WASHINGTON — Senator Elizabeth Warren vowed on Friday to pass major health care legislation in her first 100 days as president, unveiling a new, detailed plan to significantly expand public health insurance coverage as a first step, and promising to pass a “Medicare for all” system that would cover all Americans by the end of her third year in office.
The initial bill she would seek to pass if elected would be a step short of the broader Medicare for all plan she has championed. But it would substantially expand the reach and generosity of public health insurance, creating a government plan that would offer free coverage to all American children and people earning less than double the federal poverty rate, or about $50,000 for a family of four, and could be purchased by other Americans who want it.
Ms. Warren, of Massachusetts, set a timeline of passing a full Medicare for all plan no later than the third year of her presidency, creating a single government-run health insurance program that would provide generous benefits at virtually no cost to households. But her transition proposal would move people into that system gradually — in a way she hopes would build public support for a full-fledged single-payer program — while temporarily preserving the employer-based insurance system that covers most working-age adults today.
Though the details differ, the transition plan shares many features with health proposals from her more moderate rivals for the nomination, including Joseph R. Biden Jr., the former vice president, and Pete Buttigieg, the mayor of South Bend, Ind. For example, it would allow higher-income adults to voluntarily sign up for a new public plan. Ms. Warren’s plan, however, would make the optional government plan more generous, and would allow more Americans to access it for free.
Her plan attempts to offer something attractive to both sides of the Democratic health care debate, by preserving her commitment to the single-payer vision that energizes voters on the left, while offering a less disruptive set of policies in the short term to those who may be reluctant to give up their existing coverage.
It also reflects a sense of pragmatism about the politics and logistics of passing a major health bill through a closely divided Congress. Ms. Warren says she would pass the transition plan using special procedures that would require only a simple majority in the Senate, rather than the 60 votes needed to overcome a filibuster.
But Ms. Warren’s plan would still rely on Democrats winning control of the Senate, where Republicans currently hold a narrow majority. And she is laying out ambitious details for getting to a single-payer system even as voter support for the idea is narrowing; polls suggest substantially more Americans prefer the “public option” type of plans that Mr. Biden and Mr. Buttigieg have embraced.
Passing such a bill could crowd out other legislative priorities. President Trump’s efforts to repeal and replace parts of the Affordable Care Act in 2017 stretched well beyond his first 100 days and ultimately failed. In that undertaking, congressional Republicans used the same approach that Ms. Warren is planning to employ — using special procedures to bypass a filibuster — and yet they could not muster a simple majority in the Senate.
Still, Ms. Warren’s choice to put off seeking passage of a full-scale Medicare for all plan until as late as her third year in office could prompt criticism from left-leaning voters eager to see a Democratic president move more quickly to enshrine a single-payer system in law. And given the unpredictable nature of politics, a pledge to pass legislation as late as 2023 — in what would be Ms. Warren’s third year in office — represents a somewhat distant goal.
Ms. Warren offered her transition plan two weeks after she released a detailed proposal to finance a Medicare for all system, at a cost of $20.5 trillion in additional federal spending over a decade. Ms. Warren put forward that plan to rebut incessant questions about whether she would raise taxes on the middle class in order to fund a sweeping new government health insurance program.
To fund a full-scale Medicare for all program, Ms. Warren would rely on big tax increases on businesses and wealthy Americans, and she said that she would not increase taxes on middle-class families by “one penny.” Her plan was met with harsh criticism from Mr. Biden, whose campaign said it was “unrealistic” and required “mathematical gymnastics.”
Her transition plan did not come with its own detailed financing proposal, but it would cost the federal government less than an eventual Medicare for all system, over all, and would be funded using some mix of the revenue sources she has already identified, according to her plan.
When she released her financing proposal, Ms. Warren said she would release details at a later date regarding the transition to Medicare for all. With her announcement on Friday, less than a week before the next Democratic debate, she is not only fleshing out her vision for the future of America’s health care system under a Warren administration, but strongly suggesting it will be among her top priorities.
Ms. Warren’s plan also spells out a long list of administrative actions she would take to change the health care system, even if Democrats do not retake the Senate. She would roll back many Trump administration regulations that have weakened the Affordable Care Act and shore up benefits in the existing Medicare program. She would also use executive authority to allow new generic versions of expensive drugs, such as insulins taken by patients with diabetes, treatments for hepatitis C, and the overdose reversal drug Naloxone, an effort to lower their prices.
Ms. Warren’s approach to health care, a top issue in the Democratic primary race, is loaded with political risk. For much of the fall, her refusal to say whether she would raise taxes on the middle class provided an opening for some of her opponents to paint her as cagey on a key issue.
More recently, her financing plan touched off a fraught back-and-forth between Ms. Warren and Mr. Biden. After his campaign denounced her plan, Ms. Warren suggested Mr. Biden was running in the wrong party’s primary. Mr. Biden responded by suggesting Ms. Warren had displayed an “elitist attitude” and an “angry” viewpoint. Both he and Mr. Buttigieg have tried to capitalize on her financing plan by saying their public option proposals are far more realistic; they have also emphasized that her Medicare for all plan would take away people’s ability to choose private coverage.
In the longer term, Ms. Warren’s embrace of Medicare for all, along with its elimination of private health insurance, would provide ammunition to Mr. Trump and his Republican allies if she became the Democratic nominee. Mr. Trump is already fond of equating Democratic approaches to health care with socialism.
Ms. Warren is a co-sponsor of Senator Bernie Sanders’s Medicare for all legislation, which includes a four-year transition. Though Mr. Sanders typically emphasizes the endpoint of his plan, a form of generous government insurance that would cover all Americans, his bill includes a detailed plan for moving from the current health care system to that final goal.
But Mr. Sanders’s transition relies on passing his entire plan. Ms Warren, by contrast, has suggested splitting the process in two: starting with the transition plan, and only later passing a full Medicare for all bill. And Mr. Sanders, unlike Ms. Warren, has declined to spell out a detailed financing plan for his proposal.
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