Health savings account instead of Obamacare? A trojan horse

Update: 12/6/2025  So once again...health savings accounts to replace Obamacare? What if a catastrophic disease like cancer happens and the savings account is depleted? Like Obamacare, this does nothing to control the greed of insurers...it just pays for their increasing greed. GOP plan scales back Obamacare, creates Trump Health Freedom Accounts | Fox News    Trump and the GOP are trying to offer consumers the gift of more choice.  That is NOT  what consumers are seeking. They want to afford insurance, of course, but not insurance that would run out in the midst of the onslaught of a catastrophic illness or pre-existing conditions that require huge monthly outlays.  They want coverage that works, not a half-baked substitute that does not.  Health Savings Accounts, Backed by GOP, Cover Fancy Saunas but Not Insurance Premiums - KFF Health News     Another approach would be to fund only catastrophic insurance through the bronze plan, meaning consumers would have to be res;onsible for extremely high deductbles and pay a lot of money out of pocket for things like routine doctors visits and cancer screenings for breast, colon, and prostate prevention.  Imagine how many bankruptcies would be caused by unaffordable deductibles and co-pays, not to mention deaths caused by a lack of preventative care.  Obamacare (ACA) found a way to do both: cover preventative care and early detection plus cover catastrophic health crises. 

Update: 11/24/2025; An interesting about-face? Originally, Trump floated the idea of just giving money to those who need health insurance, and others proposed putting that into already existing health savings accounts. He made a big deal of going around the "middlemen, the insurers, and putting the money in the hands of consumers. That proposal got pushback: The problem: What happens when someone gets a catastrophic health problem and uses up the paltry amount in their account? Go bankrupt or sell their homes? Someone got to Trump: the insurance lobby? Now he favors extending Obamacare with some restrictions that will also limit who can qualify for the subsidized insurance offerings.

Continuing with the original post 

It looks like the GOP is going to try to substitute Obamacare with a health savings account...a long-time conservative proposal. The problem is that if you have a catastrophic illness like cancer, plan on going bankrupt or selling your home to pay the bills. What might happen is that those with means will buy catastrophic insurance out of their own pockets, and everyone else will just be taking a risk that they do not get seriously ill. If you have a pre-existing condition, good luck in finding catastrophic insurance you can afford. This is is gift horse that is a Trojan horse. The gift horse, say conservative think tanks and Trump, gives consumers more choice and cuts out the middleman, but what consumers want more than choice is efficient, affordable, and adequate coverage. By itself, health savings accounts are not adequate, and insurance middlemen still play a role.. They have to be combined with other insurance to be adequate.

FYI: Obamacare, so much hated by the GOP and now so popular with public opinion, is actually based on the plan instigated by a Republican governor. The 2006 Massachusetts healthcare law, commonly known as Romneycare  share several key features and architects with Obamacare.  "The insurance company lobby is a powerful one and whatever Trump says about the middlemen and insurers, guaranteed: the GOP Congress will not cross insurance companies...nor will Trump.

The only plan for consumers that gets rid of the middleman, gives consumers choice, is efficient, affordable, and adequate, would be Medicare for All..

So what about the interim when this all-new approach has to be established by law? Trump proposes a $2k gift to everyone. A person I know with treatment for a pre-existing condition said it would cover one month of his medical expenses.

From the Washington Post article: https://www.msn.com/.../gop-plans-to-replace.../ar-AA1QwZqC

"But FSA money generally can’t be used to pay premiums — meaning that patients would be on their own when it came to paying the regular monthly costs to stay insured.

FSAs are “great for buying eyeglasses and going to the dentist, but if you have a catastrophic health event, they’re not going to help,” said Thomas Buchmueller, a University of Michigan economist who served in the Biden administration. "

Health savings accounts have existed since 2004 and are used in combination with other insurance plans, such as employer-provided insurance and catastrophic insurance. As a stand-alone substitute for Obamacare/ACA, it is not, and if combined with Obamacare and subsidized by the federal government, there are serious repercussions to consumers. Health savings accounts were discussed during the debate on the establishment of Obamacare and rejected. Obamacare could collapse under Trump’s new plan, policy experts say - POLITICO

Even in existence, the health savings accounts have had problems: (per my Google AI search)

• Eligibility Restrictions: To be eligible for an HSA, an individual must be enrolled in an HDHP, which can expose them to high out-of-pocket costs before the deductible is met. (My observation: it has only been approved when combined with another insurance plan...so insurers still get their cut and the middle man is still involved) 
• Cybersecurity Threats: The growing value of HSAs has made them a prime target for cybercriminals and fraud, leading to security incidents and the need for robust account protection measures.
• Underutilization of Investment Potential: While funds can be invested, research indicates that only a small percentage of HSA owners invest their balances. 

GOP plans to replace Obamacare have failed. Here’s what lawmakers propose now.

Trump's new concept for health care insurance. Pay retail and get less for your money..

Update 11/17/2025 Trump says he’s talking to Democrats about direct health care payment plan   "The insurance company lobby is a powerful one and whatever Trump says about the middlemen and insurers, guaranteed: the GOP Congress will not cross insurance companies...nor will Trump.

Continuing with original post:

Trump has a concept for health care: send consumers a couple of thousand dollars toward their health care costs. Nutty and stupid. "This is, unsurprisingly, nonsensical," Sen. Chris Murphy (D-Conn.) posted on X. "Is he suggesting eliminating health insurance and giving people a few thousand dollars instead? And then when they get a cancer diagnosis, they just go bankrupt?" Trump says cut out the middleman (meaning ACA), and take federal money, and find your own, and then, red flag warning. pay full retail price and any shortfall? To whom? Of course, the insurers.

The insurers would really like this one. These insurance companies could now charge as high retail rates as they can get away with for individual purchasers and screw those with pre-existing conditions, or refuse to insure anyone with pre-existing conditions, and then offer less preventative care for more bucks. That's just like it was before Obamacare, only now you would have some money from the feds to buy your own. Insurance companies could now make off like bandits with nothing to stop them from gouging their customers with less coverage for more money. and the insurance companies will be thanking Trump on the way to the bank..They have found a way around anti-price-fixing laws by using third party hubs, so any open-market competition would not drive down prices. This is Trump's deal that takes the place of group rates with large pools to spread around risk like Obamacare offered, and without insurers having to bid against competitors, meet the required preventative care coverage, to be offered in the state marketplace.

The ACA was designed to do the major things: cover the affordability gap for those who did not get insurance from employers, Medicare, Medicaid, but the cost of private insurance was too high for their income level (subsidies are based on income level; a kind of means test), to spread risk around (the pool) so those with pre existing conditions could get insurance they could afford; and provide affordable access to preventative care and early diagnosis. There are far more efficient and cost-effective plans like Medicare for All out there, but this is what we have now...and the GOP has never come up with anything for a decade. High-risk pools have failed where they were tried, like Colorado did once. Health savings plans have been around for years, but have never worked out. These alternatives failed so badly that they led to Obamacare/ACA, which is less than perfect but at least addresses subsidies based on need and covers pre-existing conditions and preventive care.

Such a benign wannabe despot, Donald Trump, is: zap.$2k to pay oops on tariffs to all but the rich, and a couple of thousand so you can pay more for worse health insurance. Budget hawks in his party must be getting ulcers.. So you think a couple of thousand dollars, a one-time gift from the US Treasury, like Trump proposes, will make a difference?

That "oops, we screwed up so here's some bucks", worked during COVID as a political plus, but this Trump concept is different. It is a political trick to get the GOP through the 2026 midterms that does not do anything to fix the long-term damage to health care affordability. This "such a deal" is no more than a band-aid without adhesive, and half covering a wound. COVID would end; your needs for affordable health insurance will not. I predict this Trump concept will have an early death.

Some thoughts on Medicare for All replacing the ACA or the entire health care insurance system.Trump's proposal to give people 2K in compensation for making the ACA unaffordable recognized one fact. The insurance companies, the middleman, are the problem. In doing so, he opens the door to what insurance companies fear the most: Medicare for All or something comparable. The advantage of the Medicare for All approach is that the mechanism already exists, but would have to be scaled up. The wheel need not be reinvented.  The other advantage is that the "pool" of subscribers would contain many more ... likely healthy, young, spreading the risk around. The more the merrier in the world of insurance means lower costs for all in the pool. What about those middlemen?  They can still rake in bucks in Medicare Advantage and supplements, and depending on how it is structured, employer-provided insurance..  Medicare covers 80% of procedures now, and those who have the means could pay for a medigap (as some Medicare advantage plans offer), but at least those who do not will not go bankrupt or mortgage the house and they would have preventative care and cancer screenings and hospitals and providers will be assured they no longer have to write off non-pays or shift the cost to paying patients.  The largest pool would be if Medicare for All meant everyone, but a form could be just replacing the ACA with a medicare program that would be available to the self-employed, the unemployed,  young and healthy not covered by employers' insurance,  and the same requirements to cover preventative care, annual physicals, cancer screenings, and pre-existing conditions.. How the cost of prescription drugs would be handled is still an issue.  Whether it would be offered only to those of certain income levels is another issue. 

The Democrats' making healthcare the issue in the shutdown may have unintended consequences

The unintended consequence may in the long term be a total overhaul of health care affordability and the role government plays. The red states are the most harmed by the misnamed Big Beautiful Bill, and it may be a wake-up call that leads eventually to Medicare for All.

If it does not, the red state politicians can at least make sure both Medicaid and the ACA are workable because the alternative, letting the lower-income brackets go without health care accessibility and affordability, will be politically untenable and viewed as inhumane. It will be expensive for those who have health insurance, as the cost of medical care by the emergency room will be passed on to them. covered by higher costs and bigger bills for them. Those are the reasons that the ACA, Obamacare, was passed and now has more public approval than ever.

Update: 11/5/2025 MUFTIC FORUM BLOG: Killing off OBAMA care: GOP's stubborn subversion plan: remove subsidies   Their plan: subvert it by making premiums so expensive by removing subsidies, no one can afford it.

Update 10/29/25: a good analysis of the impact of the BBB on Obamacare/ACA: Americans Are Getting a Look at Next Year’s ACA Premiums and Many Don’t Like It

Continuing with the original post

That Democrats in Congress are making health care cuts the issue in the shutdown is a moral one....but it is also aiming at the soft belly of MAGA-run red states. Steve Rattner on Morning Joe this morning presented some extremely fascinating statistics in graphs that show the negative impact of the BBB on healthcare will hit the red states in the South the worst. Especially harmed were states that refused to expand Medicaid coverage when they had a chance in the Biden and Democratic administrations. Using Obamacare (the ACA) to fill in the gap they left in so many uninsured and now they will have the largest increase in their state ACA programs, more so than blue states, because the subsidies to make the ACA affordable have been taken away by the Big Beautiful Bill. Those of us in blue states will also feel the pain.... That is the short-term political dilemma that the GOP is finding itself in.

In the long term, the ACA will have to be replaced, because it has not resulted in the profit-driven health insurers reducing costs...and instead, the ACA is just a method to help consumers afford the private insurers' unbridled greed. The only way out is a Medicare for All kind of a program that has a huge advantage: the pool of insured becomes the whole country...an average that includes both the sick, elderly and the healthy, spreading the risk around and reducing the cost for everyone. There will come a time when Americans will realize that their fear of socialism will be eclipsed by the need to cope with the cost of modern medicine, and they will rise up and demand it. I am not sure we are there yet, but the BBB BS by an uncaring GOP may be a catalyst for voter attitude changes, it is so jarring and harmful.

msn.com

Steve Rattner: Red states use Obamacare more; health care cuts hit red states hardest

Morning Joe economic analyst Steve Rattner discusses how the government shutdown is impacting health care.

Killing Obamacare, a last minute issue affecting 45 million people

 Speaker Mike Johnson just promised massive changes to Obamacare with seven days to go and most Americans  will not have a chance to consider  this. Democrat candidate for the House need to grab it and run and demand their opponents tell what they plan.  

A last minute sleeper issue affecting 45 million people. https:/ut /www.nbcnews.com/.../speaker-johnson-criticizes... What are the massive reforms? Chances are that those with pre-existing conditions will be the victims among other.Whatever the GOP does, it will be to the advantage of big pharma and health insurers. Be very afraid all those on Obamacare now. Trump only hints he has a concept, but if he is afraid to give details, they probably would be political suicide if he dared Here is what is probable. It is a reproduction of a prior blog posting of mine May 27, 2024.

The Democratic National Committee came up with a list of Trumpisms spouting how he plans to destroy affordable health care.  That one issue seems to get eclipsed by others, such as abortion and democracy, but the issue of affordable health care cuts across many more demographics, sex, age, and middle-class income. "Across coverage groups, a total of 45 million Americans are enrolled in coverage related to the ACA, the highest total on record. This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (a 258% increase, or more than triple).Mar 22, 2024"    https://aspe.hhs.gov/sites/default/files/documents/a1e8128c1b9996fd5a7eb98d0860d572/aspe-2023-race-ethnicity-marketplace.pdf

In Celebration of 10 Years of ACA Marketplaces, the Biden ...

HHS.gov

While I am usually reluctant to quote a political party's press releases, I thought this one used Trump's own words against him.  I think this issue has legs and I hope during the upcoming campaign, it gets more exposure.  Like the ending of Roe v Wade, most voters don't get the message in advance of its ending until the dirty deed is done, and all of a sudden, the access door is slammed shut in their faces. The only thing left for those who sound alarms left to say is "I told you so".  Chicken little warnings often get dismissed as "the sky is falling" hysteria.  In this case, it really could fall in when it concerns the ability to get health care to cover pre-existing conditions. afford premiums, and give a vehicle for 45 million to pay for it via Obama care. 

From the DNC release with links to sources     https://democrats.org/news/trump-on-the-aca-donald-trumps-plan-for-affordable-health-care-is-getting-rid-of-it-entirely/

Trump: “We’ve really decimated Obamacare.”

“We’ve done a great job, but we’re going to be getting rid of it entirely.”  

As Trump pledges to repeal the ACA in a second term, here’s a recap of some of the most egregious statements he’s made about killing the program:

Daily Beast: “Trump Revives Plan to Dismantle Obamacare if Elected in 2024”

NBC: “Trump, by contrast, stood by his support for a lawsuit headed to the Supreme Court that seeks to invalidate Obamacare. The justices will hear the case one week after Election Day.

“‘I would like to terminate Obamacare, come up with a brand new, beautiful health care,’ Trump said at the debate, which was moderated by NBC News’ Kristen Welker.”

Trump: “Obamacare is a disaster. And I said, ‘We’re gonna do something about it.’”

Trump: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives. We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”

Trump: “And what we’d like to do is totally kill [the ACA].”

The Hill: “In a Truth Social post, the leading GOP presidential candidate claimed he’s ‘seriously looking at alternatives’ to replace ObamaCare, and that the failure to repeal the health law in 2017 while he was in office was ‘a low point for the Republican Party.’” 

Trump does not care that the majority of Americans support access to affordable health care and protections for people with preexisting conditions.

Washington Post: “But what’s clear is that an effort to ‘terminate’ Obamacare is not something Americans are pining for. Not only were the GOP’s efforts to repeal and replace Obamacare during Trump’s term historically unpopular, but the law also appears to have gotten more popular since then. … And when politicians talk of ending health insurance for tens of millions of Americans, dropping coverage of preexisting conditions and cutting Obamacare’s Medicaid funding, things get even dicier.”

Reminder: Trump spent his entire presidency trying (and failing) to get rid of the ACA while making it harder for people to sign up for health care.

NPR: “The very day President Trump was sworn in — Jan. 20, 2017 — he signed an executive order instructing administration officials ‘to waive, defer, grant exemptions from, or delay’ implementing parts of the Affordable Care Act, while Congress got ready to repeal and replace President Obama’s signature health law.” 

CNN: “Trump slashes funding that helps people sign up for Obamacare.”

NBC News: “Affirming its disdain for ‘Obamacare,’” the Trump administration on Thursday announced sharp cuts in programs promoting health care enrollment under the Affordable Care Act for next year.

“Advertising will be cut from $100 million spent on 2017 sign-ups to $10 million, said Health and Human Services officials. Funding for consumer helpers called ‘navigators’ will also be cut, from $62.5 million for 2017, to $36.8 million for next year.”

The Hill: “Insurance Experts: ObamaCare Mandate Repeal Driving Premium Increases.”

New York Times: “The Trump administration said Saturday that it was suspending a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act, a freeze that could increase uncertainty in the markets and drive up premiums this fall.”

NBC News: “Trump approved a surprise decision to push for the complete elimination of the Affordable Care Act in the courts. If it succeeds, millions of Americans will lose their private insurance or Medicaid coverage and the health care system would be thrown into chaos.”

Some still push for Medicare for All as the best alternative to Obamacare. I am slowly coming around to Medicare for all. Not only are those who are middlemen corporate profit seekers taking their bloated administrative cut but there is also an actuarial sound theory at work. The larger the number of all participating, in the pool regardless of health status, the more the cost is spread around. Much depends on how Medicare for all is structured. Are "advantage" and supplemental plans allowed. Do participants have a choice of physicians? Are private providers allowed? Do you have to belong to a network or can you go anywhere you want for care? Is there rationing based on need and urgency? and everyone else can stand in line. How much of a co-pay is required? There are many varieties and versions of this in Europe now and each country has its own kind. The most restrictive of all is Canada. My granddaughter lives in Austria and is happy with that system and she has a choice of a doctor. All of these systems are heavily subsidized by taxes but in the long run, the outcome is the best measure. France and the Scandinavian countries often poll the best in patient satisfaction. In France, high-income taxes pay for it, but if the taxpayers like the system and get their money's worth, they do not mind...and seems to be a tradeoff that is OK.  I am not sure the tradeoff would fly in the USA 

https://www.internationalinsurance.com/health/systems/

 Until then we need to reform and refine Obamacare to do what it was designed to be: a safety net for those victimized without the income or ability to get insurance in the open marketplace, or not having employer-provided insurance and meeting some financial need criteria based on income. Obamacare was based on a proposal from a conservative think tank as an alternative to "socialized medicine, though the Heritage Foundation would like to avoid getting the blame.  What differs from some proposals is a law that requires all, a mandated law, to have health insurance. Obamacare does not have that mandate. However, both left and right felt they had to provide an alternative that was affordable to all consumers regardless of pre-existing conditions. 

High-risk pools have also failed. Experiments tried that failed were to put those with pre-existing conditions is a separate pool and subsidize that.  It was tried in Colorado and failed and if that is what the GOP has in mind, know that such a plan has never worked.https://cohealthinitiative.org/articles/high-risk-pools-been-there-done-that/       Why high-risk pools fail   https://www.commonwealthfund.org/blog/2015/why-high-risk-pools-still-wont-work

 Backers of Obamacare had hoped the cost of insurance would also be reduced by the competition to be the private insurance provider in each state. That, too, has not worked and it has instead become a boondoggle for private insurers, who as a whole and as an industry exempt from anti-trust laws can get away with collusion and price setting.

https://theconversation.com/conservatives-backed-the-ideas-behind-obamacare-so-how-did-they-come

From Google AI polls of satisfaction with healthcare systems shows only a quarter of those polled in the world are happy with them. However, relatively speaking countries with universal care poll much better that the US which ranks at the bottom. According to recent polls, satisfaction with universal healthcare systems varies widely across the world, with countries like the Netherlands, Belgium, Norway, Denmark, and Switzerland reporting the highest levels of citizen satisfaction with their healthcare systems, while the United States generally shows the lowest satisfaction due to its non-universal system, with many people expressing concerns about cost and access to care; a recent Harvard study found that only a quarter of respondents globally felt their health system worked well.

Health insurance: Employer provided insurance is no gem

While many are aghast that single-payer health insurance or Medicare for All advocated by several Democratic candidates would require you to give up your employer-provided insurance, employer insurance is not the gem many think it is. Health care costs have risen, but employer contributions to health insurance have not.  Employees are paying more and more out of pocket.  However, I still believe consumers want a choice of their providers, whether it be employer-provided or offered by the government or private companies.  The problem is that to make a cost comparison among all three or even to make an informed choice is difficult or impossible. Trump and the GOP's plan to repeal Obamacare would even remove that option, leaving millions with no insurance whatsoever.  As this article points out, the real problem is the rising cost of health care and little is being done to bring down costs. Prescription drug costs are key, but even that which has had bi-partisan support cannot surmount Congressional gridlock.  The choice between unaffordable providers is no choice.  There is currently no competition to force providers to become more efficient or cost-effective.  A government public option and requiring competitive bidding for provider formularies, including Medicaid and Medicare, might at least provide incentives for providers to lower their own administrative costs and accept lower margins if they want to survive.  The Obamacare method of giving you a choice of private plans was supposed to provide a degree of competition, but it was never designed to be the whole plan.  Politics forced the Obama administration to drop the government-regulated, nonprofit public option that would have provided a greater measure of competition.  Private health provider company lobbyists did not want the competition, but now they may be faced with even the elimination of private health insurance that is threatened by some candidates.    In their greed, they may have planted the seeds of their own self-destruction.

Update: Not available to Grand County consumers, yet, but for government employees: https://www.skyhinews.com/news/grand-county-joins-peak-health-alliance/


https://finance.yahoo.com/news/health-care-employer-expensive-america-134313774.html

Democratic candidates smell and draw blood on health care

A version of this was published in the Sky Hi News, July 5, 2019.
https://www.skyhinews.com/opinion/opinion-democrats-smell-and-draw-blood-on-health-care-issues/

 Democrats smell blood when it comes to health care as a winning issue. The danger is that the loyalties to various kinds of proposals and their partisan proponents become such a  divisive issue, it loses in 2020. Any hope to improve health insurance to any degree during a Trump second term would be lost as well. 

 Democratic candidate debates last week have renewed the national focus on health care policy because nearly all of the twenty on stage put it on or near the top of the issues they addressed. It is no wonder. A Kaiser Family Foundation tracking poll in June 2019 before the debates found that 87% of Democrats put health care at the top of the list for candidates to discuss. The various candidates touted their approaches and criticized their opponents' health care plans with enough passion and drawing blood with criticism to give rise to the fear that the party is seriously divided.

 Both Republican and Democratic strategists will be sharpening their swords on the issue. In the 2018 midterms, coverage of pre-existing conditions was the hot button topic, even forcing Trump and some GOP candidates to pledge to protect pre-existing condition coverage without even providing a plan of how to do it or its cost.  

 What we can expect is for the GOP to claim that any plan with Medicare for All in its title or any variations thereof is nothing but socialism, a term that frightens GOP voters, but it does not scare most  Democrats,  especially younger ones, per a recent Pew Research Center poll.  The GOP has a grand old historical tradition of calling "socialism"  any government provided assistance to seniors such as Medicare and Social Security and they have begun beating the war drums against Medicare for All now with the same fire breathing tactics of yore. They would benefit from seeing the health care debate becoming lost in a socialism v capitalism controversy.

In taking sides of the various health care proposals,  Democrats could lose sight of who are the real enemies. They are the GOP who failed in their first attempt to repeal without replacing Obamacare and the Trump administration who would sabotage Obamacare out of existence, making it either unaffordable for many consumers or economically unsustainable.  Using executive orders,  Trump has eliminated the mandate for all to be insured and now permits employers to provide junk and cheaper insurance plans without all of the essential benefits.  Both of these  Trump actions are undermining the balance in the  "pool" of potential claimants. Increasing the numbers in the pool of those who use the benefits more than those who do not, leaves more of the sicker more expensive to treat in the pool,  increasing the costs for all of the participants and taxpayers associated with Obamacare.   There are fears that if employers offer poorer quality insurance plans,  they will dump the underinsured or uninsured sicker into Obamacare, unbalancing the pool even more.  Trump will want voters to buy his promises to repeal Obamacare with no comparable replacement proposals. Trump voters were pacified by those empty promises in 2016 and again in 2018 and may believe him again in 2020. 


There are several fundamental issues that may decide which plan comes out on top. One is the cost of the total replacement of Obamacare with Medicare compared to the public option method that allows consumers to buy into Medicare as a choice within or outside of Obamacare exchanges. The cost to taxpayers or to consumers of any Medicare for All plan at this stage is speculative and subject to self-serving claims. In fact, we may never get the official nonpartisan actuarial cost projections until the Congressional Budget Office weighs in on specific legislation being proposed in Congress. 

 The cost factor is not the only a worry to taxpayers, but it is also Important to consumers who fear they still have to pay too much out of their own pockets in co-pays and deductibles in any plan. Bernie Sanders proposed to replace all health insurance, Obamacare, employer or union provided, or private plans with Medicare for All. Sanders will have to convince voters higher taxes will be offset by the elimination of premiums and lower out of pocket expenses.  An issue that may scuttle the Sanders type proposal is the loss of union or employer-provided insurance, private plans, or supplementals. being proposed by him and some Democratic party candidates. The issue is fluid.  What was revealed in the KFF poll is that voters currently do not have a clear picture of the differences between the various Medicare for All proposals. The majority feared taxes would increase, there would still be deductibles and co-pays,  and 55% thought employer health insurance would still be provided. 

 Sen. Kamala Harris has supported both Sanders' plan and public options in the past and clarified her position after the debate to permit private insurance to exist in any case.  Julian Castro and Andrew Yang along with Sen. Kristen Gillibrand in the debate, and/or in prior public statements supported Medicare or Medicaid for All closer to the Sanders' model, but still permitted some limited private insurance.  The remainder of the debaters, including former vice president Joe Biden, supported the public option approach to some degree or another and would not eliminate private or employer insurance. 



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https://newsatjama.jama.com/2019/01/03/jama-forum-the-2018-midterm-election-results-and-health-care/
https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-june-2019/

https://time.com/5616864/2020-democratic-candidates-health-care/

 https://thehill.com/homenews/campaign/436162-medicare-for-all-where-2020-dems-stand 

https://www.pewresearch.org/fact-tank/2019/06/25/stark-partisan-divisions-in-americans-views-of-socialism-capitalism/

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