Joe Biden unveils his alternative to ‘Medicare for all’

Former Vice President and Democratic presidential candidate Joe Biden speaks Saturday in Londonderry, N.H.
(Robert F. Bukaty / Associated Press)

Joe Biden unveiled a robust plan to expand Obamacare by adding a public program that all Americans could choose, as the former vice president argued Monday that medical insurance can be made universally accessible without scrapping the nation’s current model of delivering healthcare.

The Biden plan would provide tens of billions of dollars in new healthcare spending in a bid to lower the out-of-pocket costs that families face for healthcare, make Medicare-style coverage available to any American who wants it and significantly expand tax credits to help people pay for insurance.

He would pay for that primarily by raising capital gains taxes on those earning more than $1 million, according to a summary Biden’s campaign provided to reporters in advance.


The blueprint comes amid intensified tangling between the former vice president and progressive rivals who are pushing more transformational change in healthcare, through a “Medicare for all” system that would abolish private insurance.

As progressives in the race dismiss the current system as unfixable and beholden to corporate pharmaceutical and insurance interests, Biden warns that walking away from Obamacare could leave a large swath of the country vulnerable to losing coverage.

“He is remembering... how hard it was to get the Affordable Care Act passed,” said a senior campaign official, who would speak only on condition of anonymity before Biden presented the plan. “It took a century of presidents thinking about and pushing for healthcare reform before Barack Obama and Joe Biden got it done.

“He is going to oppose every Republican who is seeking to tear down Obamacare, just as he’s going to oppose Democrats seeking to tear down Obamacare,” the aide said. A new campaign video includes a clip of candidates at last month’s Democratic debate being asked if they want to eliminate private insurance altogether, with several of Biden’s rivals raising their hands to show they do.

“Some said, ‘yes,’” Biden says in the video. “I said, ‘absolutely not.’”

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Sen. Bernie Sanders accuses Biden of using the same tactics as President Trump and the insurance industry to mischaracterize his Medicare for all plan.


“I traveled all over the country to fight the repeal of Obamacare,” Sanders wrote in a tweet Monday. “But I will not be deterred from ending the corporate greed that creates dysfunction in our health care system. We must pass Medicare for All.”

As the candidates trade barbs, Biden is unveiling a blueprint that would step up the generosity of Obamacare and expand coverage to the poor even in conservative states that rejected the Medicaid expansion in the Affordable Care Act.

The plan still fundamentally preserves the employer-based health insurance system that most working-age Americans rely on for coverage. It builds off the health insurance system created by the Affordable Care Act, with targeted adjustments that appear aimed at fixing some of the law’s shortcomings.

Biden’s plan envisions creating a new government health plan akin to Medicare — popularly called a “public option” — that any American could elect to purchase if they are unhappy with their commercial health plan option. It’s not a buy-in to the actual Medicare program that Biden had earlier signaled would be the linchpin of his program, but a new public insurance system styled after Medicare.

Biden would expand financial assistance available to Americans who don’t get health insurance through a job and instead rely on insurance marketplaces created by the 2010 law.

These marketplaces — which currently serve about 11 million people — have been popular with Americans who make less than four times the federal poverty level and therefore qualify for subsidies to offset the cost of health plans sold on the marketplaces.


But people who earn too much to qualify for the aid often complain that health plans on the marketplaces are too expensive. And the Trump administration has taken a series of steps to make it easier for people to buy skimpier health plans, which consumer advocates warn are often inadequate and weaken insurance markets.

Biden’s plan would allow more middle- and upper-middle income people to qualify for subsidies, which could add to the attraction of more comprehensive coverage. The plan would lift the current income cap for tax credits and lower the maximum amount families would spend on health insurance from 9.86% of their income to 8.5%.

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The campaign estimates a family of four with an income of $110,000 per year would save on average $750 per month on insurance costs.

Biden also envisions extending no-cost government coverage to 4.9 million poor residents of the 14 states that have not expanded Medicaid through the healthcare law.

The Obama healthcare law made billions of dollars of federal assistance available to states to open their Medicaid program to low-income adults, a population not traditionally covered by the government safety net program.


But a group of mostly conservative states clustered in the Deep South continues to resist expansion, which has left millions of poor residents of Texas, Florida and other states without health insurance. Biden’s plan would sidestep the political leadership in those states by allowing low-income people in those places to enroll in the public-option plan with no premiums.

That would effectively get around a Supreme Court decision that said the federal government could not require states to expand their Medicaid programs.

In addition to expanding access to health coverage, Biden has embraced several policies for controlling costs long championed by Democrats:

He would allow Medicare to negotiate directly with drug companies to secure lower prices for seniors, something that’s currently banned.

The Trump administration — pushed by the president — has identified lowering drug prices as a priority, but has so far taken mostly minor steps and has stopped short of expanding government authority to rein in prices.

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Biden also targets surprise medical bills, a scourge that has drawn increasing ire of consumers and pushed lawmakers on Capitol Hill to propose legislation. Biden’s plan would prohibit out-of-network charges if a patient is hospitalized at an in-network hospital and therefore cannot choose which doctor provides care.

With the healthcare plan rollout, Biden is aiming to carefully navigate the politics of healthcare in this primary without throwing Obamacare overboard.

Even as Medicare for all proves popular among the Democratic base, enthusiasm for it in the wider electorate is limited. In a poll last month by the Kaiser Family Foundation, just 15% of Democrats and voters who lean Democrat said they wanted candidates to talk about “implementing single-payer or Medicare for All,” just below the 16% who wanted to hear them talk about “protecting the Affordable Care Act.”

But more than a quarter of the voters wanted to hear candidates talk about “lowering the amount people pay for healthcare.”

The former vice president also seems to be using the plan to co-opt policy proposals of rivals. He would expand nationwide a California initiative that diminished the racial gap in mortality death rates, for example, and write abortion rights into federal law. Biden has struggled with those ideas, which Sen. Kamala Harris has championed. And his targeting of big pharmaceutical companies throughout his plan has echoes of the populism of Sanders and Massachusetts Sen. Elizabeth Warren.