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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 SandersObama book excerpt: 'Hard to deny my overconfidence' during early health care discussions Americans have a choice: Socialized medicine or health care freedom Ocasio-Cortez says Democrats must focus on winning White House for Biden MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalOcasio-Cortez, progressives call on Senate not to confirm lobbyists or executives to future administration posts Pocan won't seek another term as Progressive Caucus co-chair Poll shows Biden leading Trump, tight House race in key Nebraska district MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory Anthony BookerDemocratic senators unveil bill to ban discrimination in financial services industry Obama endorses Espy in Mississippi Senate race Durbin says he will run for No. 2 spot if Dems win Senate majority MORE (D-N.J.), Kirsten GillibrandKirsten GillibrandInternal Democratic poll: Desiree Tims gains on Mike Turner in Ohio House race Hillicon Valley: Facebook, Twitter's handling of New York Post article raises election night concerns | FCC to move forward with considering order targeting tech's liability shield | YouTube expands polices to tackle QAnon Democrats question Amazon over reported interference of workers' rights to organize MORE (D-N.Y.), Kamala HarrisKamala HarrisHarris blasts GOP for confirming Amy Coney Barrett: 'We won't forget this' GOP Senate confirms Trump Supreme Court pick to succeed Ginsburg The painstaking, state-by-state fight to protect abortion access MORE (D-Calif.) and Elizabeth WarrenElizabeth WarrenAll fracked up: Biden's Keystone State breakdown What do Google, banks and chicken salad have in common? Final debate: War Admiral vs. Seabiscuit MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardHarris faces biggest moment in spotlight yet Ocasio-Cortez slams Tulsi Gabbard for amplifying ballot harvesting video Republicans call on DOJ to investigate Netflix over 'Cuties' film MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegLGBTQ voters must show up at the polls, or risk losing progress Buttigieg says it's time to 'turn the page' on Trump administration Sunday shows preview: Coronavirus cases surge in the Midwest; Trump hits campaign trail after COVID-19 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 DeLauroCongress must repeal tax breaks for the wealthy passed in CARES Act Century of the Woman: The Fight for Equal Pay Female lawmakers, officials call for more women at all levels of government to improve equity MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyPelosi, Mnuchin continue COVID-19 talks amid dwindling odds for deal Pocan won't seek another term as Progressive Caucus co-chair Hillicon Valley: Facebook to label posts if candidates prematurely declare victory | Supreme Court hears landmark B Google, Oracle copyright fight | House Dem accuses Ratcliffe of politicizing election security intel 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 BennetSenate Democrats hold talkathon to protest Barrett's Supreme Court nomination Cotton mocks NY Times over claim of nonpartisanship, promises to submit op-eds as test Democrats sense momentum for expanding child tax credit MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineDemocrats brace for nail-biting finish to Senate battle Democratic Senate emerges as possible hurdle for progressives  Two Loeffler staffers test positive for COVID-19 MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoGOP leader says he doesn't want Chamber's endorsement: 'They have sold out' US Chamber of Commerce set to endorse 23 House freshman Democrats Democrats go big on diversity with new House recruits MORE (D-N.Y.), John Larson John Barry LarsonAnxious Democrats amp up pressure for vote on COVID-19 aid AARP endorses Democrats' measure to overturn Trump payroll tax deferral GAO clears way for Democrats to try to overturn Trump's payroll tax deferral MORE (D-Conn.) and Brian HigginsBrian HigginsEighth person charged in alleged plot to kidnap Michigan Gov. Whitmer Biden slams Trump for promoting conspiracy theory about man shoved by police Trump claims 75-year-old man shoved by Buffalo police could be part of 'set up' MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy KlobucharStart focusing on veterans' health before they enlist Durbin says he will run for No. 2 spot if Dems win Senate majority Democrats seem unlikely to move against Feinstein 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 StabenowDemocratic senator votes against advancing Amy Coney Barrett nomination while wearing RBG mask Healthcare, retirement security seen as top issues for older voters, lawmakers say Dems to focus on issues, not character, at Barrett hearings 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 BaldwinInfrastructure, energy investments urgently needed to create U.S. jobs Senate Democrats call for ramped up Capitol coronavirus testing Baldwin calls for Senate hearing on CDC response to meatpacking plant coronavirus outbreak MORE (D-Wis.), a sponsor of the bill. 

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