BidenCare Facts

Get the Facts on BidenCare.

BidenCare is Joe Biden’s plan to ‘protect and build’ ObamaCare. It includes expanded cost assistance, a Medicare-like public option, and other healthcare reform measures.

You can see Biden’s ‘Protect and Build” ObamaCare (AKA Bidencare) plan on his website. Or, keep reading to get the facts on BidenCare and a summary of BidenCare’s provisions.

What is BidenCare? BidenCare is Joe Biden’s version of the Affordable Care Act (ObamaCare). It is his plan to lower premiums, deductibles, and drug prices and to offer everyone a choice, keep private insurance or join a Medicare-like public option. The plan aims to expand coverage by expanding assistance and insurance options, and as you’ll see below, it also includes other insurance reforms.

FACT: Biden said he will pass ObamaCare with a public option and call it BidenCare at the Oct 22nd Presidential debate. This is where the term “BidenCare” came from. It is a reference to “ObamaCare.”

A Quick Summary of BidenCare

Below is a quick summary of BidenCare, you can see a more complete list of ideas on Joe Biden’s website or our more detailed breakdown of BidenCare below.^[1][2]

1. Keep and expand marketplace cost assistance (for example premiums capped at 8.5% of family income instead of 9.5%).
2. Keep Medicaid expansion and work to see it expanded in more states.
3. Keep pre-existing conditions protections.
4. Keep other popular provisions in the ACA.
5. Add a “Medicare-like” public option (for those who currently have employer plans, who are buying coverage, or who are currently uninsured).
6. Let Medicare negotiate drug prices.

FACT: According to the Kaiser Family Foundation, the number of uninsured nonelderly Americans decreased from over 46.5 million in 2010 to just below 27 million in 2016 under ObamaCare. However, since 2016 the number of uninsured has decreased, especially with Americans who don’t qualify for cost assistance. Biden’s plan expands cost assistance to cover more people who didn’t previously qualify for cost assistance.

What Does BidenCare Cost? BidenCare is estimated to have a price tag of $750 billion over the next decade, but would be in part paid for by rolling back some of the Trump era tax cuts on the highest tax bracket and by getting rid of the 20% long-term capital gains tax.

BidenCare Explained (Joe Biden’s “Protect and Build” ObamaCare Plan Explained)

Below is our summarized version of BidenCare. The aim is to provide a short and simple version of the plan as found on Biden’s website that includes some key points, historical context, and commentary.

I. Expanding Coverage – Expanding Assistance and a Medicare-like Public Option:

• BidenCare creates a public health insurance option like Medicare (a Medicare-like public option). This option is for currently non-Medicare eligible individuals, families, and employees who don’t like their current coverage or don’t have coverage. This is Biden’s answer to Medicare-for-all. However, BidenCare doesn’t expand Medicare to everyone like Bernie’s Medicare-for-all plan would have. Instead, Biden’s plan includes a public option for both individuals and small employers that is styled after Medicare (for example, the Medicare-like public option will be able to negotiate and coordinate with healthcare providers to reduce costs). A public option was initially going to be included in the ACA but it didn’t make it into the final law, and in that sense, this provision “builds” on ObamaCare as originally intended.

FACT: The Biden website estimates BidenCare will insure more than an estimated 97% of Americans. According to Gallup data, the uninsured rate of the 18-64 demographic under the Affordable Care Act (ObamaCare) dropped to record lows of 10.9% in 2016 but rose to 13.7% in 2019.

• BidenCare expands tax credits to expand affordable coverage. The Biden plan not only increases the value of tax credits (tax credits will be capped at 8.5% of income, and based on a Gold and not Silver plan), it also expands tax credits to those making above 400% of the poverty level. Previously the cut-off meant that families who went over 400% of the level got no assistance or owed back tax credits, this caused real issues for middle-class families that can be seen in the reduction of insured since 2016 in this demographic. This plan solves some very real affordability issues for the middle-class especially. As a bonus,

FACT: Basing the credits on Gold plans means more families will end up with higher-tier plans and will thus have plans with lower deductibles and out-of-pocket costs.

• BidenCare expands coverage to low-income Americans. Biden’s plan covers low-income Americans without access to Medicaid by offering premium-free access to the Medicare-like public option. Further, those currently covered under Medicaid expansion can also be moved to the public option if the state decides to do this. Finally, people will be automatically reenrolled if eligible when they go to access certain services like public schools and SNAP.

FACT: Today governors and state legislatures in 12 states still haven’t expanded or voted to expand Medicaid and over 4.8 million adults that should have been covered under ObamaCare aren’t.

II. Addressing complexity – Stopping Suprise Billing, Breaking up Big HealthCare, and Supporting the Healthcare Workforce.

• BidenCare stops “surprise billing.”  The plan stops “surprise medical billing” (billing that occurs when a person accidentally accesses out-of-network care). It does this by barring health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization). Due to how networks work with insurance, where out-of-network costs are higher and don’t count toward in-network cost-sharing, surprise billing can mean a lot of accidental extra spending, especially in emergency situations. They found that most surprise medical bills were related to emergency care.

FACT: A 2012 Health Services Research survey found that 8% of privately insured individuals had used out-of-network care in 2011 and 40% of those claims involved surprise out-of-network claims.

FACT: According to the NewYorkTimes, “The average surprise charge for an emergency room visit is just above $600, but patients have received bills larger than $100,000 from out-of-network providers they did not select.”

UPDATE 2020: The first step toward Bidencare was taken when a measure to stop surprise billing by 2022 was included in the stimulus bill passed in December 2020.

• BidenCare breaks up “big healthcare.” The Biden Administration will use its existing antitrust authority to address the concentration of power in healthcare that is driving up prices for consumers.

FACT: For an example of the monopolies created in healthcare, consider one single company has 64% of the market share for Syringes & Injection Needle Manufacturing, a $3.8 billion industry.

• BidenCare lowers costs and improves health outcomes by partnering with the health care workforce. The Biden Administration will partner with health care workers and accelerate the testing and deployment of innovative solutions that improve quality of care and increase wages for low-wage health care workers, like home care workers. One example of this is called “upskilling.” Upskilling training trains home care workers to deliver better care at home.

FACT: According to one study at the The University of New Mexico [PDF download], “Upskilling of 6,000 home care workers in California’s In-Home Supportive Services program contributed to a 41% decline in the rate of repeat emergency department (ED) visits and a 43% decline in the rate of rehospitalization, yielding savings up to $12,000 per patient.”

III. Drug Reform – Allowing Medicare to Negotiate Drug Prices and Other Measures to Keep Drug Prices Down

• BidenCare Allows Medicare to Negotiate Drug Prices. Like with Bernie’s plan, and like Trump said he would do, Biden’s plan allows Medicare to negotiate with drug companies. This would help lower the cost of Medicare and the cost of the public options noted above.

• BidenCare limits launch prices for drugs. In some cases, drug manufacturers are unfairly pricing drugs. The plan creates a board to recommend a reasonable price for a new drug, based on the average price in other countries (a process called external reference pricing) or, if the drug is entering the U.S. market first, based on an evaluation by the independent board members. This reasonable price will be the rate Medicare and the public option will pay. In addition, the Biden Plan will allow private plans participating in the individual marketplace to access a similar rate.

• BidenCare limits price increases for all brand, biotech, and abusively priced generic drugs to inflation. As a condition of participation in the Medicare program and public option, all brand, biotech, and abusively priced generic drugs will be prohibited from increasing their prices more than the general inflation rate. The Biden Plan will also impose a tax penalty on drug manufacturers that increase the costs of their brand, biotech, or abusively priced generic over the general inflation rate.

• BidenCare allows consumers to buy prescription drugs from other countries. The Biden Plan will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe. This creates more competition for US drug companies.

FACT: According to a 2019 study by the Ways and Means House Committee [PDF], “U.S. drug prices were nearly four times higher than average prices compared to similar countries and the U.S. could save $49 billion annually on Medicare Part D alone by using average drug prices for comparator countries.”

• BidenCare gets rid of pharmaceutical corporations’ tax break for advertisement spending. Currently, drug corporations may count spending on ads as a deduction to reduce the amount of taxes they owe. Biden’s plan ends the tax deduction for prescription drug ads.

FACT: Drug corporations spent an estimated $6 billion in 2016 alone on prescription drug advertisements to increase their sales, a more than four-fold increase from just $1.3 billion in 1997.

• BidenCare Improves the supply of quality generics. Generics help reduce health care spending, but brand drug corporations have succeeded in preserving a number of strategies to help them delay the entrance of a generic into the market even after the patent has expired. The Biden Plan supports numerous proposals to accelerate the development of safe generics, such as Senator Patrick Leahy’s proposal to make sure generic manufacturers have access to a sample.

IV. Expanding HealthCare Rights – More Rights and Protections, Especially for Women and People of Color

The plan increases healthcare rights, especially for groups that saw their healthcare rights slip from the Obama-era into the Trump-era. The plan does this by:

• BidenCare expands access to contraception and protect the constitutional right to an abortion. The Affordable Care Act offered free preventive care, including contraception. The public option expands on that by covering contraception and a woman’s constitutional right to choose. In addition, the Biden Plan will:
  • Reverse the Trump Administration and states’ actions on women’s right to choose. This includes Biden working to codify Roe v. Wade, to stop other measures such as so-called TRAP laws, parental notification requirements, mandatory waiting periods, and ultrasound requirements.
  • Restore federal funding for Planned Parenthood. Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information. The plan will also reverse the Trump Administration’s rule preventing Planned Parenthood and certain other family planning programs from obtaining Title X funds.
  • Just as the Obama-Biden Administration did, President Biden will rescind the Mexico City Policy (also referred to as the global gag rule) that President Trump reinstated and expanded. This rule currently bars the U.S. federal government from supporting important global health efforts – including for malaria and HIV/AIDS – in developing countries simply because the organizations providing that aid also offer information on abortion services.

• BidenCare Reduces our unacceptably high maternal mortality rate, which especially impacts people of color. Compared to other developed nations, the U.S. has the highest rate of deaths related to pregnancy and childbirth, and we are the only country experiencing an increase in this death rate. This problem is especially prevalent among black women, who experience a death rate from complications related to pregnancy that is more than three times higher than the rate for non-Hispanic white women. California came up with a strategy that halved the state’s maternal death rate. As president, Biden will take this strategy nationwide.

• BidenCare defends health care protections for all, regardless of gender, gender identity, or sexual orientation. Before the Affordable Care Act, insurance companies could increase premiums merely due to someone’s gender, sexual orientation, or gender identity. Further, insurance companies could increase premiums or deny coverage altogether due to someone’s HIV status. Yet, President Trump is trying to walk back this progress. For example, he has proposed to once again allow health care providers and insurance companies to discriminate based on a patient’s gender identity or abortion history. President Biden will defend the rights of all people – regardless of gender, sexual orientation, gender identity – to have access to quality, affordable health care free from discrimination.

• BidenCare Doubles America’s investment in community health centers. Community health centers provide primary, prenatal, and other important care to underserved populations. The Biden Plan will double the federal investment in these centers, expanding access to high-quality health care for the populations that need it most.

• BidenCare works to achieve mental health parity and expanding access to mental health care. As Vice President, Biden was a champion for efforts to implement the federal mental health parity law, improve access to mental health care, and eliminate the stigma around mental health. As President, he will redouble these efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.

Additionally, Biden will put forward plans to tackle health challenges affecting specific communities, including access to health care in rural communities, gun violence, and opioid addiction.

V. Tax Reform – A Change to the Long-Term Capital Gains Tax

The Biden Plan also gets rid of the 20% long-term capital gains tax, increases the top tax rate, and cuts out loopholes that let some people avoid paying taxes and capital gains. Getting rid of the long-term capital gains tax would for example freed up $127 billion in fiscal year 2019 alone to put toward healthcare.

1. HEALTH CARE. JoeBiden.com.
2. See the on-page links for other citations.