Medicaid work requirements costing states millions On The Money: Trump to meet China's vice premier during trade talks | Appeals court says Deutsche Bank doesn't have Trump's tax returns | House Appropriations Chair Nita Lowey to retire DeLauro enters race to succeed Lowey as Appropriations chief MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyHillicon Valley: Google, Reddit to testify on tech industry protections | Trump joins Amazon-owned Twitch | House to vote on bill to combat foreign interference Congress must get pharma out of NAFTA 2.0 Reddit, Google to testify before House panel on tech's legal protections 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 Bennet2020 primary debate guide: Everything you need to know ahead of the October showdown The Hill's Campaign Report: Impeachment fight to take center stage at Dem debate 2020 Presidential Candidates MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael Kaine2020 general election debates announced Senators call for Trump administration to testify on Syria Schumer: Transcript 'absolutely validates' Trump impeachment inquiry MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoTrump impeachment battle hits TV ads Pelosi-backed group funding ads for vulnerable Democrats amid impeachment inquiry Trump impeachment calls snowball, putting pressure on Pelosi MORE (D-N.Y.), John Larson John Barry LarsonThe Hill's 12:30 Report: All eyes on Pelosi as calls for impeachment grow More Democrats threaten impeachment over Trump's dealings with Ukraine Why young people should support expanding Social Security 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 KlobucharHillicon Valley: Warren takes on Facebook over political ads | Zuckerberg defends meetings with conservatives | Civil liberties groups sound alarm over online extremism bill Analysis: Warren and Booker most cyber-aware 2020 candidates Poll: Democratic support for Warren climbs to record high 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 nixes release of multiple reports over researcher exodus Schumer throws support behind Pelosi impeachment inquiry Senate Democrats hesitant to go all-in on impeachment probe 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 BaldwinFederal funding for Chinese buses risks our national security Democrats threaten to withhold defense votes over wall The Trump downturn: Trouble ahead for the US economy MORE (D-Wis.), a sponsor of the bill. 

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