Former Vice President Joe Biden gave more insight into his healthcare plan, which relies on keeping the Affordable Care Act in place, but would allow Americans to opt into a public option — a choice that was dropped from the original 2010 law.
The Democratic front-runner in the race for the White House also takes aim at drug prices in his plan, promoting the idea of allowing Medicare to negotiate directly with biopharmaceutical manufacturers on what the program pays — a proposal embraced by many in his party.
In addition, Biden wants to provide tax credits to more Americans to subsidize their insurance premium costs, helping to make healthcare coverage more affordable.
Former Vice President Joe Biden
The former vice president has estimated his plan would cost the U.S. $750 billion over 10 years.
Biden has rejected the idea of a single-payer Medicare for All system backed by some Democratic presidential contenders — an idea long championed by Sen. Bernie Sanders, I-Vt.
Other Democrats, however, have proposed public option ideas similar to Biden's, including presidential candidate Sen. Amy Klobuchar of Minnesota, who noted at a July 15 AARP forum in Iowa that the former vice president's plan sounded a lot like her own.
After announcing his presidential run earlier this year, Biden initially was vague about what types of proposals he would pursue if he takes the White House in 2020.
He later embraced the idea of adding a public option to the ACA.
Biden's public option plan also resembles an earlier idea proposed by Sen. Elizabeth Warren, D-Mass., another Democratic presidential candidate, though she later fully embraced Sanders' single-payer approach to reaching universal coverage in the U.S.
Biden's plan calls for letting the public option compete with private insurance and would be open to all Americans, whether they have coverage through an employer or not.
A public option buy-in
Under Biden's plan, Americans could buy-in to the federal government's Medicare program for seniors and disabled people.
Low-income Americans who live in states that did not expand Medicaid under the ACA could join the public option without having to pay any premiums.
The states that have expanded Medicaid would have the choice of moving their beneficiaries to the premium-free public option as long as the states continued to pay their current share of the costs for covering those individuals.
But Biden's proposal would essentially reward states that did not expand Medicaid because in those cases, the federal government would pick up the full tab.
A spokesperson for the campaign told S&P Global Market Intelligence the former vice president's healthcare plan would allow undocumented immigrants to buy into the public option, though they could not qualify for the tax credit subsidies.
But at the July 15 AARP forum, Biden said "That doesn't mean they have health insurance. That means they get covered for the crisis they're facing at the moment."
His campaign did not respond to questions about whether Biden meant those individuals would only qualify for high-deductible catastrophic or short-term coverage, like the plans Democrats have criticized the Trump administration for allowing insurers to sell.
At the AARP event, Biden also repeated the much-criticized pledge from former President Barack Obama that if Americans liked their employer-based health insurance plans, they could keep them — a line that is likely to be criticized by the former vice president's opponents.
For people who purchase health insurance on the ACA exchanges, Biden would eliminate the income cap on the tax credit eligibility and lower the limit on the cost of spending for coverage from 9.86% of a family's income to 8.5%.
A family of four earning about $110,000 per year would save $750 per month on their premiums, the Biden campaign said.
Kaiser Family Foundation Vice President Larry Levitt said Biden's plan would be the "least disruptive way to expand coverage and improve affordability," but he said many questions remained about the package of ideas.
Lowering drug costs
In addition to letting Medicare negotiate with drugmakers on prices, Biden also wants to permit Americans to import drugs from other countries — a plan that is currently being mulled over by the Trump administration.
The former vice president also wants to end the tax breaks that biopharmaceutical companies receive on the money they spend on product advertisements.
In addition, Biden wants to create a an independent review board established by the U.S. Department of Health and Human Services that would assess the value of innovative specialty medicines that lack competition and recommend a fair and reasonable price based on the average of what foreign nations pay for the products.
President Donald Trump, whom Biden is hoping to challenge in 2020, has pursued his own idea of testing an international drug pricing index model for expensive injectable medicines — a proposal under review by the White House Office of Management and Budget.
Biden also said that any drugmaker that wants its products to be covered by Medicare and his public option — if he can get it through Congress — must not raise the prices of their medicines more than the general rate of inflation.
He also wants to impose a tax penalty on any companies that raise the prices of their brand-name or generic drugs beyond the rate of inflation.
Nonprofit pausing operations
Biden's nonprofit cancer initiative also revealed it was suspending operations during the former vice president's 2020 run for the White House, citing "unique circumstances."
"We remain personally committed to the cause, but at this time will have to pause efforts," Greg Simon, president of the Biden Cancer Initiative, said in a statement. "We thank the community for their incredible response to our mission to improve the cancer journey for patients and to improve outcomes for all patients for generations to come."
The initiative was borne out of the Obama's Cancer Moonshot program, which he called on Biden to lead.
Cancer research and development had become a key focus for Biden after his son Beau died in May 2015 of glioblastoma — the deadliest form of brain cancer.
The U.S. National Institutes of Health, under the Trump administration, has continued Obama's Cancer Moonshot program, with strong backing from Congress.