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Elizabeth Warren lays out ambitious four-year timeline to transition to Medicare for All

Elizabeth Warren.
Elizabeth Warren.Sarah Rice/Getty Images

WASHINGTON — Senator Elizabeth Warren on Friday said she would use her first 100 days in office if elected president to dramatically expand government health insurance and she offered an aggressive four-year timeline to transition the nation to Medicare for All.

Warren’s plan would turn the sweeping transformation of health care coverage into a two-step process. She would use a budgetary maneuver in Congress to create a generous “Medicare for All option” at the outset of her presidency. Then she would seek to complete the transition to a fully government-run system — and largely eliminate private health insurance — in standalone legislation by the end of her third year in the White House.

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Health care has loomed larger in Warren’s campaign for the Democratic presidential nomination as her opponents have pressed her for details on the issue. The plan, presented in a Medium post on Friday, represents the latest plank of the Massachusetts senator’s effort to lay out her agenda on the thorny issue after focusing much of her candidacy on topics like economic inequality and corruption.

The first step alone would require Warren to spend a significant amount of political capital on health care early in her term, even though she has outlined other issues, including ending the Senate filibuster, passing an anticorruption plan, and enacting a wealth tax as her initial priorities.

“Every step in the coming fight to improve American health care — like every other fight to improve American health care — will be opposed by those powerful industries who profit from our broken system,” Warren wrote in the post outlining her plan. “But I’ll fight my heart out at each step of this process, for one simple reason: I spent a lifetime learning about families going broke from the high cost of health care.”

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The proposal won praise from Medicare for All advocates, like Democratic Representative Pramila Jayapal, who wrote the House bill on the issue, but also seemed aimed at defusing the criticism that her embrace of the idea is too extreme.

The first stage of Warren’s plan bears some similarity to those of moderate rivals like former vice president Joe Biden and South Bend, Ind., Mayor Pete Buttigieg, who also want to give Americans the option to buy into a government-run health care plan if they want to.

Buttigieg’s campaign blasted Warren’s transition plan Friday, calling it “transparently political.”

“Despite adopting Pete’s language of ‘choice,’ her plan is still a ‘my way or the highway’ approach that would eradicate choice for millions of Americans,” said Lis Smith, a spokeswoman for Buttigieg, levying an attack that other Democrats have used to brand Warren as divisive. But Buttigieg has described his own “Medicare for all who want it” plan as a “glide path” toward a fully government-run system — the same place Warren wants to end up.

The plan also could open Warren up to criticism from liberals, who may suggest she is backing down from the goal of enacting Medicare for All in one fell swoop. Legislation offered by Vermont Senator Bernie Sanders sets up a four-year transition to Medicare for All in a single bill, although he has not put forward a detailed plan for how to pay for it.

In recent months, Warren has trod a treacherous political path over her support for Medicare for All, a proposal catapulted by Sanders into Democratic discourse. Warren’s embrace of the idea without saying how she would pay for it opened her up to criticism and left her playing defense after a summer-long rise in the polls.

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Two weeks ago, Warren released a plan to fund a $20.5 trillion Medicare for All plan without raising taxes on the middle class, but it was immediately derided by rivals who said the proposal was not realistic. Even Sanders, who rarely attacks Warren, called his plan more “progressive.”

On Friday, Warren seemed to attempt to head off criticism of her transition plan by pointing out that any plan that expands public coverage — including those from more moderate rivals — will be a heavy lift.

“Any candidate who believes more modest reforms will avoid the wrath of industry is not paying attention,” Warren said.

Her plan is essentially divided into two phases.

In the first, which she says would play out during her initial 100 days in office, she would use the budget reconciliation process — which requires a simple majority in the Senate, instead of a filibuster-proof majority of 60 votes — to create a Medicare for All “option” that would be available for anyone to buy into. It would be free for Americans under 18 and anyone with annual income below twice the poverty level — about $51,000 for a family of four this year. Americans over 50 would be able to enter an expanded version of the traditional Medicare plan, down from the current eligibility age of 65.

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Warren has built her campaign on a series of ambitious policy proposals, and she has called for eliminating the Senate’s legislative filibuster to get it all done. Her decision to turn to the budget reconciliation process to expand Medicare at the outset of her presidency, however, is an acknowledgment that it may not be possible to end the filibuster right away.

“I’m not going to wait for this to happen to start improving health care — and I’m not going to give [Senate majority leader] Mitch McConnell or the Republicans a veto over my entire health care agenda,” Warren wrote.

Warren’s plan also depends on Democrats taking control of the Senate in 2020, which is no sure bet. Budget reconciliation is used by political parties to advance major pieces of their agenda; Republicans used it to pass their tax cut legislation in 2017.

Her plan also includes administrative actions that would not require assent from Congress, including lowering the prices of drugs like insulin and EpiPens, protecting people with preexisting conditions, expanding enrollment in the Affordable Care Act, and prohibiting Medicaid restrictions like work requirements.

The second phase would come by the end of the third year of her presidency. Warren said she will “fight” to pass legislation that would complete the transition to Medicare for All, which is when private insurance companies would be mostly eliminated.

Fewer than 800 words of the more than 8,900 word timeline proposal deal with that phase of the effort, which is all but certain to generate pushback from Republicans and Democrats alike.

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In the post, Warren acknowledges private insurance would have some role in her new system. Sanders’ plan, she points out, allows for it to cover services that aren’t covered by Medicare for All. “For unions that seek specialized wraparound coverage and individuals with specialized needs, a private market could still exist,” she wrote.

“But the point of Medicare for All,” Warren wrote, “is to cut out the middle man.”


Jess Bidgood can be reached at Jess.Bidgood@globe.com. Follow her on Twitter @jessbidgood