Healthcare — and its skyrocketing costs — has been a key platform in the 2020 presidential election, and a significant campaign issue in the Democratic primary.

Democratic front-runners Joe Biden and Bernie Sanders both agree that we need to lower costs and improve healthcare in this country.

But the two candidates have each proposed a different plan outlining what they believe is the best way to achieve these goals.

Working with an independent panel of healthcare industry experts, Healthline examined each candidate’s healthcare proposals based on how well they met the following top concerns of American voters:

Does the plan provide free or affordable coverage for all Americans?

Will it improve coverage compared to the current healthcare options?

Will it limit out-of-pocket costs?

Can you opt out of the plan?

Will the plan increase taxes?

Is the plan likely to pass?

We also examined how Biden and Sanders' individual plans could potentially affect the general healthcare landscape for America and, working with our panel of experts, determined a letter grade for each candidate’s current healthcare plan.

Here are our results:

Illustrations by Ruth Basagoitia

Joe Biden: Expand and improve Obamacare

Former Vice President Joe Biden’s healthcare platform is defined through the lens of his former boss, President Barack Obama, with whom Biden worked to pass the Affordable Care Act (ACA) in 2010.

Biden proposes a public health insurance option for Americans without private coverage.

Biden doesn't support Medicare for All, but does intend to initially maintain the Affordable Care Act and eventually expand its coverage.

Biden’s plan proposes to “lower out-of-pocket costs for many people, but there would still be deductibles and copays that some people would no doubt find unaffordable,” said Larry Levitt, the Kaiser Family Foundation’s Executive Vice President for Health Policy. “It would certainly expand coverage but likely not get fully to universal insurance.”

Biden’s plan would not be free for all Americans. Instead, it would extend free coverage to low-income Americans who live in states that haven't expanded Medicaid under Obamacare.

It would also increase the value of tax credits to lower premiums overall.

The former VP is “strong on the rhetoric and detail on expanding coverage and taking the ACA a lot further,” said Rosemarie Day, CEO of Day Health Strategies and author of "Marching Toward Coverage: How Women Can Lead the Fight for Universal Health Care."

Biden’s plan would end surprise billing and attack ballooning prescription drug costs through a number of initiatives.

To raise the money to expand Obamacare, Biden proposes to eliminate capital gains tax loopholes for the super rich, among other ideas.

However, experts like Jay Wolfson, DrPH, JD, argue that Biden hasn’t yet made it clear exactly how he’ll pay for his healthcare plan and that raising taxes for the middle class will likely be necessary to make it work.

The bottom line

Joe Biden wants to continue the legacy of Barack Obama’s administration, ensuring that healthcare is a basic human right. Biden would keep Obamacare, but build upon it for broader and better coverage for all Americans.

How much this would cost, and where the money comes from, isn’t entirely clear yet.

Illustrations by Ruth Basagoitia

Bernie Sanders: Medicare for All — or nothing

Senator Bernie Sanders quickly became the poster child for universal healthcare after making it a tentpole of his 2016 run for president.

Thanks to Sanders, “Medicare-for-all has become one of the major litmus tests in the 2020 primary,” notes the Washington Post, forcing every other Democratic candidate to address Medicare for All whether they wanted to or not.

Sanders’ healthcare goals are direct: to “Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive healthcare coverage, free at the point of service.”

He pledges to reform outsize healthcare costs and healthcare corruption in America, offering coverage to all, with “no networks, no premiums, no deductibles, no copays, no surprise bills.”

Wolfson said Sanders is "the only one being honest that he wants to restructure the system.”

The Senator wishes to vastly improve Medicare as we now know it, offering dental, hearing, vision, long-term care, in-patient and out-patient services, mental health and substance use treatment, reproductive and maternity care, prescription drugs, and more.

He also promises to “stop the pharmaceutical industry from ripping off the American people,” capping prescription drug costs at $200 per year for all Americans.

But experts like Wolfson — and millions of Americans — have been clear that while universal healthcare sounds good in a speech, “having the federal government pay for the nation’s medical expenses for everything” is not realistic in a capitalist country.

It’s also not necessarily something all Americans want.

With Sanders’ plan, “there is no opt out — it’s my way or the highway,” said Day.

“It’s important for consumers to feel they are going to be saving money, but it’s also important to most Americans to know that they have a choice. Many, many Americans do not trust government, so as soon as they feel like there’s a government plan and they don’t have a choice, that’s a big negative.”

The bottom line

Sanders is campaigning on nothing short of a full-scale revolution of our healthcare system, and critics say his plan is way too socialist to even approach actual execution.

In terms of how this ambitious plan would be funded, Sanders “does want to hit the upper income people, and reduce prices here, there, and everywhere,” said Day, but she questions how realistic his proposals to fund this plan are according to the details he's provided so far.

Illustrations by Ruth Basagoitia

Different approaches to a shared goal

While the differences between these two candidates’ healthcare proposals may seem extreme, the reality is that they do have a lot in common as well.

They both want to defend the ACA and protect people with preexisting conditions. They also want to make healthcare more affordable and easier to navigate for all Americans.

Nevertheless, experts on both ends of the political spectrum admit that Medicare for All is an unlikely goal for the next 4 years.

Levitt said that even the compromise of a public option would “still be quite controversial and difficult to pass, even if Democrats sweep the election.”

However, he said that doesn’t mean all of this campaigning around reform doesn’t have the potential to create positive change.

“One thing that unites all of the Democratic candidates is strong action to bring down the price of prescription drugs by allowing the government to negotiate with drug companies," Levitt said. "There’s been a lot of oxygen taken up by the debate over Medicare for All and the public option, but maybe the most tangible way a Democratic president would bring down costs is by negotiating drug prices."

Both candidates have also committed to defending a woman’s right to choose and protecting reproductive rights.

On the issues of mental healthcare and substance use treatment, both candidates have also been outspoken.

Additionally, both Biden and Sanders support undocumented immigrants being able to get some kind of healthcare coverage as well.

How Healthline determined these grades

The Healthline News team analyzed the healthcare policy proposals for the top democratic candidates who qualified for the February 19, 2020 Nevada Democratic debate.

We based our analysis on the published policy outlines on each candidate’s official website. From there, we worked with our independent panel of health policy experts and senior editorial team to evaluate each plan.

We determined the evaluation criteria by examining our own audience data, organic search trends, and third-party data.

As the election unfolds, we will revise and update our analysis as, and when, the candidates revise their policies.

Our panelists:

Dr. Jay Wolfson, Senior Associate Dean of Morsani College of Medicine, and Associate Vice President of University of South Florida Health

Rosemarie Day, CEO of Day Health Strategies, author of just released "Marching Toward Coverage: How Women Can Lead the Fight for Universal Health Care" (Beacon, 2020)

Larry Levitt, Executive Vice President for Health Policy, Kaiser Family Foundation

Elizabeth Wallace contributes to Healthline, CNN Underscored, Architectural Digest, Domino, and Us Weekly, and is the author of The Ambition Decisions: What Women Know About Work, Family, and the Path to Building a Life (Viking, 2018).