Joe Biden’s health care plan, unveiled in July, is an ambitious proposal to expand affordable health insurance to more Americans. But it’s also a rebuttal to the increasing call for some type of Medicare-for-all that several other Democratic candidates have proposed.

For the last decade, the Affordable Care Act (ACA) has been a lightning rod for political attacks. For several years, they came mostly from right-leaning politicians who were intent on repealing the law.

But the 2020 presidential campaign includes a crowded field of Democratic contenders, and several of them have proposed health care platforms that would essentially dismantle the ACA and replace it with some type of single-payer system.

“Medicare-for-all” is often used to describe these proposals, although it’s a bit of a misnomer, as they are generally not calling for an expansion of the current Medicare system to cover everyone.

Although the specifics vary considerably from one candidate to another, their general idea in terms of the future for health care is to eventually get everyone into a health coverage system funded largely by tax dollars (some proposals include additional monthly premiums, some do not; some include cost-sharing at the time a person receives medical services, some do not).

Improving Obamacare

Biden, on the other hand, has made it clear that he wants to “protect and build on Obamacare” rather than replace it with something new.

In a nutshell, Joe Biden’s health care plan would:

  • Expand health insurance subsidies by eliminating the current income cap on subsidy eligibility and ensuring that nobody, regardless of income, has to spend more than 8.5 percent of their income on premiums if they buy their own coverage. (Read about low-income disparity in health insurance)
  • Base premium subsidies on the cost of a gold plan rather than a silver plan. Subsidies would be larger, and affordable health insurance would have more generous benefits.
  • Add a public option. Lawmakers initially intended this to be part of the ACA, but it was taken off the table almost immediately.
  • Eliminate the Medicaid coverage gap by allowing low-income residents in states that haven’t expanded Medicaid to enroll, without premiums, in the public option.

How the ACA has helped Americans

In introducing his health care platform, Biden highlighted how proud he is of all the ways Obamacare has helped Americans over the last several years.

Although it has increased under the Trump administration, the uninsured rate is under 14 percent, compared with 18 percent before the bulk of the ACA was implemented.

Medicaid enrollment has increased by nearly 16 million people, thanks in large part to the ACA’s expansion of Medicaid to cover low-income adults.

People who buy their own health insurance no longer need to worry about their pre-existing conditions being covered, or fear having their application rejected altogether due to their medical history (this was a common occurrence in most states prior to 2014, when the ACA changed the rules).

People who obtain coverage in the individual market or under a small business plan are guaranteed coverage for essential health benefits, including a wide range of free preventive care.

Depending on their income, people who buy their own health insurance are eligible for health insurance subsidies that reduce their monthly premiums, and in some cases, reduce their out-of-pocket costs as well.

People with serious medical conditions no longer need to worry about annual or lifetime caps on the amount that their insurance plan will pay. And annual out-of-pocket costs are also capped.

The ACA is not perfect, and even most supporters have long said that it could use some improvements. But it has been successful in many regards and has weathered numerous legislative and judicial attacks.

Matthew Goldfuss, Director of new business development for TrueCoverage says  “Personally at first I was skeptical of the ACA, and without doubt there are some areas that it still needs to improve. But all in all, I can tell you firsthand that the law has tremendously helped many of those who could not afford health insurance and the satisfaction that it provides us in helping out all these folks get access to care is what it is all about.”

Biden’s plan would build on the ACA, and addresses some of the most significant flaws in the current system, including the lack of affordable health insurance for people with income above 400% of the poverty level, increasingly unaffordable out-of-pocket costs, and the fact that 2.5 million Americans have no realistic access to coverage simply because their states have refused to expand Medicaid.

Written by: Louise Norris

Louise is the co-owner of Insurance Shoppers, Inc., a health insurance brokerage in Colorado. She writes about health insurance and health care reform for, Verywell, HSA Store, and Anthem’s Benefits Guide. Her work has also appeared in Health Affairs and she was a panelist for a Brookings Institution event in 2018 that focused on health care reform at the state level.  

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