August 27, 2019

Many of the candidates seeking the 2020 Democratic nomination for president at one point backed Sen. Bernie Sanders' (I-Vt.) "Medicare-for-All" proposal to transition the United States to a single-payer health system. However, mounting concerns from U.S. residents and employers about eliminating private health insurers have caused some candidates to back away from Sanders' proposal and instead call for more incremental reforms.

Where do the 2020 Democratic hopefuls stand on health care?

Background: Many 2020 candidates expressed support Sanders' Medicare-for-All proposal

Many of the current Democratic candidates for president in the past either have co-sponsored or publicly backed Sanders' Medicare-for-All proposal. Sanders' proposal would eliminate most private health insurance and, over a four-year period, replace it with a government-run health system that would expand Medicare to cover all U.S. residents. During the first year, the bill would expand eligibility for Medicare to all U.S. residents age 18 and under, and it would lower the current age threshold for adults from 65 to 55. The Medicare eligibility age would then drop to 45 in the second year and 35 in the third year. Coverage would be expanded to U.S. residents of all ages—including those enrolled in Medicaid and some other government-run health programs—in the fourth year.

Current candidates seeking the Democratic nomination for president who at some point co-sponsored or publicly backed Sanders' proposal include:

  • Sen. Cory Booker (D-N.J.);
  • Former Department of Housing and Urban Development Secretary Julian Castro;
  • Rep. Tulsi Gabbard (D-Hawaii);
  • Sen. Kirsten Gillibrand (D-NY);
  • Sen. Kamala Harris (D-Calif.);
  • Former Rep. Beto O'Rourke (D-Texas);
  • Sen. Elizabeth Warren (D-Mass.); and
  • Marianne Williamson, an author and lecturer.

Sanders also is seeking the 2020 Democratic nomination for president.

Some Democratic presidential candidates back away from Sanders' proposal

However, polling in recent months has shown that U.S. residents and employers are concerned about eliminating private health insurance in the United States, and instead favor more incremental reforms. As such, some candidates who formerly endorsed Sanders' proposal now are calling for alternative reforms.

During primary debates in June, Booker, Castro, Gabbard, O'Rourke, and Williamson declined to raise their hands in support of eliminating private health insurance to implement a Medicare-for-All plan.

Booker in May said he would take incremental steps to reform the U.S. health system if he is elected president. "I stand by supporting Medicare for All," Booker told CNN, adding, "But I'm also that pragmatist that when I'm chief executive of the country ... I'm going to find the immediate things that we can do." Booker said, "I'm telling you right now, we're not going to pull health insurance from 150 million Americans who have private insurance who like their insurance."

Gillibrand during a Washington Post Live event last week said she now favors implementing a public option health plan.

Meanwhile, Harris in July unveiled her own Medicare-for-All proposal that would allow private health insurers to offer Americans coverage modeled after Medicare Advantage plans. Harris' proposal would gradually expand Medicare coverage to all Americans over a 10-year transition period. Under Harris' proposal, Americans would have the option to purchase a traditional Medicare plan, which would be considered a public health plan, or to buy a Medicare plan from a private insurer that offers additional benefits, which would be considered a certified private Medicare plan.

Harris earlier this month said, "I don't think it was any secret that I was not entirely comfortable—that's an understatement." She continued, "I finally was like, 'I can't make this circle fit into a square.' I said: 'We're going to take hits. People are going to say she's waffling. It's going to be awful.'"

O'Rourke also had previously expressed support for Sanders' Medicare-for-All proposal, with O'Rourke in 2017 calling it the "best way" to achieve universal coverage in the United States. But O'Rourke more recently has expressed skepticism about the plan. When asked directly about his stance on single-payer options during a March campaign stop in Iowa, O'Rourke said, "My goal is to get to guaranteed, high-quality universal health care for all, and I think there are many ways to get there." He later added that he is "no longer sure" that Medicare-for-All or a single-payer system would be "the fastest way for us to get there."

In addition, Warren, who during the primary debates said she was "'with [Sanders] on Medicare-for-All,'" since "has given herself wiggle room, saying that 'there are a lot of different pathways' to achieving the goal of the Sanders bill."

Neera Tanden, president of the Center for American Progress, said, "What I think has happened in the Democratic primary is people recognize that some of the concerns about single-payer are not coming from special interests but the public."

Former HHS Secretary Kathleen Sebelius, who served in former President Barack Obama's administration and consulted on Harris' plan, said, "There is nothing more personal to people than their health care," adding, "Anything that calls for the vast majority of Americans to lose what they have—that's a very dangerous place to start a conversation."

Democratic senate candidates also shirk Medicare for All

The shift in candidates' stances on Medicare for All is not limited to the presidential election.

Democrats running for senate in major battleground states also are not supporting Medicare-for-All proposals, and instead are focusing on expanding Medicaid, protecting the Affordable Care Act, and implementing a public option health plan.

Politico reports that the split between the senate candidates and presidential candidates such as Sanders and Warren "could make for an awkward general election if either Warren or Sanders becomes the Democratic presidential nominee campaigning on Medicare for All" (Janes/Scherer, Washington Post, 8/20; Cote, CNN, 5/5; Golshan, Vox, 3/14; Hensley-Clancy, BuzzFeed News, 3/15; Parti/Collins, Wall Street Journal, 8/23; Ollstein/Arkin, Politico, 8/25).

Health Insurance 101: Get the slide decks

Confused about the U.S. health insurance system? You're not alone—it's one of the most complicated systems in the world. If you missed our recent webconference series diving deep into the system, don't worry; we've got you covered.

Review the slide decks from our recent webconferences for a quick overview of each program:

Get the Slides
Download Now

Topics