According to Warren’s plan, she would seek to move to a government-run, single-payer program in two phases: The first would come during the first 100 days of her administration, with the second beginning no later than her third year in the White House.
She aims for the full shift to be completed by the end of her first term.
During the first phase, Warren would use the Senate budget reconciliation process to pass legislation that would immediately offer Medicare for All’s full suite of benefits – at no cost – to children under 18 and people at up to 200% of the poverty level, around $51,000 in income for a family of four. The option would be open to any American who wants to use it, but they would have to pay for it, though costs would decline over time. Additionally, the legislation would lower the current Medicare eligibility age to 50 from 65, while while also expanding the program’s benefits and lowering what enrollees have to pay.
During the second phase, she would push Congress to pass the full Medicare for All legislation.
The fight over Medicare for All has been central to the Democratic primary from early on, with Sanders and Warren prominently supporting the sweeping overhaul, and moderates like former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg proposing more modest expansions of the government’s role in the health insurance system. The debate has also underscored the broader divide over the party’s direction as it prepares for a 2020 showdown with President Donald Trump.
The Massachusetts Democrat, in a Medium post published Friday, laid out a different path from Sanders, her fellow Democratic primary candidate and progressive ally in the Senate. Sanders would start the clock on a four-year transition period, which is written into his Medicare for All bill, upon its passage in Congress.
Warren, who laid down a marker at the first primary debate when she declared “I’m with Bernie on Medicare for All,” said on Friday that she would immediately use Senate budget reconciliation rules to fast-track the passage legislation to begin the transition process.
In her post, Warren argued that by getting enough Americans on to a Medicare for All-like option early on in her administration, she will be able to build political and public support for the passage of the full bill, which she hopes to achieve in her first four years in office.
“Given the quality of the public alternatives, millions are likely to move out of private insurance as quickly as possible,” Warren wrote. “No later than my third year in office, at which point the number of individuals voluntarily remaining in private insurance would likely be quite low, I will fight to pass legislation to complete the transition to the Medicare for All system defined by the Medicare for All Act by the end of my first term in office.”
Sanders’ transition plan, which he first introduced in 2017, would, in its first year, place every American age 55 or older, along with people up to the age of 18, into his Medicare for All program. People would also have the option to buy in immediately. Over the next two years, according to the current bill’s language, the Medicare for All enrollment age would drop to 45, then 35 years old. By the fourth year, everyone would be covered.
The idea of reforming the health care system in part by using the budget reconciliation rule is expected to draw immediate criticism from opponents, because the rule narrowly defines what can and can’t be covered under the Senate procedure. But Sanders’ camp is unlikely to be among them. The Vermont senator’s team has in the past floated a similar process as a means of passing the entirety of his Medicare for All Act.
Warren’s new plan implicitly acknowledges the headwinds facing any realistic effort to pass Medicare for All in the current political climate. By using budget reconciliation, Warren wrote, she would be seeking to deny “Mitch McConnell a veto over my health care agenda.” If that hurdle can be cleared, and the process begun, the conversation around the proposed overhaul would, in Warren’s estimation, be very different.
“By this point,” Warren wrote of her third year in office, “the American people will have experienced the full benefits of a true Medicare for All option, and they can see for themselves how that experience stacks up against high-priced care that requires them to fight tooth-and-nail against their insurance company.”
In the first phase, Warren’s option would offer broad coverage – including vision, dental and some long-term care benefits – and be offered on the Affordable Care Act exchanges. Children and those under 200% of the poverty level would not have to pay premiums, while others would shell out no more than 5% of their income.
There would be no deductibles, and those under 200% of the poverty level would have no cost-sharing when they get medical care. Others would have some out-of-pocket costs. Over time, premiums and cost sharing would gradually decrease to zero for everyone.
Warren’s proposal would be more generous in terms of benefits and cost than the public option plans put forward by Biden and Buttigieg.
Those in Medicare, meanwhile, would be eligible for expanded benefits, including vision, dental, hearing aids and long-term care “to the greatest extent possible,” under Warren’s plan. Premiums and cost sharing would eventually decline to zero.
In addition to spelling out her path Medicare for All, Warren on Friday also listed a series of executive actions she would take immediately, including steps to lower drug prices for certain medications like EpiPens and insulin through “existing legal authorities.”
Like other Democrats, Warren also promises to immediately “reverse” Trump administration efforts to weaken and undermine the Affordable Care Act.