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 SandersDemocrats face critical 72 hours Overnight Health Care — Presented by Altria — Manchin nixes Medicare expansion Manchin shutting down Sanders on Medicare expansion MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalDemocrats say GOP lawmakers implicated in Jan. 6 should be expelled Matt Stroller: Amazon's Bezos likely lied under oath before Congress Which proposals will survive in the Democrats' spending plan? MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory BookerSenate Democrats call for diversity among new Federal Reserve Bank presidents Progressives push back on decision to shrink Biden's paid family leave program Emanuel to take hot seat in Senate confirmation hearing MORE (D-N.J.), Kirsten GillibrandKirsten GillibrandWhich proposals will survive in the Democrats' spending plan? Proposals to reform supports for parents face chopping block Under pressure, Democrats cut back spending MORE (D-N.Y.), Kamala HarrisKamala HarrisObama looks to give new momentum to McAuliffe Kamala Harris engages with heckler during New York speech Biden's safe-space CNN town hall attracts small audience, as poll numbers plummet MORE (D-Calif.) and Elizabeth WarrenElizabeth WarrenDemocrats face critical 72 hours The Hill's Morning Report - Presented by Facebook - Biden, Democrats inch closer to legislative deal This week: Democrats aim to unlock Biden economic, infrastructure package MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardThe perfect Democratic running mate for DeSantis? Progressives breathe sigh of relief after Afghan withdrawal Hillicon Valley: US has made progress on cyber but more needed, report says | Democrat urges changes for 'problematic' crypto language in infrastructure bill | Facebook may be forced to unwind Giphy acquisition MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegThe Hill's Morning Report - Presented by Facebook - Biden, Democrats inch closer to legislative deal Republican spin on Biden is off the mark Unanswered questions remain for Buttigieg, Biden on supply chain catastrophe 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 DeLauroWhich proposals will survive in the Democrats' spending plan? Proposals to reform supports for parents face chopping block On The Money — Democrats eye tough choices as deadline looms MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyOvernight Health Care — Presented by The National Council for Mental Wellbeing — FDA panel advises Moderna booster shot for high-risk people Hillicon Valley — Presented by LookingGlass — Congress makes technology policy moves House Democrats announce bill to rein in tech algorithms 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 BennetBuilding back better by investing in workers and communities Biden signs bill to help victims of 'Havana syndrome' Colorado remap plan creates new competitive district MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineObama gives fiery speech for McAuliffe: 'Don't sit this one out' Biden injects new momentum into filibuster fight Democratic frustration with Sinema rises MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoUS Chamber targets more House Democrats with ads opposing .5T bill Business groups create new headache for Pelosi Chamber of Commerce warns moderate Democrats against voting for reconciliation MORE (D-N.Y.), John Larson John Barry LarsonSocial Security benefits increasing almost 6 percent next year Senate, House Democrats split over taxes in .5T package Happy 86th birthday, Social Security — it's time to expand benefits MORE (D-Conn.) and Brian HigginsBrian HigginsBiden's keeping the Canada-US border closed makes no sense Biden administration stokes frustration over Canada Canadian ambassador calls for close coordination in handling of US border MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy Klobuchar'Facebook Papers' turn up heat on embattled social media platform Omar, Klobuchar lead charge seeking Congressional Gold Medal for Prince Klobuchar: 'Facebook knew' it was hurting communities 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 weigh future of methane fee in spending bill Senate Democrats dial down the Manchin tension Democrats surprised, caught off guard by 'framework' deal 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 BaldwinProviding affordable housing to recruit our next generation of volunteer firefighters Progressives push back on decision to shrink Biden's paid family leave program Building back better by investing in workers and communities MORE (D-Wis.), a sponsor of the bill. 

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