Health care was a divisive issue among 2020 Democratic presidential candidates, with the far-left flank pushing for a complete government takeover of the industry in the form of “Medicare for All” and more moderate Democrats pushing for a toned-down public option.
Creating a public option and expanding Medicare
Biden wants to “build on the Affordable Care Act with a plan to insure more than an estimated 97% of Americans.” The central feature of this is the creation of a public option, which would be a government-run insurance plan available for anyone to sign up for.
“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,” his campaign explains.
Medicare rates are generally lower than private insurance because the government is able to leverage the massive program’s bargaining power. Biden is betting that a public option would extrapolate those cheaper rates to all Americans.
Separately from the public option, Biden wants to expand the Medicare program as it currently exists. As part of his coronavirus economy recovery plan, Biden wrote in April that he would lower the Medicare eligibility age from 65 to 60, making millions more older Americans eligible.
Make ACA subsidies more generous
Currently, under the Affordable Care Act families that make between 100 percent and 400 percent of the federal poverty level are eligible for a tax credit to help buy health insurance on the Obamacare marketplace. Biden’s plan would get rid of this cap on financial assistance to ensure that families who make more than 400 percent of the federal poverty level can also get help from the government.
The Biden plan would also reduce the amount of family income that goes toward health care premiums by “lowering the limit on the cost of coverage from 9.86% of income to 8.5%.”
Finally, the Biden plan would also calculate tax credits based on the cost of “gold” plans instead of “silver” plans, which should bring down out-of-pocket costs.
Making prescription drugs more affordable
Biden would make a few changes to the prescription drug marketplace with the intention of making drugs more affordable.
The primary reform here is allowing Medicare to negotiate lower prices with drug companies. The Biden plan would also allow consumers to buy prescription drugs from other countries, which should promote competition in the industry.
Crack down on surprise billing
Biden says he would crack down on “surprise” medical bills by barring health care providers from charging people out-of-network rates if they don’t have control over what provider they are seeing at the time, such as in emergency situations.
Surprise medical bills have become a big problem in recent years. A Kaiser Family Foundation survey in 2016 found that 70 percent of “individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care.”
How would he pay for it?
Biden's campaign told the Wall Street Journal his plan would cost $750 billion over the next 10 years. Biden would foot the bill by reversing President Trump's tax cuts and eliminating capital gains tax loopholes for the super-wealthy.
"I'm going to get rid of the bulk of Trump's $2 trillion tax cuts, and a lot of you may not like that, but I'm going to close loopholes like capital gains and stepped-up basis," Biden said last month, according to a pool report of a virtual fundraiser.