Joe Biden unveiled a proposal Monday to expand the Affordable Care Act with an optional public health insurance program, escalating a fierce debate with his Democratic rivals who favor a more sweeping Medicare-for-all system.
Bidenâ€™s plan, which campaign officials estimate would cost $750 billion over 10 years, would also expand tax credits to pay for health premiums, and it would create a new coverage option to help people living in states that have resisted the ACAâ€™s expansion of Medicaid.
The plan, which formalized ideas Biden has campaigned on for months, sharpens one of the biggest dividing lines in the Democratic presidential primary. One on side are traditional Democrats such as the former vice president, who warn that scrapping President Barack Obamaâ€™s signature health law could have dire consequences. On the other side are liberals such as Sen. Bernie Sanders (I-Vt.), who argue that a complete health-care overhaul is necessary to achieve universal coverage.
â€œI understand the appeal of Medicare-for-all, but folks supporting it should be clear that it means getting rid of Obamacare, and Iâ€™m not for that,â€ Biden said in a video released by his campaign. â€œI was very proud the day I stood there with Barack Obama, and he signed that legislation. .â€‰.â€‰. Starting over makes no sense to me at all.â€
The dispute between Biden and Sanders, who in many ways represent the ideological poles of the Democratic field, has ramped up is recent days. Biden said he had â€œprofound differencesâ€ with Sanders and another candidate on health care and suggested their approach could imperil peopleâ€™s coverage, prompting Sanders to forcefully rebut him. And Sanders plans to deliver a speech Wednesday to confront opponents of the single-payer, government-run plan he has long championed.
Bidenâ€™s team signaled he is ready to embrace the fight, even if it risks alienating some in the partyâ€™s liberal base, suggesting that a fight over an unattainable goal will only undermine badly needed improvements in the short term.
â€œYouâ€™ll see him make a case about the urgency of now, that starting over from scratch is not the way to ensure that people in this country who need more affordable coverage are going to be able to get it,â€ said one of the senior Biden campaign officials who previewed the plan ahead of its release.
Disagreements over health care, an issue that polls show is important to many voters, loom heavily over the general election as well. Many Democrats are eager to reprise their successful midterm strategy of pointing to Republican efforts to repeal and replace the ACA. President Trump and his allies are looking to counter with attacks casting Medicare-for-all as a scary takeover of the health-care system that would be detrimental to many Americans, a line of attack that worries some Democrats.
With AARP hosting a series of candidate forums this week in Iowa, and the next Democratic debate coming up at monthâ€™s end, other candidates are also seeking to clarify their positions on health care. Sen. Cory Booker (D-N.J.) will release a proposal Monday to allow more people to be eligible for Medicaid services.
Biden, who leads the crowded pack in state and national polls and is running heavily on the Obama record, faces particular pressure. Among other things, he hopes to turn the page on a series of controversies â€” most notably his comments praising his past work with segregationists, which he recently said he regretted.
At the heart of Bidenâ€™s health-care plan, which senior campaign officials said would cover more than 97 percent of Americans, is a proposal to let people choose a government-run health system like Medicare if they arenâ€™t happy with private insurance. Obama initially set out to include such a public option in the ACA law, but later backed away from the idea amid political resistance.
The former vice president would bolster other parts of the ACA designed to help people purchase insurance. It would get rid of the income cap â€” 400 percent of the federal poverty level â€” used to determine who qualifies for tax credits that help Americans pay insurance premiums.
Bidenâ€™s plan would also seek to circumvent the resistance by many Republican-led states to accepting the expansion of Medicaid, a program for low-income and disabled Americans. In the 14 states that have not expanded Medicaid as allowed by the ACA, Bidenâ€™s proposal would let those who would otherwise qualify for assistance buy into the public option without premiums.
Abortion rights are also part of Bidenâ€™s plan. He would provide federal funding for Planned Parenthood and combat the actions of states that have moved to tighten restrictions on abortions. And the overall plan would be funded by raising taxes on the investment income earned by wealthy Americans.
After initially aiming most of his fire at Trump, Biden now appears eager to contrast his position on health care with his Democratic rivals. Many centrist Democrats fear that if the partyâ€™s nominee embraces Medicare-for-all, including the sidelining of private health insurance, it will scare off many voters and play into Trumpâ€™s hands.
Of the four Democrats leading in the polls, only Biden wants to build on the ACA rather than push Medicare-for-all. Sens. Elizabeth Warren (D-Mass.) and Kamala D. Harris (D-Calif.) are largely following Sandersâ€™s approach.
Campaigning in New Hampshire last week, Biden said it â€œtook a long time to get us to where it is now,â€ referring to the decades-long battle to pass health-care restructuring. Too many people are at risk, he warned, to go through another lengthy debate about overhauling the system.
He went after proponents of Medicare-for-all both directly and obliquely. Biden said Sanders has â€œbeen very honestâ€ about raising taxes on the middle class to pay for his plan and ending private insurance, suggesting those ideas are political poison.
Sanders acknowledges his proposal would require tax increase on middle-class Americans, but he argues that they would pay far less in health-care costs, saving them significant money overall. And while his plan would bar private insurers from replicating services covered under Medicare-for-all, he has said they could still finance elective procedures.
The debate over private insurance has been complicated. Some candidates have tried to walk a fine line, endorsing Sandersâ€™s plan while trying to avoid alienating Americans who want the option of keeping their insurance. Harris, who is co-sponsoring Sandersâ€™s Medicare-for-all bill in the Senate, recently had to clarify that she does not support abolishing private insurance.
Asked by a reporter whether Harris has been clear in her position on private insurance, Biden grinned and said, â€œIâ€™ll let you guys make that judgment.â€
Sandersâ€™s aides say a core part of their strategy is emphasizing that the senator from Vermont has spent decades advocating for ideas that have only recently come into vogue with other Democrats. In his speech this week, Sanders intends to â€œconfront the Democratic opponents of Medicare-for-all and directly challenge the insurance and drug industry,â€ according to his campaign.
Over the weekend, Sanders was just as eager to single out Biden as Biden was to name him.
â€œHere are the facts. Under Medicare-for-all, over a four-year period, we will transition to a system in which Medicare is expanded to cover every man, woman, and child in the country,â€ Sanders said in a Saturday statement responding to Biden. He added, â€œIt is preposterous to argue that as we expand Medicare-for-all that people with cancer and other illnesses will not get the care that they need.â€
When it comes to the Affordable Care Act, 46 percent of the public hold favorable views of the law while 40 percent hold unfavorable views, a major improvement from several years ago, according to a recent Kaiser Family Foundation poll.
John Wagner contributed to this report.