2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

It's this simple: ALL the Dems' plans EXPAND healthcare coverage for millions; Trump's strips it away from millions.

Back in late June, right after the first Democratic Primary Candidate Presidential Debate, I posted an analysis & table to break out exactly where each of the then-20 (!) candidates stood when it comes to the Next Big Thing in U.S. healthcare policy. I posted a couple of updates as the summer and early fall progressed.

At the time, my main point was that regardless of their official campaign rhetoric, the truth was that nearly all of the candidates were open to multiple paths towards expanding healthcare coverage...both in terms of the number of people covered, the scope of that coverage and the cost of coverage to the enrollees, with a greater portion of the total cost being borne by the federal government.

This, of course, is a vast contrast to what the Trump Administration and Congressional Republicans have been pushing for, which amounts to the exact opposite: Fewer people being covered, by less comprehensive care, with fewer protections, and with less (or ideally none) of the costs being borne by the federal (or state) government.

It's now early November, a few more have dropped out, and while there's still officially over a dozen candidates running, the likely field has now been narrowed (in my view) down to eight:

  • Former VP Joe Biden
  • Sen. Elizabeth Warren
  • Sen. Bernie Sanders
  • Mayor Pete Buttigieg
  • Sen. Kamala Harris
  • Sen. Amy Klobuchar
  • Sen. Cory Booker
  • Former HUD Sec. Julian Castro

No, I'm not including Tulsi Gabbard, Andrew Yang or Tom Steyer. Again, if one of them manages to surge, fine; I'll eat crow and deal with it at that time.

With this in mind, I've decided to repost a "clean" version of this analysis instead of adding another messy update to the old one, so here goes:


With all the fuss & bother being made over whether Democratic Presidential candidates support or don't support eliminating private insurance in favor of a universal, fully-mandatory "Medicare for All" single-payer healthcare system, I decided to attempt to put together a comprehensive table listing which healthcare expansion/overhaul bills each of the candidates actually support or oppose.

This may sound like a simple question: Senators Sanders (obviously), Warren and Harris are all cosponsors of Bernie Sanders' "Medicare for All" bill, S.1129, right?

Well, it's more complicated than that. Most of the Senators (and some of the House members) running have actually cosponsored other significant healthcare expansion bills as well as "pure" Medicare for All...and many have made public statements indicating that they'd likely also be open to some of the other bills on the table (or some variant thereof). Harris has formally split from her prior support of Bernie's bill and is now proposing a hybrid variant which would allow for a "Private Option" in the form of beefed-up Medicare Advantage plans with much tighter regulations (similar to my preferred bill, "Medicare for America")...but she still calls her plan "Medicare for All", confusing the issue further.

Meanwhile, Biden & Buttigieg can't officially "cosponsor" any bills since they aren't in the House or Senate, so I had to go with their official plans as laid out on their campaign websites. Klobuchar has cosponsored several bills; her campaign site doesn't specify any one particular bill but the description of it is very similar to several of them as well as being similar to Biden & Buttigieg's proposals.

Since my earlier version of this analysis, I've simplified not only the list of candidates but also the types of plans--I've cut them down from eight specific bills/plans on the table down to four types of plans, each of which may include more than one specific bill. I've done my best to clarify which candidates either officially support, officially oppose or are open to supporting each. I've also thrown in my own preferred route forward for the heck of it.

There are technically fourteen different specific bills referenced, although in several cases they're basically just the House and Senate versions of essentially the same bill. These break out into four main categories:

ACA 2.0:

ACA 2.0 with a Public Option:

Universal Coverage WITH a Private Option:

Universal Coverage with NO Private Option:

Here's my methodology:

  • The blue fields are the candidates' officially-declared healthcare policy proposals, regardless of any other bills or plans they might be co-sponsors of/etc.
  • The green fields are bills/plans each candidate is a formal co-sponsor of or which they've indicated that they generally support.
  • The yellow fields are bills/plans each candidate might grudgingly support if it becomes clear that this is the bill which is going to come across their desk to sign.
  • The red fields are bills/plans which the candidate has either expressly rejected or now says they oppose (even as a stop-gap) if they used to support it.

For instance:

  • Elizabeth Warren is also a cosponsor of Sen. Schatz's "State Public Option Act" as well as being the lead sponsor of CHIPA which she just re-introduced this spring...yet she's avoided talkinga about either of them for a good six months now.
  • Sen. Harris also cosponsored both of those bills as well as Sen. Sanders' Medicare for All bill...but she recently split with him on his bill, introducing her own variant which would include a longer transition period and allow for privately-administered Medicare Advantage plans to continue, and so on.

My larger point is that all of the bills listed below are good, and they'd all represent a significant improvement to existing law.

The irony of this is that WHATEVER the Big Healthcare Overhaul Bill ends up being (and remember, all of this assumes a blue trifecta, with Democrats retaking the White House and Senate while retaining control of the House), it’s NOT going to end up looking exactly like ANY of the current plans on the table anyway.

Again, I may be a strong proponent of Medicare for America, but I still recognize that even if that becomes the basis for the final bill, there would no doubt be some changes made before it gets passed by the House, Senate and signed into law by whichever candidate below ends up winning...and that's fine.

UPDATE 11/16: I decided to add both Corry Booker and Julian Castro back onto the table after all. I've also made a update in light of Elizabeth Warren having released her proposed "transition plan" to supposedly achieve "pure" Medicare for All within a single Presidential term of office; in response, I've also added a new "proposed timeline" row below mine and the clarification that Bernie's bill currently would involve a 4-year transition period.

UPDATE 12/09: I avoided it for awhile out of respect, but I've gone ahead and removed Sen. Harris from the table below. This leaves only one of the likely nominees who supports a "Medicare for All w/Private Option" solution now that both Beto O'Rourke and Kamala Harris are out of the running (note: It's possible that Cory Booker falls into this category as well...I haven't delved deeply enough into his proposal to be certain):


Meanwhile, here's Donald Trump's "healthcare plan":

  • That's it. That's his plan.

(Yes, technically speaking, the House GOP's "Republican Study Committee" recently came out with their own "replacement plan" for the ACA if it's struck down...but it's basically just the same warmed-over glop they tried to push a couple of years ago in the form of the "Graham-Cassidy" bill, which amounts to a mish-mash of terrible ideas like "block grants", "high risk pools" and the like. Otherwise, that's it.)