Health care will be a dividing issue between President Donald Trump and his 2020 opponent, but recent policy announcements show Democrats will first have to sort out their ideas within the party.
While there is variation among policy proposals, there are two main paths for 2020 Democrats to follow: Medicare for All or a reboot of the Affordable Care Act, commonly known as Obamacare.
Both policies allow for more government intervention than Republicans have offered, but the policies are very different and highlight the factions within the Democratic Party.
Here are five things to know about the health care debate in the United States:
What is Medicare for All?
While several Democrats have hopped aboard the Medicare for All train, Senator Bernie Sanders (I-Vt.) deserves credit for pushing the policy into the mainstream. His Senate office introduced Medicare for All in the Senate in 2017. His bill didn’t have takeoff on Capitol Hill, but it captivated many liberals, including his 2020 competitors like Sens. Kamala Harris (D-Calif.), Elizabeth Warren (D-Mass.), and Cory Booker (D-N.J.).
Aptly named, Medicare for All is a program that would take the current Medicare system and expand it to all Americans. There are two visions for Medicare for All from the current pool of 2020 Democrats.
The first option simply opens up the option for Americans to be covered through Medicare if they do not want to leave their private insurance. This policy is backed by candidates like Mayor Pete Buttigieg (D-Ind.). The second option abolishes private health care altogether, forcing everyone into the Medicare system. This option is touted by Harris and Sanders.
“We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right,” Sanders wrote. “All Americans are entitled to go to the doctor when they’re sick and not go bankrupt after staying in the hospital.”
What would Obamacare 2.0 look like?
Not all Democrats are on board with Medicare for All. Some believe that the Affordable Care Act is a solid foundation on which to build a health care system in the United States.
Among this group of Democrats is former Vice President Joe Biden. Biden isn’t looking to throw away former President Barack Obama’s health care legacy, rather he would like to build it up.
Since President Trump won in 2016, the ACA has been his number one target, stripping the legislation of its cornerstone: the individual mandate. This required that all Americans get health insurance or face a fine. Now the ACA is tangled up in a courtroom battle about its constitutionality.
Still, Biden believes the program will make it through the courts. He plans to rebuild the program.
Watch Biden’s video:
“Instead of starting from scratch and getting rid of private insurance,” Biden’s team wrote, “he has a plan to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate.”
His policy, which he announced earlier this week, would reinstate the elements stripped away by Republicans, including the individual mandate, and open a smaller public option that would open the door for those interested in a Medicare-like option.
He would also provide tax credits to help offset the annual costs of health care and expand the eligibility for ACA coverage to automatically enroll those on government assistance programs like SNAP, commonly known as food stamps.
What do the programs cost?
Cost is one of the most significant defining issues for Medicare for All. The universal program could cost $32.6 trillion over the first 10 years. As IJR previously reported, not even a 100% tax bracket for millionaires could cover Harris’s version of the plan. That means that most Americans will see their taxes rise to cover the program.
Sanders has acknowledged this fact, noting that he feels comfortable raising taxes on middle-class Americans to pay for Medicare for All because it could still be lower than their annual payments for premiums and copays under their current coverage.
As for Obamacare 2.0, Biden’s plan claims it will be fully funded by repealing the Republican-backed Tax Cuts and Jobs Act and levying a tax on capital gains and dividends. The sticker price for the new-and-improved ACA, according to Biden’s campaign, is $750 billion over 10 years.
Biden’s cost comes in at just 2.3% of the total cost of Medicare for All.
Who do they cover?
Medicare for All, especially the plans laid out by Harris and Sanders, fully covers every single person in the United States. There would be no more premiums, copays, or negotiations with insurance providers.
Obamacare 2.0 doesn’t go nearly as far. For most people, there should be very little change to their current coverage because they would keep the plan they currently have. Biden would expand the ACA to include more low-income Americans and work to lower costs for prescription drugs and ban surprise billing, but it would not encompass all Americans like Sanders’ plan.
Additionally, 2020 Democrats gave unanimous support for covering undocumented immigrants under their plans during one night of the primary debates, a move many Republicans questioned.
2020 Democrats' radical health care agenda would:
— Iowa GOP (@IowaGOP) July 17, 2019
What is the GOP’s health care plan?
For now, the Republican Party has offered criticisms of the ACA and Medicare for All, but they haven’t coughed up much of a plan on their own. In 2017, President Trump attempted to repeal the ACA, but even the so-called “skinny repeal” failed after the late Senator John McCain (R-Ariz.) made a last-second reversal and voted against the measure.
Since then, Republicans haven’t really touched the issue. President Trump has made some changes from the executive level, including reforms to the organ donation process and a massive expansion of HRAs (Health Reimbursement Arrangements) by granting the accounts tax-advantaged status.
As IJR previously reported, HRAs have the potential to reform the individual market by allowing employers to give employees pre-tax allotments to pay for their health care, rather than buying it as a company.
“Under the rule, employers will be able to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market,” the White House noted.
This could help small businesses cut down on their expenses while adding competition to the individual market to drive down insurance costs.
Beyond Trump’s actions, Republicans don’t have much of a plan — which could come back to bite them in 2020. Health care was one of the biggest issues in the 2018 midterm elections, and Republicans didn’t fare as well as they had hoped. It remains a top priority, with 36% of Americans listing it as their biggest concern.