Health care comes in focus as risk for Dems

WASHINGTON -- With health care at the center of presidential politics, Democrats are split over eliminating employer-provided health insurance under "Medicare for All."

The risk is history has shown voters are wary of disruptions to job-based insurance, the mainstay of coverage for Americans over three generations.

Divisions were on display in the two Democratic debates this week, with Sens. Bernie Sanders and Elizabeth Warren calling for a complete switch to government-run health insurance for all. In rebuttal, former Vice President Joe Biden asserted "Obamacare is working" and promised to add a public option. Sen. Kamala Harris was in the middle with a new Medicare for All concept preserving private insurance plans employers could sponsor and phasing in more gradually. Other candidates fall along that spectrum.

Medicare for All

The Medicare for All plan advocated by Sanders and Warren would replace America's hybrid system of employer, government and individual coverage with a single government plan paid for by taxes. Benefits would be comprehensive, and everybody would be covered, but the potential cost could range from $30 trillion to $40 trillion over 10 years. It would be unlawful for private insurers or employers to offer coverage for benefits provided under the government plan.

"If you want stability in the health care system, if you want a system which gives you freedom of choice with regard to doctor or hospital, which is a system which will not bankrupt you, the answer is to get rid of the profiteering of the drug companies and the insurance companies," said Sanders, a Vermont senator.

Building on the ACA

On the other end is the Biden plan, which would boost the Affordable Care Act and create a new public option enabling people to buy subsidized government coverage.

The plan wouldn't cover everyone, but the Biden campaign contends it would reach 97% of the population, up from about 90% currently. The campaign said it would cost $750 billion over 10 years. Biden would leave employer insurance largely untouched.

Other moderate candidates take similar approaches.

For example, Colorado Sen. Michael Bennet's plan is built on a Medicare buy-in initially available in areas with a shortage of insurers or high costs.

New entrant

The Harris plan is the new entrant, a version of Medicare for All preserving a role for private plans closely regulated by the government and allowing employers to sponsor such plans. The campaign said it would cover everybody. The total cost is uncertain, but Harris said she would not raise taxes on households making less than $100,000.

"It's time that we separate employers from the kind of health care people get. And under my plan, we do that," Harris said.

Harris' plan might well reduce employer coverage, while Sanders' plan would replace it. Either would be a momentous change.

Job-based coverage took hold during the World War II years, when the government encouraged employers and unions to settle on health care benefits instead of wage increases feeding inflation. According to the Congressional Budget Office, about 160 million people under age 65 -- or about half the population -- are currently covered by employers.