Joe Biden’s Health Care Plan Focuses on Shoring Up the Affordable Care Act

After remaining vague for months about his plans to expand on the Affordable Care Act, Joseph R. Biden Jr. is planning to offer more details in a speech Monday, including changes to the law that would let more people get subsidies to help pay for their health insurance and reduce the maximum percentage of income they would have to spend on premiums.

Mr. Biden, who has led the Democratic presidential field in the first months of the race, is setting himself apart from other leading candidates by calling for improving the 2010 health law, former President Barack Obama’s signature domestic policy, instead of replacing it with a single-payer system that would essentially eliminate private health coverage.

He has argued that the country cannot afford to go down a policy path that involves replacing the Affordable Care Act, also known as Obamacare, with a more sweeping overhaul of the insurance system that he says would prove impossible to achieve in the short term. He will be introducing the new details of his health plan on Monday at a candidate forum sponsored by AARP, the lobby for older Americans, who are a large part of Mr. Biden’s base.

For weeks, Mr. Biden has been previewing parts of his health care platform, particularly his plan to create a “public option,” or government-run health plan like Medicare, for all Americans. Such a plan would compete with private insurers and potentially drive down prices while letting people choose private insurance, either through a job or on the individual market, if they prefer.

Many of Mr. Biden’s leading rivals, including Senators Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts, favor the single-payer system, which has come to be known as “Medicare for all.” Mr. Biden attacked that plan over the weekend, citing its $3 trillion price tag and saying it would raise taxes on the middle class.

Mr. Sanders, in response, said Mr. Biden was “ignoring the fact that people will save money on their health care because they will no longer have to pay premiums or out-of-pocket expenses.”

[Here’s where all the Democratic 2020 candidates stand on Medicare for all.]

Speaking to reporters on Sunday, officials with the Biden campaign said his plan would cost $750 billion over 10 years and would be financed by rolling back the $1.5 trillion tax cut Congress passed last year and doubling the tax rate on capital gains for the wealthiest Americans, those with annual incomes of more than $1 million.

The campaign officials emphasized how hard it was for Mr. Obama and Mr. Biden, his vice president, to get the Affordable Care Act through Congress in 2010. “It took a century of presidents thinking about and pushing for health reform before Obama and Biden were able to get it done,” one official said.

They also pushed back against the idea, promoted by Mr. Sanders and others pushing Medicare for all, that the law is a “half measure” that left many without coverage or with coverage they could not use because their out-of-pocket costs were too high.

“You’ll see him make a case about the urgency of now — that starting over from scratch isn’t the best way to help people in this country who need more affordable coverage,” one campaign official said, adding that Mr. Biden’s position was “a strong contrast with Medicare for all.”

The officials also said Mr. Biden would roll out additional pieces of his health care plan over the coming months, including proposals to reduce gun violence and address cancer, diabetes, addiction and Alzheimer’s disease.

Perhaps the most significant piece of Mr. Biden’s health care plan, which he had previously discussed, would provide free insurance coverage through a public option to all low-income adults in 14 states that have not expanded Medicaid under the Affordable Care Act. There are roughly 2.5 million poor uninsured adults in those states who would qualify for Medicaid if their governors and legislatures, which are largely Republican, had allowed it.

“This would be a huge boost to poor people in states that have not expanded Medicaid, who are today left with no options at all to get affordable health coverage,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

But Mr. Levitt said Mr. Biden’s plan could also have “the unintended consequence of encouraging some states that have already expanded Medicaid to pull back.” Under the Affordable Care Act, states will pay about 10 percent of the cost of expanded Medicaid moving forward, while the federal government will pay 90 percent.

Mr. Biden’s plan, which bears many similarities to Hillary Clinton’s health care proposal in 2016, could also help middle-class Americans who rely on the individual market for health insurance but have paid a high price because they do not qualify for the law’s premium subsidies. Those people have felt the most financial pain from premium increases.

“Extending subsidies to those left out of the system today could help people a lot,” Mr. Levitt said, “especially those who are older and in rural areas, where premiums are the highest.”

He added, however, “Obviously, the details matter.”

Another Biden proposal that could help the middle class would allow people with government subsidies to buy “gold” plans through the Obamacare marketplaces, which generally have lower deductibles than the “silver” plans they are currently required to buy.

His plan would also require that no one buying insurance on the individual market spend more than 8.5 percent of their income on their premiums. Currently, under the health law, the limit is 9.86 percent.

Asked if Mr. Biden had a contingency plan in case the Affordable Care Act is thrown out by the courts — a distinct possibility since a district court judge in Texas has already invalidated it and the case is being appealed — the campaign officials said he was expecting the law to be upheld.

They did not directly answer a question about how many of Mr. Biden’s proposals would need approval from Congress. Instead, they said, his “longstanding history of getting stuff done” in Congress would help ensure he could carry out his plans.


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