Joe Biden on Monday unveiled a health care plan intended to shore up and expand the Affordable Care Act, sharpening the contrast with other 2020 Democratic presidential candidates who are backing a more sweeping transition to a Medicare for All system.
"I believe we have to protect and build on Obamacare," Biden said in a video on his campaign website. "I understand the appeal of Medicare-for-all, but folks supporting it should be clear that it means getting rid of Obamacare, and I'm not for that. … Starting over makes no sense to me at all."
Among its key elements, Biden's plan would:
Create a public option: Create a new Medicare-like public health insurance option that any American could buy. Biden's camp argues that a public option would lower health insurance costs by competing with private insurers. President Obama had initially sought to include such an option in the ACA, but the idea was dropped after it met with resistance from centrist Democrats, leaving some liberals fuming that the White House had failed to push for progressive priorities. "We're starting with the Affordable Care Act as the base and going to insist on the elements that we sought last time -- and we'll get them this time," a senior Biden campaign official said.
Biden would also allow millions of low-income residents in the 14 states that have not expanded Medicaid under the ACA to enroll in the public option without premiums. States that have expanded Medicaid will be allowed to move their expansion population to the premium-free public option if they choose, as long as they still pay their share of the cost of covering those people.
Provide more generous subsidies: Expand tax credits available to help Americans pay for Obamacare plan premiums, allowing higher earners to qualify for subsidies that reduce their costs. Under Obamacare, only those who earn up to four times the federal poverty level - or nearly $50,000 a year for an individual - are eligible for help paying their premiums.
Biden would eliminate that cap, and he would base the size of federal subsidies on the cost of more generous Obamacare gold plans, which have higher premiums and lower deductibles, rather than the silver plans currently used. Biden would also lower the maximum amount families could spend on health insurance from 9.86% of their income to 8.5%.
Address "surprise" medical bills: Biden's plan would prohibit health care providers from charging out-of-network rates to patients treated at in-network hospitals.
Seek to lower prescription drug prices: Biden would allow Medicare to negotiate prices with drugmakers; limit prices for certain new drugs being launched, and cap price increases for most other drugs at the rate of inflation; and allow patients to import prescription drugs from other countries.
Biden's campaign says his plan would insure more than 97% of Americans, and it estimates that a family of four with annual income of $110,000 would save $750 a month on premiums.
What it would cost: The campaign estimates that the plan would cost $750 billion over 10 years. That cost would be paid for, it says, by rolling back some of the GOP's 2017 tax cuts and increasing the capital gains tax rate from 20% to 39.6% on those earning more than $1 million a year.
What's not clear yet: CNN's Eric Bradner and Tami Luhby say the plan "leaves unclear some important details about how it would work, including how the plan would be administered and the rates at which doctors and hospitals would be paid -- which plays a crucial role in determining which health care providers would accept patients enrolled in the public option."
The responses: "Building on the ACA, as Joe Biden is proposing, is the quickest and least disruptive way to expand coverage and improve affordability. It also dovetails with a strategy of attacking President Trump on efforts to repeal the ACA," Larry Levitt of the Kaiser Family Foundation tweeted. But Levitt also warned that the plan could have "the unintended consequence of encouraging some states that have already expanded Medicaid to pull back" and said that Biden's incremental improvements to Obamacare would leave "an inefficient and costly health care system in place."
The health care industry also criticized Biden's plan. "Vice President Biden's proposal for a new government insurance system through a 'public option' would undermine the progress our nation has made and ultimately lead our nation down the path of a one-size-fits-all health care system run by Washington," said Lauren Crawford Shaver, executive director of the Partnership for America's Health Care Future, a coalition of pharmaceutical, hospital and insurance groups.
Biden and Sen. Bernie Sanders, a rival for the Democratic presidential nomination, have increasingly sparred over health care in recent days. Sanders reportedly plans to deliver a speech Wednesday addressing opponents of his single-payer plan.
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