Former Vice President Joe Biden snubbed Medicare for All in favor of a government public health option, albeit with few details on how the program would work, when unveiling his campaign’s long-awaited healthcare proposal on Monday.
Biden — who in recent weeks has sparred with more liberal 2020 competitors like Sen. Bernie Sanders (D-VT) over health care — couched his opposition to Medicare for All in terms of strengthening the Affordable Care Act passed under President Barack Obama.
“I believe we have to protect and build on ObamaCare. That’s why I’ve proposed adding a public option to ObamaCare as the best way to lower costs and cover everyone,” Biden said in a video accompanying the release of his proposal. “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.”
Biden’s plan seeks to expand the number of people eligible for government-run health care by incorporating both a public and private approach. The crux of the plan revolves around creating a new “public health insurance option” that will function similarly to other government-run programs like Medicare and Medicaid.
“If your insurance company isn’t doing right by you, you should have another, better choice,” the plan states. “Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare.”
It is unclear what form Biden’s public option will take. Although exact details are scarce, Biden’s proposal appears to indicate it will not allow people who take advantage of the public option to simply join the Medicare or Medicaid rolls.
Unlike Medicare for All, most public option programs limit enrollment to a specific subsection of the population, like the elderly or low-income families. Biden’s plan does not include information on eligibility requirements. It does, however, promise to ensure coverage for individuals earning less than 138 percent of the federal poverty level, which is the criteria for Medicaid eligibility in most states. The plan would automatically enroll such individuals in the public option when they “interact” with governmental institutions, such as schools, or sign up for welfare assistance.
In fact, the plan seems to be heavily geared towards enrolling individuals in the public option who would otherwise be eligible for Medicaid if their states had expanded the program under Obamacare. Biden’s proposal estimates it can provide health insurance to more than 4.9 additional people by extending “premium-free access to the public option” to individuals in the 14 states that have refused to expand Medicaid.
Such a provision would benefit conservative-leaning states like Alabama, Wyoming, and Tennessee that have refused to expand Medicaid at the expense of liberal states like New York, Illinois, and California. Biden’s plan does include a provision allowing states that have already expanded Medicaid to transition their “expansion population” to the “premium free public option” as long as they “continue to pay their current share” for covering such individuals. It does not appear conservative-leaning states would be forced to do the same.
Apart from the public option, Biden’s proposal seeks to lower the overall cost of health care. Biden plans to achieve that goal in part by limiting the premiums one can be charged for health insurance on the individual market to 8.5 percent of income. Under current laws, premiums are capped at 9.86 percent.
To further drive down prices, Biden suggests eliminating income caps for tax credits going to those that buy health insurance on the market place. By removing the eligibility cap of more than 400 percent of the federal poverty level — an income of $50,000 for an individual earner or $100,00 for a family of four — and changing the formula for tax credits, Biden argues he can subsidize the cost of health care for middle-class families.
The plan also proposes to cut costs by ending surprise medical billing, “tackle” concentration in the health market through anti-trust measures, and partnering with healthcare workers to “accelerate the testing and deployment of innovative solutions.”
Biden is similarly fuzzy on arresting the skyrocketing price of prescription drugs. The former vice president’s plan proposes allowing Medicare to negotiate the price of prescriptions directly with drug companies and limiting the price the federal government will pay for both new and existing drugs. Biden also proposes putting pressure on pharmaceutical giants by eliminating the tax break they receive for drug advertising. The plan, however, does not address drug costs for those on private health insurance plans, apart from allowing “consumers” to buy medication from other countries and “improving the supply of quality generics.”
Likewise, the plan offers little information about how employer-provided insurance plans will function in the new system, only noting individuals will have the opportunity to transition to the public option if their employer-provided plan forces them to pay more than 8.5 percent of their income on premiums.
The points where Biden’s plan is the most clear and concise is on abortion. In his plan, Biden’s pledges to codify Roe v. Wade into the U.S. Constitution, restore federal funding for Planned Parenthood, and repeal the Hyde Amendment, which prevents federal tax dollars from subsidizing abortion, among others.
“Joe Biden believes that every American – regardless of gender, race, income, sexual orientation, or zip code – should have access to affordable and quality health care,” the plan states. “Yet racism, sexism, homophobia, transphobia, and other forms of discrimination permeate our health care system just as in every other part of society.”
Even before releasing the plan, Biden had signaled he was not among the cadre of 2020 Democrats supporting Medicare for All. The former vice president has been heavily critical of Sanders and other candidates for promising to raise taxes on the middle class to shore up the $60 trillion or more required to implement the program over the next decade.
Despite the criticism, Biden’s proposal, which his campaign estimates would cost $750 billion in the first ten years of implementation, would also be funded by raising taxes back to the level they were before President Donald Trump’s signature tax cut of 2017.