Former Vice President Joe Biden is waging a two-front fight on health care reform by vowing in his latest presidential campaign proposal to protect the Affordable Care Act from Republicans and Democrats alike.
In announcing his plans to shore up Obamacare Monday, Biden equated Republican efforts to repeal the law with plans from other Democratic presidential contenders that would completely overhaul the U.S. health care system and eliminate private health insurance.
“I knew the Republicans would do everything in their power to try and repeal Obamacare,” Biden said in an email to supporters Monday. “But I’m surprised that so many Democrats are running on getting rid of it.”
“I know how hard it was to get passed,” he added. “Starting over just makes no sense to me.”
Biden’s new proposal, which includes plans to expand federal subsidies and create a public option comparable to Medicare, stands as an alternative to the “Medicare for All” system supported by presidential candidates including Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.).
In both the email to supporters and a video uploaded to YouTube on Monday, Biden directly addressed Democratic supporters of Medicare for All, saying he opposes any plan that would overturn former President Barack Obama’s signature health care law.
“I understand the appeal of Medicare for All,” Biden said in the video. “But folks supporting it should be clear that it means getting rid of Obamacare, and I’m not for that.”
Sanders shot back at Biden on Monday morning, noting on Twitter that he “fought to improve and pass Obamacare” and “traveled all over the country to fight the repeal of Obamacare.”
“But I will not be deterred from ending the corporate greed that creates dysfunction in our health care system. We must pass Medicare for All,” he added.
The thrust of Biden’s actual health care plan is to retain the public-private structure of the Affordable Care Act’s health insurance marketplaces and the health care system at large while adding new benefits and stronger financial assistance to make coverage more affordable and accessible. The proposals are very similar to 2016 Democratic presidential nominee Hillary Clinton’s platform and to health care plans promoted by centrist Democrats in Congress, the state level and the 2020 presidential field. Obama himself endorsed a similar slate of proposals in 2016, although he more recently praised Medicare for All.
“Instead of starting from scratch and getting rid of private insurance, he has a plan to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, making our health care system less complex to navigate,” a senior Biden campaign official told reporters Sunday. “And he will not support any policies that would mean getting rid of Obamacare.”
Single-payer Medicare for All-style plans seek to replace every current form of health coverage ― both private insurance and public programs like Medicaid and Medicare ― with a sole government-run system that would pay everyone’s medical bills and be financed by taxes. By contrast, Biden aims to preserve most of the existing health care infrastructure, including the job-based health plans that cover the majority of working-age Americans.
In starker contrast to both Democratic approaches, President Donald Trump and the Republican Party are fighting to completely eliminate the Affordable Care Act and make huge cuts to Medicaid and Medicare, with no plans for how to replace the coverage millions would lose as a result.
Biden’s proposal calls for the creation of a government-run public option health care program that consumers could choose in lieu of private insurance, an idea that was a feature of early versions of the Affordable Care Act until centrist Senate Democrats insisted it be scrapped to win their crucial votes on the final bill in 2010.
Biden also would improve the tax credit subsidies used by health insurance exchange customers. Currently, there is no financial assistance available to exchange users who earn more than four times the federal poverty level, which amounts to $103,000 a year for a family of four. Instead, tax credits would become available to anyone and cap their annual health insurance premiums at 8.5% of their income. The subsidies would be more generous, too, because Biden would peg their value to the cost of a Gold exchange policy instead of the less-comprehensive Silver plans, which often carry deductibles in the thousands of dollars.
The Affordable Care Act’s expansion of Medicaid to adults earning just above poverty wages has been very effective at expanding coverage to low-income people, but a 2012 Supreme Court ruling made this policy optional for states, and 14 states have refused to participate. Biden proposes allowing people in those non-expansion states to sign up for the new public option plan at no cost.
The Democratic debate over the future of the health care system has become notably more pointed in recent weeks. In New Hampshire over the weekend, Biden repeatedly took issue with other Democratic plans that he said would take too long to enact.
“I don’t want to start over,” he said Friday. “How many of you out there have had someone you’ve lost to cancer? Or cancer yourself? No time, man. We cannot have a hiatus of six months, a year, two, three, to get something done. People desperately need help now.”
In turn, Sanders released a statement over the weekend saying he hoped his “fellow Democrats would not resort to misinformation about my legislation.” Sanders plans to give a speech in D.C. this week that will directly “confront the Democratic opponents of Medicare for All.”
Biden’s support for Obamacare reportedly wasn’t always so strong. In the early years of the Obama administration, the former vice president urged the president to avoid entering a protracted battle to reform the U.S. health care system so early in his tenure.
“It was just, ‘We shouldn’t do this. This will be terrible for us. I know politics, I know people, I’ve been doing this for 36 years. You are all well-intentioned, but you don’t get it,’” a former official said.
This post has been updated to included Sanders’ statement in response to Biden on Monday.