What policy changes are we talking about? To the extent that the Biden plan has received any attention at all, this attention has largely been focused on his proposed introduction of a “public option” — a Medicare-like plan that individuals could buy instead of purchasing private insurance. This option might be a first step toward a single-payer system, but it would be a small step, and in the near term would be much less important than other aspects of the plan.
First and foremost, the Biden plan — Bidencare? ObamaBidencare? — would substantially increase the subsidies that currently help many but not all Americans who don’t get insurance from their employers.
The Affordable Care Act, as passed in 2010, was underfunded, because Democrats wanted to hold down the headline cost. This meant that premiums and co-payments were and are too high for many families. Since then, however, the politics have shifted: Public opinion has shifted in favor of the A.C.A., the Democratic Party has moved somewhat to the left and Republican willingness to ram through expensive, unfunded tax cuts has encouraged Democrats to be more aggressive.
So the Biden plan would increase subsidies and also remove the upper-income limit that prevents many middle-class families from receiving aid. This would cost a fair amount of money: The Committee for a Responsible Federal Budget puts the price tag at $850 billion over a decade. But it would cost far less than the 2017 tax cut, much of which went to corporations, which were supposed to respond by increasing investment, but didn’t.
The Biden plan would also automatically enroll low-income Americans in the public option, which is more important than it might sound. One of the defects of our system is that it’s complex and confusing, and those who need help the most are often the least able to navigate their way to getting it. Ideally we’d just move to a simpler system, but for now auto-enrollment would be an important palliative measure.
Oh, and the plan would also provide significant aid for long-term care, rural health, and mental health.
None of this amounts to revolutionary change — in contrast to Trump’s efforts to kill Obamacare, which would drastically change American health care, for the worse. But Bidencare would still be, as Biden didn’t quite say when President Barack Obama signed the A.C.A. into law, a pretty big deal.