2020 Democratic Presidential Candidate Positions on Medicare For All
The leading 2020 Democratic Presidential candidates have dedicated much of their campaigns to discussing healthcare. With many candidates already back-pedaling on their stance about Medicare For All, we thought it important to break down where they really stand. The main point of disagreement between those advocating improved healthcare is whether it should be handled through single-payer, which essentially abolishes private insurance companies.
Sanders and Warren are the only two in support of Medicare For All as a single-payer plan. However, Warren has consistently changed her level of support and is now promoting a slower transition into Medicare-for-All.
The policy position is less clear for the others, with some explicitly not supporting Medicare for All but supporting the improvement of the Affordable Care Act (ACA). All others claim to support Medicare for All but not the most significant aspects.
- Key Healthcare Terminology
- Who supports single-payer Medicare for All and who supports expanding the Affordable Care Act (ACA) instead of Medicare For All?
- Who claims to support single-payer Medicare for All, but actually does not because they support keeping private insurance companies?
- How will Medicare for All be paid for?
FACT 1: Important Healthcare Terminology
- Affordable Care Act (ACA) is the most significant overhaul to the U.S. healthcare system since Medicare and Medicaid. It was implemented under President Obama in 2014 in order to provide health insurance to more Americans. There has been a lot of controversy around the ACA due to many inadequacies, but most people value the advances made as it provided healthcare access to millions more people. Medicare For All would replace the ACA with a better health insurance plan.
- Medicare For All became popular during Bernie Sanders’ 2016 presidential campaign and is a single-payer system. Due to its popularity, candidates now use the term more loosely to refer to expanded/improved healthcare even if it is not a single-payer system.
- Single-payer is a type of Medicare For All system that will abolish private insurance in order to save America tax-payers money, increase quality, and provide more freedom for patients and doctors.
- Public-option allows people to have a form of public health insurance that people can purchase instead of private insurance.
FACT 2: Who supports single-payer Medicare for All and who supports expanding the Affordable Care Act (ACA) instead of Medicare For All?
- Sen. Bernie Sanders is the only candidate who has not wavered from his stance that he would abolish private health insurance in favor of a single-payer system.
- He is the only candidate who has introduced a bill for single-payer Medicare For All (S.1129).
- Sen. Elizabeth Warren supported Medicare For All single-payer early in her campaign, but she later back-pedaled on abolishing private health insurance. She then came out strong in support of it once again, but recently changed her position. She now wants to begin with a Public Option and transition to single-payer.
- Former Vice President Joe Biden promises to protect the Affordable Care Act, “giving Americans a new choice, a public health insurance option like Medicare,” and possibly add a public option.
- Mayor Pete Buttigieg’s “Medicare for All Who Want It” positions Medicare as a public option, claiming that competition will bring down private healthcare costs.
- John Delaney’s “BetterCare” would replace the ACA and absorb Medicaid where “people would be allowed to opt-out and receive a tax credit to buy their own insurance policy if they choose.”
- Sen. Amy Klobuchar proposes, “a public option that expands Medicare or Medicaid.”
- Marianne Williamson promises to, “make Medicare an option on the Obamacare exchanges.”
FACT 3: Who claims to support single-payer Medicare For All, but actually does not because they support keeping private insurance companies?
- Sen. Cory Booker says he will fight for Medicare For All and was a co-sponsor of Sen. Sanders’ bill, but he does not agree that private insurance should be abolished.
- Mayor Julian Castro’s campaign website does not have a section under issues for healthcare, although he has been quoted in the past as being in support of Medicare For All. He has also made it clear that he does not support getting rid of private insurance on more than one occasion: “If somebody wants to have their own private health insurance plan, then they ought to have that.” During the Houston debate in September 2019, Castro doubled down on not getting rid of private insurance.
- Rep. Tulsi Gabbard co-sponsored Rep. Jayapal’s single-payer bill, but she believes private insurance should still play a role in some form.
- Sen. Kamala Harris has wavered on this subject quite a bit. While she was a co-sponsor of Sen. Sanders’ bill, and raised her hand during a debate that she would get rid of private health insurance, she retracted that in a subsequent interview. During the Houston debate in September 2019, Harris doubled down on not getting rid of private insurance.
- Andrew Yang’s campaign website declares that he supports Medicare-for-All. However, he does not support abolishing private health insurance, evidenced by the fact that he did not raise his hand in response to this question during the first Democratic Presidential primary debate in Miami, Florida on June 26, 2019, and June 27, 2019.
FACT 4: How will Medicare for All be paid for?
- Total health spending in the country goes down. This is continually overlooked or ignored by the media. The decrease in health spending by households and employers is more than offset by the increase in federal spending/taxes. In other words, it’s simply a shift of money already being spent on healthcare in our current system, not new or additional money.
- Three recent studies have verified that net savings for the country ranges from 3.5% to 24.6% depending on the study and the decade. 1 | 2 | 3
- The average middle-class family will see an increase in after-tax income of between 14% and 18%.
- The current cost of healthcare for the typical family of four with employer-based insurance is on average $28,166, with $15,788 paid by the employer and $12,378 paid by the employee in the form of premiums ($7,674) and out-of-pocket costs ($4,704). Replacing such private expenditures with a 10.87% predictable payroll tax means the average middle-class family will see an increase in after-tax income of between 14% and 18%.
- For example, a household with $65,000 in income will see its income boosted by $9,750 (15%) under a Medicare-for-All system.
- In addition to having no out-of-pocket costs at point of service, Medicare patients will also no longer need to purchase supplemental coverage like expensive private MediGap policies, Part D drug plans, long-term care or dental insurance.
- Savings will also be a result of reduced paperwork and negotiating power of a single-payer system.
- Simplified administration under Medicare-for-All will generate savings of over $500 billion a year.
- Medicare-for-All single payer would save $327 billion per year from administrative costs. Doctors could cut their overhead in half and free up more billable hours taking care of patients. (P. 7) 1
- Government will be able to negotiate drug prices, which will reduce costs by hundreds of billions per year. 1 | 2 | 3
- The additional federal revenue for Medicare-for-All would come from a variety of progressive taxes, not an equal flat amount from each person and not solely by taxing the wealthy.
- Every proposal we could find has a “progressive tax” structure, which means the vast majority of the population would pay something into the system, albeit less than they pay now, with the wealthy paying more. For example, see the sample tax package below that accompanied Sanders’s Medicare for All Act of 2019.
- Sanders’s financing proposals from 2016, 2017, and 2019, have all included some income-based premiums (payroll taxes) on employees/employers or households.
- Sanders’s 2016 plan, 2017 bill and 2019 bill all offer a variety of different taxes that require some contribution from nearly all Americans, with the wealthy contributing a larger percent of their income in a progressive tax structure.
- Not including tax expenditure savings from eliminating subsidies for private insurance (which most analyses include in existing government spending), Senator Sanders offered the following list of financing options with his S. 1129 Medicare for All Act of 2019. The first two items apply to most households and medium to large businesses, while the remaining taxes only apply to high incomes, the wealthy, or large corporations:
- Creating a 4% income-based premium paid by employees, and exempting the first $29,000 in income for a family of four.
- Imposing a 7.5% income-based premium paid by employers, and exempting the first $2 million in payroll to protect small businesses.
- Making the federal income tax more progressive, including a marginal tax rate of up to 70% on those making above $10 million, taxing earned and unearned income at the same rates, and limiting tax deductions for filers in the top tax bracket.
- Making the estate tax more progressive, including a 77% top rate on an inheritance above $1 billion.
- Establishing a tax on extreme wealth.
- Closing the Gingrich-Edwards loophole, which allows some wealthy business owners to avoid paying payroll taxes (for Social Security and Medicare) on a large part of their income.
- Imposing a fee on large financial institutions.
- Repealing corporate accounting gimmicks.
For more information, see our original fact sheet about this subject: Families Will Save Money Under Medicare for All and Medicare for All Costs and What it Really Means.
Goals
- Help people understand the debate around Medicare for All.
- Clarify where Democratic Presidential candidates stand on healthcare
- Help voters sift through confusing, even misleading, information regarding Democratic Presidential candidates’ position on healthcare so that voters can make an informed decision
Who To Contact
| Name | Contact Info | Purpose |
| Sen. Bernie Sanders | Twitter: @SenSanders Facebook:https://www.facebook.com/senatorsanders/ Instagram:https://www.instagram.com/berniesanders/ | Thank for championing single-payer Medicare For All |
| Sen. Elizabeth Warren | Twitter:@SenWarrenFacebook:https://www.facebook.com/senatorelizabethwarren/ Instagram:https://www.instagram.com/senwarren/ Email:https://www.warren.senate.gov/contact/shareyouropinion | Ask her to champion single-payer Medicare For All |
| Sen. Cory Booker | Twitter:@SenBooker Facebook:https://www.facebook.com/SenatorCoryBooker/ Instagram:https://www.instagram.com/corybooker/ Email:https://www.booker.senate.gov/?p=contact | Ask for support of single-payer Medicare For All |
| Andrew Yang | Twitter:@AndrewYang Facebook:https://www.facebook.com/andrewyang2020/ Instagram:https://www.instagram.com/andrewyang2020/ | Ask for support of single-payer Medicare For All |
| Sen. Kamala Harris | Twitter:@SenKamalaHarris Facebook:https://www.facebook.com/KamalaHarris/ Instagram:https://www.instagram.com/kamalaharris/ | Ask for her to be consistent and honest about where she actually stands. |
| Former VP Joe Biden | Twitter:@JoeBiden Facebook:https://www.facebook.com/joebiden/ Instagram:https://www.instagram.com/joebiden/ Email:https://go.joebiden.com/page/s/contact-us | Ask for support for single-payer Medicare For All |
| Tom Steyer | Twitter:@TomSteyer Facebook:https://www.facebook.com/officialtomsteyer Instagram:https://www.instagram.com/tomsteyer/ | Ask for support for single-payer Medicare For All |
| Mayor Pete Buttigieg | Twitter:@PeteButtigieg Facebook:https://www.facebook.com/petebuttigieg1/ Instagram:https://www.instagram.com/pete.buttigieg/ | Ask for support for single-payer Medicare For All |
| Sen. Amy Klobuchar | Twitter:@SenAmyKlobuchar Facebook:https://www.facebook.com/amyklobuchar/ Instagram:https://www.instagram.com/amyklobuchar/ | Ask for support for single-payer Medicare For All |
| Mayor Julian Castro | Twitter:@JulianCastro Facebook:https://www.facebook.com/julianforthefuture/ Instagram:https://www.instagram.com/juliancastrotx/ | Ask for support for single-payer Medicare For All |
| Rep. Tulsi Gabbard | Twitter:https://twitter.com/TulsiGabbard Facebook:https://www.facebook.com/RepTulsiGabbard/ Instagram:https://www.instagram.com/tulsigabbard/ Email:TulsiOffice@mail.house.gov | Ask for support for single-payer Medicare For All |
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