About 20 million Americans have gained coverage under ObamaCare since it was passed in 2010, but nearly 9 percent of the population — 30 million people — still don’t have health insurance.
All Democrats running for president say they want to provide universal health coverage to all 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. (I-Vt.) has offered a plan in the Senate, and Rep. (D-Wash.) has introduced similar legislation in the House.
Who supports it: Sens. (D-N.J.), (D-N.Y.), (D-Calif.), (D-Mass.) and Rep. (D-Hawaii) have all sponsored the Medicare for All bills in the House and Senate. South Bend, Ind. said he wants to work toward a “Medicare for all” system.
What it would do:
Of all the plans to expand Medicare, Sanders’ 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.
Medicare for All would also eliminate most other federal health programs, like Medicaid, but keep the Indian Health Service and the Veterans Health Administration, though those could also eventually be eliminated.
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, like 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 weary of getting rid of a multi-billion 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 Medicare for All typically point to increased taxes as a downside. But Sanders’ notes that his plan would eliminate virtually all cost-sharing, including premiums, deductibles and co-pays.
Medicare for America
Sponsors: Reps. (D-Conn.) and (D-Ill.).
Who supports it: Former Rep. Beto O’Rourke (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 it would automatically enroll newborns, the uninsured and anyone receiving coverage through Medicaid, Medicare, ObamaCare and the Children’s Health Insurance Program.
Large employers could continue offering coverage, as long as it’s comparable to the new Medicare plans, or it could make contributions to the Medicare plans on behalf of its 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 America.”
Unlike Sanders’ 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’ bill.
There’s no cost estimate for this legislation either, 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. (D-Va.), Cory Bennet (D-Colo.) and Reps. (D-N.Y.), (D-Conn.) and (D-N.Y.)
Who supports it: O’Rourke, Sen. (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 for Medicare, allowing individuals of any age to purchase plans that include access to the program’s network of health care providers.
These Medicare plans would be made available across the country over a period of four years, and would cover ObamaCare’s ten 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 that 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. (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. (D-Wis.), a sponsor of the bill.
“Medicare at 50 is a very bold step in the right direction.”