2020 Democratic presidential candidates agree they want universal health coverage. They only differ in their views on how to get there.
Some Democrats threatened to block the Affordable Care Act over a Medicare opt-in in 2009. A decade later, the same public option looks like a small step for a Democratic Party that has embraced sweeping change on health care as it looks to recapture the White House.
Other Democrats think such a proposal would move too far, too quickly. Sen. Sherrod Brown, an Ohio Democrat who is considering a presidential bid, wants instead to lower the Medicare eligibility age to 55 from 65. Sen. Amy Klobuchar — a Minnesota Democrat seen as one of the more centrist 2020 primary candidates — has floated a public option to allow consumers to choose whether to buy into a government-run plan.
"All of these candidates support a wide range of proposals that would move toward universal coverage and create at least an option for public coverage," said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation."The Democratic candidates differ more in how quickly they want to move and what's immediately possible politically than what the end goal is.
A bill reintroduced last month by Sen. Brian Schatz, D-Hawaii, offers one example. It would let states create a program for residents with any income to buy into a Medicaid insurance plan. The federal and state Medicaid system, which 36 states and the District of Columbia chose to expand under Obamacare, currently offers coverage to low-income Americans.
But many Democrats want more ambitious action. Sanders, who helped to bring single-payer more into the political mainstream during his 2016 presidential bid, has said a more drastic overhaul is"what we must do to end the international disgrace of being the only major country not to make health care a right.
Democratic leaders have had to grapple with those possible political consequences ahead of the 2020 elections. Democrats not only want to deny Trump a second term, but also hold House seats in ideologically split areas that propelled the party to control of the chamber in November. House Speaker Nancy Pelosi has showed skepticism of"Medicare-for-all" as she tries to maintain a House majority. In a Rolling Stone interview published last week, she asked in part:"How's it gonna be paid for?"
The group said it opposes"Medicare-for-all" based on what it calls a"mountain of evidence" about high costs and the potential to disrupt innovation and quality of care. The AMA also criticized a Medicare public option, expressing doubts about its solvency and potential damage to the private market.The public option was not always seen as a more moderate step for Democrats.
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