Joe Biden is taking an aggressive approach to defending the Affordable Care Act, challenging not just U.S. President Donald Trump but also some of his rivals for the Democratic presidential nomination who want to replace the current insurance system with a fully government-run model.
The former vice president will spend much of the coming week talking about his approach to health care, including his unveiling Monday of a plan that would add a āpublic optionā to the 2010 health care overhaul, with expanded coverage paid for by raising taxes on the wealthiest Americans. Bidenās almost singular focus on former President Barack Obamaās health care law, often called āObamacare,ā has been on display recently in early voting states.
In Iowa, Biden declared himself āagainst any Republican (and) any Democrat who wants to scrapā the Affordable Care Act. Later in New Hampshire, he said āwe should not be scrapping Obamacare, we should be building on it.ā
Biden hopes his positioning as Obamacareās chief defender helps him on several fronts. Itās a reminder of his close work alongside Obama, who remains popular among Democratic voters. And it could reinforce Bidenās pitch as a sensible centrist promising to rise above the strident cacophony of Trump and Democrats like Sens. Bernie Sanders, Elizabeth Warren and Kamala Harris, all single-payer advocates.
Bidenās proposal, outlined by advisers ahead of its release, is anchored by a āMedicare-likeā plan that any American, including the 150 million-plus Americans now covered by job-based insurance, could buy on ACA exchanges.
The proposal would make existing subsidies more generous and make more middle-income households eligible for them, lowering their out-of-pocket costs. It also would extend premium-free coverage to lower-income Americans who have been denied eligibility to Medicaid in Republican-run states that refused to participate in the Affordable Care Act.
The campaign puts the taxpayer cost at $750 billion over 10 years, with the campaign saying that would be covered by returning the top marginal income tax to 39.6 percent, the rate before the 2017 GOP tax cuts . Some multimillionaires also would lose certain capital gains tax advantages.
Bidenās aides framed his plan as more fiscally responsible and politically realistic than a single-payer overhaul. The idea behind a public option is to extend coverage to those who canāt afford decent private coverage, while forcing corporate insurers to compete alongside the government, theoretically pressuring those private firms to lower their premiums and out-of-pocket costs for their policy holders.
Perhaps as important to Bidenās campaign prospects, the Obamacare emphasis is an opportunity for Biden to go on offense ahead of the next presidential debates at the end of July. Biden has spent the past several weeks on defense, reversing his position on taxpayer funding for abortions and highlighting his past work with segregationist senators . Harris slammed Biden during the first debates , blasting the segregationist comment and criticizing his opposition to federal busing orders to desegregate public schools during the same era.
Those episodes called Bidenās front-runner status into question, and in New Hampshire over the weekend it was clear Biden wanted to turn the tables on his rivals backing āMedicare for All.ā
āI think one of the most significant things weāve done in our administration is pass the Affordable Care Act,ā Biden said. āI donāt know why weād get rid of what in fact was working and move to something totally new. And so, there are differences.ā
He argued that some of his opponents, with the exception of Sanders, arenāt fairly representing the consequences of their proposals.
āBernieās been very honest about it,ā Biden said. āHe said youāre going to have to raise taxes on the middle class. He said itās going to end all private insurance. I mean, heās been straightforward about it. And heās making his case.ā
Asked specifically whether Harris has been honest about how her plan would affect private insurance, Biden said, āIāll let you guys make that judgment.ā
During last monthās debates, Harris, Warren and Sanders raised their hands when candidates were asked as a group whether they supported eliminating private insurance. Harris, a Senate co-sponsor of Sandersā single-payer bill, reversed her answer a day later ā the second time since her campaign launch that sheād walked back her seeming endorsement of eliminating private insurance.
She explained that she interpreted the moderatorās question as asking whether sheād be willing to give up her existing coverage as part of a single-payer model. She said she wants private policies to remain āsupplementalā options for consumers.
Sanders, meanwhile, hit back at Biden, clarifying that his plan would be a net financial benefit for most households: Their federal taxes would go up, but their private insurance premiums, deductibles and co-pays would be eliminated.
āAt a time when Donald Trump and the health insurance industry are lying every day about āMedicare for All,ā I would hope that my fellow Democrats would not resort to misinformation about my legislation,ā Sanders said in a statement responding to Bidenās comments.
Biden isnāt the only public-option advocate running for president.
Former Colorado Gov. John Hickenlooper warns that Republicans will brand single-payer as āsocialism.ā Colorado Sen. Michael Bennet echoes Bidenās argument with a call to āfinish the work we started with Obamacareā and warned Sunday in Iowa that Sandersā nomination would doom the party in 2020.
Minnesota Sen. Amy Klobuchar touts a public option as the next logical move even for single-payer advocates.
āI think it is a beginning and the way you start and the way you move to universal health care,ā she said in the first debate.
If anything, the dynamics illustrate Democratsā overall leftward shift on health care.
A decade ago, as Obama pushed for the ACA, the public option was effectively the left-flank for Democrats, a reality made obvious when Obama angered House liberals by jettisoning the provision to mollify some moderate Senate Democrats needed to pass the legislation. Now, after Sandersā insurgent 2016 presidential bid and his promise of āhealth care as a human right,ā the left has embraced single-payer, with moderates moving to the public option.
Yet with the exception of Biden, the moderates are languishing far back in polls, leaving the former vice president to capitalize on the dividing lines and promising that he will do what Obama couldnāt.
āAnd,ā he declared, āit can be done quickly.ā
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Associated Press writers Alexandra Jaffe in Cedar Rapids, Iowa, and Hunter Woodall and Julie Pace in Portsmouth, New Hampshire, contributed.
