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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 SandersPBS White House reporter Yamiche Alcindor to moderate 'Washington Week' Pressure builds for Biden to back vaccine patent waivers Democrats confront difficult prospects for midterms MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalWhite House raises refugee cap to 62,500 The Hill's Morning Report - Biden launches blitz for jobs plan with 'thank you, Georgia' Democrats push to add drug pricing, Medicare measures to Biden plan MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory BookerNever underestimate Joe Biden Police reform talks ramp up amid pressure from Biden, families Victims' relatives hold Capitol Hill meetings to push police reform MORE (D-N.J.), Kirsten GillibrandKirsten GillibrandOvernight Defense: Top general drops objection to major change in prosecuting military sexual assault | Supreme Court declines to take up case from former West Point cadet | Pentagon says 'small' attacks not affecting Afghanistan withdrawal A historic moment to truly honor mothers Biden's poor TV ratings against Trump is exactly what this administration wants MORE (D-N.Y.), Kamala HarrisKamala HarrisAlabama museum unveils restored Greyhound bus for Freedom Rides' 60th anniversary Never underestimate Joe Biden Prosecuting the Flint water case MORE (D-Calif.) and Elizabeth WarrenElizabeth WarrenSchumer works to balance a divided caucus's demands DNC gathers opposition research on over 20 potential GOP presidential candidates Warren book reflects on losing 2020 bid: 'Painful' MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardFox News says network and anchor Leland Vittert have 'parted ways' New co-chairs named for congressional caucus for millennials Tulsi Gabbard blasts new House rules on gender neutral language as 'height of hypocrisy' MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegBusiness groups target moderate Democrats on Biden tax plans Biden plugs infrastructure with a personal favorite: Amtrak CDC says cruises could begin in July 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 DeLauroOvernight Health Care: Biden sets goal of at least one shot to 70 percent of adults by July 4 | White House to shift how it distributes unallocated vaccines to states Pressure builds for Biden to back vaccine patent waivers A historic moment to truly honor mothers MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyOvernight Health Care: Biden sets goal of at least one shot to 70 percent of adults by July 4 | White House to shift how it distributes unallocated vaccines to states Pressure builds for Biden to back vaccine patent waivers Acting FTC chair urges Congress to revive agency authority after Supreme Court decision 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 BennetDemocrats vow to push for permanent child tax credit expansion Senate Democrats push Biden over raising refugee cap Schumer waiting for recommendation on Supreme Court expansion MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineOn The Money: Incomes, consumer spending soared in March | Harris, senators work behind scenes on jobs package | Biden cancels some border wall construction Harris, senators work behind scenes on jobs package Overnight Defense: Gillibrand makes new push for military sexual assault reform | US troops begin leaving Afghanistan | Biden budget delay pushes back annual defense policy bill MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoCuomo job approval drops 6 points amid nursing home controversy: poll Cuomo takes heat from all sides on nursing home scandal We lost in November — we're proud we didn't take corporate PAC money MORE (D-N.Y.), John Larson John Barry LarsonTo encourage innovation, Congress should pass two bills protecting important R&D tax provision Democrats have a growing tax problem with SALT On The Money: Social Security gives IRS data for COVID-19 relief checks | Senate passes bill heading off Medicare cuts MORE (D-Conn.) and Brian HigginsBrian HigginsHouse GOP campaign arm adds to target list Democrats have a growing tax problem with SALT Eighth person charged in alleged plot to kidnap Michigan Gov. Whitmer MORE (D-N.Y.)

Who supports it: O’Rourke, Sen. Amy KlobucharAmy KlobucharWashington keeps close eye as Apple antitrust fight goes to court Senate Democrats push Biden over raising refugee cap Hillicon Valley: Acting FTC chair urges Congress to revive agency authority after Supreme Court ruling | Senate Intel panel working on breach notification bill 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 StabenowOvernight Health Care: Biden sets goal of at least one shot to 70 percent of adults by July 4 | White House to shift how it distributes unallocated vaccines to states The Hill's Morning Report - Presented by Emergent BioSolutions - Can Cheney defy the odds and survive again? Overnight Health Care: WHO-backed Covax gets a boost from Moderna 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 Democrats push Biden over raising refugee cap House Dems to unveil drug pricing measure ahead of Biden package World passes 3 million coronavirus deaths MORE (D-Wis.), a sponsor of the bill. 

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