Some Democrats threatened to block the Affordable Care Act over a Medicare opt-in in 2009. A decade later, the same public option looks like a small step for a Democratic Party that has embraced sweeping change on health care as it looks to recapture the White House.
A party buoyed by resistance to recent GOP efforts to repeal the law known as Obamacare will now have to decide how far to move toward insuring all Americans as they try to defeat President Donald Trump next year.
Democratic presidential candidates agree they want universal health coverage. They only differ on how to get there — and on which plan can earn enough support nationwide.
Sen. Bernie Sanders of Vermont has called for a transition to a universal "Medicare-for-all" system. Hopefuls including Sens. Elizabeth Warren, D-Mass., and Kamala Harris, D-Calif., endorsed a bill he introduced in the Senate to move to government-run universal health coverage.
Other Democrats think such a proposal would move too far, too quickly. Amy Klobuchar — a Minnesota Democrat seen as one of the more centrist 2020 primary candidates — has floated a public option to allow consumers to choose whether to buy into a government-run plan. Sen. Sherrod Brown, an Ohio Democrat who opted not to make a presidential bid after considering one, wants instead to lower the Medicare eligibility age to 55 from 65. Sen.
The fact that Democrats broadly view a public option as a more incremental step shows just how much the health- care debate has moved in recent years. After all, Democrats spent most of a decade taking a political beating over the Affordable Care Act, then flipped control of the House last year after Republicans got their first real chance to repeal it.
Former Montana Sen. Max Baucus illustrates the party's shift. As Senate Finance Committee chairman, he helped to torpedo the public option in 2009, earning the ire of liberals. His tune changed by 2017. Baucus told NBC News that "the time has come" to consider single-payer government health care.
The differences on health care in the Democratic primaries essentially come down to how dramatically to build out the public Medicare and Medicaid programs: Cover all Americans in one bold stroke, justifying significant tax increases in the name of lower costs, or expand coverage more slowly, through a plan that Americans seem more ready to digest?
"All of these candidates support a wide range of proposals that would move toward universal coverage and create at least an option for public coverage," said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. "The Democratic candidates differ more in how quickly they want to move and what's immediately possible politically than what the end goal is."
Yet, despite the primary candidates' differences, Levitt believes not as wide of a gulf exists between them as many would perceive.