Former Vice President Joseph R. Biden on Monday put his stamp on the 2020 health care debate, rolling out a proposal that seeks to expand Obamacare and reduce the costs of buying coverage by boosting federal subsidizes and providing a new public health insurance option.

Mr. Biden’s proposal ties him to President Obama’s signature achievement and distances him from Sen. Bernard Sanders of Vermont and others in the 2020 Democratic presidential race who want to replace the current health care system with a “Medicare for All” program and, in some cases, end private health insurance.

Mr. Biden raised concerns that Medicare for All can be too costly and that forcing 300 million people into the program would be risky.

“What I would do immediately is restore all the cuts that have been made [to Obamacare], and then provide a public option,” Mr. Biden said at a forum in Iowa sponsored by AARP and the Des Moines Register. “I’d give people the option. If you like your health care plan enough and your employer-based plan, you can keep it. If in fact you have private insurance, you can keep it.

“I think it is the quickest, most reasonable and rational and best way to get to universal coverage,” he said.

Mr. Biden, who has led the 2020 Democratic primary polls, said the government-run “public option” would compete with private insurers, which would help drive down costs and allow Americans to purchase private insurance.

Nineteen of the Democratic presidential candidates are slated to appear in Iowa this week for five days of forums hosted by AARP and the Register. They will have a chance to outline their plans to bolster health care, multi-employer pensions and Social Security.

Sens. Cory A. Booker of New Jersey and Amy Klobuchar of Minnesota, and former Gov. John Hickenlooper of Colorado also appeared at the forum Monday.

They vowed to defend Obamacare and fight for a public option.

“This is something President Obama wanted to do from the very beginning,” Ms. Klobuchar said of the public option. “It simply allows for an option that doesn’t involve insurance companies, but still does not dismantle our entire hospital system and our entire way of covering people because it would concern me to kick half of America off their insurance in four years, which is what the [Medicare for All] plan specifically says.”

Mr. Booker said he backs Medicare for All but showing the public that the government can create a strong public option could be a necessary first step in that direction.

“There’s no way, even if we have 60 Democrats right away, I don’t think it’s likely we’re going to have some mass transformation of our system,” Mr. Booker said. “Every American, I don’t care what your party is, has a right to be skeptical of big, broad changes.”

Mr. Sanders and Sen. Elizabeth Warren of Massachusetts have been among the leading advocates for a Medicare for All system and are expected to promote their visions at the AARP forum this week.

Sen. Kamala D. Harris of California also has vouched for a government-run health care system.

Before the Iowa appearance, Mr. Biden released an online video saying, “I understand the appeal of Medicare for All, but folks supporting it should be clear that it means getting rid of Obamacare, and I am not for that.”

Mr. Biden said 20 million Americans have gained coverage under Obamacare and 100 million with preexisting conditions also have benefited.

“Starting over makes no sense to me at all,” he said. “I knew the Republicans would do everything in their power to repeal Obamacare. They still are. But I’m surprised so many Democrats are running on getting rid of it.”

Mr. Sanders said he fought to pass, strengthen and defend Obamacare.

“At the end of the day, you’ve either got to be on the side of the people or the side of the health insurance companies,” he said. “I know what side I’m on; others will have to make their own choice. We must pass Medicare for All.”

Mr. Sanders circulated a video of Mr. Obama telling voters before the 2018 midterm elections that “Democrats aren’t just running on good old ideas like a higher minimum wage; they are running on good new ideas like Medicare for All.’”

Polls have shown that voters support the idea of a single-payer Medicare for All system, but that support falls off significantly when they learn about the likely trade-offs, including losing their private health insurance coverage, facing longer wait times and paying higher taxes.

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