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 Sanders Texas House Republican tests positive for coronavirus in latest breakthrough case In defense of share buybacks Progressives seething over Biden's migrant policies MORE (I-Vt.) has offered a plan in the Senate, and Rep. Pramila JayapalPramila JayapalPelosi sets Thursday vote on bipartisan infrastructure bill Lawmakers gear up for spending bill, infrastructure votes Sunday shows - All eyes on spending votes MORE (D-Wash.) has introduced similar legislation in the House.

Who supports it: Sens. Cory BookerCory BookerLawmakers gear up for spending bill, infrastructure votes Booker: End of police reform negotiations a 'frustrating experience' Sunday shows - All eyes on spending votes MORE (D-N.J.), Kirsten GillibrandKirsten Gillibrand11 senators urge House to pass .5T package before infrastructure bill Hochul tells Facebook to 'clean up the act' on abortion misinformation after Texas law Democratic senators request probe into Amazon's treatment of pregnant employees MORE (D-N.Y.), Kamala HarrisKamala HarrisBiden, Harris push big lie about Border Patrol Two 'View' hosts test positive for coronavirus ahead of Harris interview Rep. Karen Bass to run for mayor of Los Angeles: report MORE (D-Calif.) and Elizabeth WarrenElizabeth WarrenIn defense of share buybacks Democrats urge Biden to go all in with agenda in limbo In Washington, the road almost never taken MORE (D-Mass.) and Rep. Tulsi GabbardTulsi GabbardProgressives 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 YouTube rival Rumble strikes deals with Tulsi Gabbard, Glenn Greenwald MORE (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegDOJ sues to block JetBlue-American Airlines partnership On The Money — Presented by Wells Fargo — Pelosi plows full speed ahead on jam-packed agenda Blumenthal calls on Buttigieg to investigate American Airlines-JetBlue partnership 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 DeLauroHolding back on defensive systems for Israel could have dangerous consequences On The Money — Democrats rush to finish off infrastructure Overnight Defense & National Security — Presented by AM General — Defense bill takes center stage MORE (D-Conn.) and Jan SchakowskyJanice (Jan) Danoff SchakowskyDemocrats seek to cool simmering tensions American workers need us to get this pandemic under control around the world Democrats repeal prohibition on funding abortions abroad 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 BennetBuild Back Better Act must include funding to restore forests, make communities resilient and create jobs Interior reverses Trump, moves BLM headquarters back to DC Conservation group says it will only endorse Democrats who support .5T spending plan MORE (D-Colo.) and Tim KaineTimothy (Tim) Michael KaineDemocrats urge Biden to go all in with agenda in limbo Panic begins to creep into Democratic talks on Biden agenda Congress facing shutdown, debt crisis with no plan B MORE (D-Va.) and Reps. Antonio DelgadoAntonio Ramon DelgadoBusiness groups create new headache for Pelosi Chamber of Commerce warns moderate Democrats against voting for reconciliation Six takeaways: What the FEC reports tell us about the midterm elections MORE (D-N.Y.), John Larson John Barry LarsonSenate, House Democrats split over taxes in .5T package Happy 86th birthday, Social Security — it's time to expand benefits Lobbying world 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 KlobucharHillicon Valley — Presented by Xerox — Officials want action on cyberattacks Senate panel advances antitrust bill that eyes Google, Facebook This week: Democrats face mounting headaches 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 StabenowDemocrats surprised, caught off guard by 'framework' deal Congress facing shutdown, debt crisis with no plan B GOP warns McConnell won't blink on debt cliff 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 BaldwinDemocrats confront 'Rubik's cube on steroids' Warren, Daines introduce bill honoring 13 killed in Kabul attack This week: Democrats kick off chaotic fall with Biden's agenda at stake MORE (D-Wis.), a sponsor of the bill. 

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