Former Vice President Joe Biden released his health care plan on Monday, formally entering the Democratic debate about how to solve the country’s health care crisis, in which 26% of Americans struggle to afford services even with insurance and out-of-pocket medical costs outpace wage growth.

The Biden plan expands upon the Affordable Care Act (ACA) by adding a government-run public option to compete alongside private insurers and by making existing subsidies for private plans more generous. The plan nears universal coverage, but falls short by the campaign’s own admission: It would cover an estimated 97% of Americans.

While unveiling his policy, which shores up the ACA, Biden took shots at Democrats who endorse Medicare for All — likening them to Republicans who tried to repeal the 2010 law without a replacement. Medicare for All, endorsed by some other presidential contenders, including Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA), would disrupt the current health system by having everyone move into a single public plan with zero premiums and minimal out-of-pocket costs.

“I understand the appeal for Medicare for All, but folks supporting it should be clear: that it means getting rid of Obamacare and I’m not for that,” Biden said in a campaign video accompanying the release of his health plan.


“I knew Republicans would do everything in their power to repeal Obamacare — they still are. But I’m surprised that so many Democrats are running on getting rid of it,” he added.

Biden is offering a less disruptive way to expand coverage but keeps a complicated and costly health care system whereas Medicare for All, as proposed by Sanders, upends the system because it views it as untenable. There are subtle differences among the plans. For example, the Biden plan lets undocumented immigrants purchase private plans on the ACA exchanges, but they wouldn’t be eligible for subsidies. Medicare for All, alternatively, has its public plan cover every U.S. resident regardless of immigration status.

Sanders took issue with Biden’s characterization likening Democrats who favor Medicare for All with Republicans who sought to kill the Affordable Care Act.

“I fought to improve and pass Obamacare. I traveled all over the country to fight the repeal of Obamacare,” Sanders said on Twitter. “But I will not be deterred from ending the corporate greed that creates dysfunction in our health care system. We must pass Medicare for All.”

Medicare for All supporters also rejected Biden’s characterization. This is the second time within a week advocates have called out the former vice president, accusing him of arguing against Medicare for All in bad faith.


“Vice President Biden is using a cheap rhetorical trick to try and paint Medicare for All advocates as a threat to the healthcare gains made under President Obama,” said Dylan Dusseault, the executive director of the Business Initiative for Health Policy, an organization that represents business owners in favor of single payer.

Republican lawmakers have tried to repeal the ACA since its inception, oftentimes voting to eliminate it without offering their own plan. Even today, some are rooting for the federal courts to invalidate the entire law, even if there’s no back-up plan for the 21.2 million who could lose insurance.

“Do I hope the lawsuit succeeds? I do,” Sen. Kevin Cramer (R-ND) told Politico over the weekend. “What I wish is we had some idea where we are going if it does succeed, as it looks more and more like it might.”

It’s true that while Medicare for All eliminates the ACA’s exchanges and Medicaid expansion, it also replaces these plans with an improved Medicare plan that covers everything they cover and more.

Biden’s plan is the most detailed alternative to Medicare for All so far among Democrats running for president — and it is moderate by comparison. Both have trade-offs, though not all the trade-offs are clear yet because the plans still omit critical details.

The thinking behind Biden’s incrementalist approach to health reform is that this is likelier to be enacted sooner. But complicating this strategy is the fact that the health industry is against any plan that further expands the role of the federal government.


The Partnership for America’s Health Care Future already pushed back against the Biden plan. The Partnership’s members include the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America.

“Vice President Biden’s proposal for a new government insurance system through a ‘public option’ would undermine the progress our nation has made and ultimately lead our nation down the path of a one-size-fits-all health care system run by Washington,” said Lauren Crawford Shaver, executive director of the Partnership for America’s Health Care Future. The Partnership’s members include the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America.

This story was updated for clarity.