Healthcare makes up one of the largest slices of the federal budget and is a key driver of an unsustainable rising national debt. How to address and reform the healthcare industry is a hot topic among Democratic presidential candidates. New analysis from the Committee For a Responsible Federal Budget finds Mayor Pete Buttigieg's healthcare plan would actually save money.
Sens' Bernie Sanders and Elizabeth Warren, also among the frontrunners in the race, have plans that would cost trillions, CRFB found.
For each plan, CRFB scored the fiscal impact of coverage and other spending provisions, reductions in current and proposed healthcare costs, direct offsets proposed as part of their plans to expand coverage, and further offsets meant to finance remaining costs.It focused on federal fiscal impact rather than the effect on total national health expenditures.
In addition to those three candidates, the analysis also examined the healthcare plan promoted by former Vice President Joe Biden.
WHAT'S THE IMPACT
The four front-runners in Iowa, less than a week before the Iowa Caucus on February 3, are Sanders, Buttigieg, Biden and Warren, in that order.
Biden's health plan has a gross cost of $2.25 trillion and, incorporating offsets, would add $800 billion to deficits over ten years under CRFB's central estimate, the analysis found. It would save $300 billion in the low-cost estimate and add $1.3 trillion to deficits in the high-cost estimate.
Biden proposes to expand the Affordable Care Act by increasing marketplace subsidies, adopting auto-enrollment, and offering a new public option available to those in the individual market or with employer coverage.
Buttigieg's health plan has a gross cost of $2.85 trillion and, incorporating offsets, would save $450 billion over 10 years under the central estimate. It would save $1.4 trillion in the low-cost estimate and add $350 billion to deficits in the high-cost estimate.
Buttigieg proposes to expand the ACA by increasing marketplace subsidies, expanding auto-enrollment, establishing a retroactive enrollment process to essentially mandate coverage, and offering a new "Medicare for All Who Want It" public option available to those in the individual market or with employer coverage. Buttigieg would also establish a federal long-term care program, cap out-of-pocket costs in Medicare and for prescription drugs, and increase funding for rural health and mental health services.
Sanders' health plan has a gross cost of $30.6 trillion and, incorporating offsets, would add $13.4 trillion to deficits over ten years under the central estimate. It would add $8.8 trillion to deficits in the low-cost estimate and add $19.5 trillion to deficits in the high-cost estimate.
Sanders proposes to replace most current public and private health insurance with a universal, publicly-funded Medicare for All program that would provide health and long-term care benefits to all U.S. residents with virtually no out-of-pocket costs or provider networks. He would also eliminate medical debt and enact other targeted spending increases.
Warren's health plan has a gross cost of $31.75 trillion and, incorporating offsets, would add $6.1 trillion to deficits over 10 years under the central estimate. It would save $1.2 trillion in the low-cost estimate and add $11.2 trillion to deficits in the high-cost estimate.
Her plan is very similar to Sanders', and she would also plan to negotiate prescription drug prices substantially below current levels.
WHAT ELSE YOU SHOULD KNOW
Biden's plan would cover an additional 15 to 20 million people, compared to 20 to 30 million for Buttigieg and 30 to 35 million for Sanders and Warren. National health expenditures would fall modestly under the Biden and Buttigieg plans and rise modestly under the Sanders and Warren plans. Average premiums and out-of-pocket costs would fall under the Biden and Buttigieg plans and would be nearly eliminated under the Sanders and Warren plans.
THE LARGER TREND
Voter support for a Medicare For All plan is largely dependent on its rollout. In the HealthPrep Data Service report, a Medicare for All option -- such as the one proposed by Buttigieg -- enjoys a 2:1 preference against mandatory programs proposed by Warren and Sanders. Voting age Americans would prefer no change at all to the current private health system over mandatory Medicare for All.
Optional Medicare for All was the most popular policy among respondents to the poll, at 45.4%. Keeping the current private system intact came in second at 33.3%, while a mandatory Medicare for All system garnered the least support at 21.2%.
This suggests that, while there's public support for a shift to some form of universal healthcare, voting age Americans are wary of a complete break from the current system.