WASHINGTON — Senator Elizabeth Warren vowed on Friday to pass major health care legislation in her first 100 days as president, unveiling a new, detailed plan to significantly expand public health insurance coverage as a first step, and promising to pass a “Medicare for all” system by the end of her third year in office that would cover all Americans.
The initial bill she would seek to pass if elected would be a step short of the broader Medicare for all plan she has championed. But it would substantially expand the reach and generosity of public health insurance, creating a government plan that would offer free coverage to all American children and people earning less than double the federal poverty rate, or about $50,000 for a family of four, and that could be purchased by other Americans who want it.
Ms. Warren has not previously outlined a timeline for enacting Medicare for all. In essence, Friday’s plan is a detailed road map for eventually achieving that goal, which would create a single government-run health program and end private insurance coverage. Her proposal would move people into that system gradually — in a way she hopes would build public support for a full-fledged single-payer program — while temporarily preserving the employer-based insurance system that covers most working-age adults today.
Ms. Warren’s eventual goal — a wholesale transformation of how Americans get health insurance — is a big political gamble. Her Medicare for all plan would require an estimated $20.5 trillion in new federal spending over a decade, and to provide funding for it, she would impose new taxes on businesses and the richest Americans.
But the plan she presented on Friday stops short of calling for the enactment of such a sweeping overhaul at the beginning of her presidency. That piecemeal strategy could be more politically palatable to voters who are not sold on Medicare for all, but it could also draw criticism from liberals that she is unwilling to spend political capital at the outset of her presidency to press for the establishment of a single-payer system.
Though the details differ, Ms. Warren’s transition plan shares many features with health proposals from her more moderate rivals for the nomination, including Joseph R. Biden Jr., the former vice president, and Pete Buttigieg, the mayor of South Bend, Ind. For example, it would allow higher-income adults to voluntarily sign up for a new public plan. Ms. Warren’s proposal, however, would make the optional government plan more generous, and would allow more Americans to access it for free.
Her plan attempts to offer something attractive to both sides of the Democratic health care debate, by preserving her commitment to the single-payer vision that energizes voters on the left, while offering a less disruptive set of policies in the short term to those who may be reluctant to give up their existing coverage.
“I believe the next president must do everything she can within one presidential term to complete the transition to Medicare for all,” Ms. Warren wrote in her plan. “My plan will reduce the financial and political power of the insurance companies — as well as their ability to frighten the American people — by implementing reforms immediately and demonstrating at each phase that true Medicare for all coverage is better than their private options. I believe this approach gives us our best chance to succeed.”
Ms. Warren’s plan also reflects a sense of pragmatism about the politics and logistics of passing a major health bill through a closely divided Congress. Ms. Warren says she would pass the transition plan using special procedures that would require only a simple majority in the Senate, rather than the 60 votes needed to overcome a filibuster.
But she would still rely on Democrats winning control of the Senate, where Republicans currently hold a slim majority. And she is laying out ambitious details for getting to a single-payer system even as voter support for the idea is narrowing; polls suggest substantially more Americans prefer the “public option” type of plans that Mr. Biden and Mr. Buttigieg have embraced.
Passing a health bill could crowd out other legislative priorities. President Trump’s efforts to repeal and replace major parts of the Affordable Care Act in 2017 stretched well beyond his first 100 days and ultimately failed. In that undertaking, congressional Republicans used the same approach that Ms. Warren is planning to employ — using special procedures to bypass a filibuster — and yet they could not muster a simple majority in the Senate.
Still, Ms. Warren’s choice to put off seeking passage of a full-scale Medicare for all plan until as late as her third year in office could prompt criticism from left-leaning voters eager to see a Democratic president move more quickly to enshrine a single-payer system in law. And given the unpredictable nature of politics, a pledge to pass legislation by the end of 2023 represents a somewhat distant goal.
“Elizabeth Warren is trying to have her cake and eat it, too,” Senator Michael Bennet of Colorado, another presidential contender, said Friday.
Ms. Warren offered her transition plan two weeks after she released a detailed proposal to finance a Medicare for all system. She put forward that plan to rebut incessant questions about whether she would raise taxes on the middle class in order to fund a sweeping new government health insurance program.
When she laid out her financing plan, she said that she would not increase taxes on middle-class families by “one penny.” Among other revenue sources, Ms. Warren would require employers to pay an amount similar to what they are currently spending on their employees’ health care, and she would raise taxes on the richest Americans, including by steepening her proposed wealth tax for billionaires. Her financing plan was met with harsh criticism from Mr. Biden, whose campaign said it was “unrealistic” and required “mathematical gymnastics.”
Her transition plan did not come with its own detailed financing proposal, but it said the interim program would cost the federal government less than an eventual Medicare for all system and would be funded using some mix of the revenue sources she has already identified.
The plan also spells out a long list of administrative actions Ms. Warren would take to change the health care system, even if Democrats do not retake the Senate. She would roll back many Trump administration regulations that have weakened the Affordable Care Act and shore up benefits in the existing Medicare program. She would also use executive authority to allow new generic versions of expensive drugs — such as insulins taken by patients with diabetes, treatments for hepatitis C and the overdose reversal drug Naloxone — in an effort to lower their prices.
As Ms. Warren has established herself as a leading candidate for the Democratic nomination, her opponents have frequently attacked her over health care, a top issue in the race. For much of the fall, her refusal to say whether she would raise taxes on the middle class provided an opening for some of her rivals to paint her as cagey on a key issue.
More recently, her financing plan touched off a fraught back-and-forth between Ms. Warren and Mr. Biden. After his campaign denounced her plan, Ms. Warren suggested Mr. Biden was running in the wrong party’s primary. Mr. Biden responded by suggesting Ms. Warren had displayed an “elitist attitude” and an “angry” viewpoint. Both he and Mr. Buttigieg have tried to capitalize on her financing plan by saying their public option proposals are far more realistic; they have also emphasized that her Medicare for all plan would take away people’s ability to choose private coverage.
Lis Smith, a spokeswoman for Mr. Buttigieg, described Ms. Warren’s transition plan as “a transparently political attempt to paper over a very serious policy problem, which is that she wants to force 150 million people off their private insurance — whether they like it or not.”
“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,” she said Friday. “No amount of Washington political games can save her plan from that fatal flaw: She still doesn’t trust the American people to make the right health care decisions for themselves.”
In the longer term, Ms. Warren’s embrace of Medicare for all, along with its elimination of private health insurance, would provide ammunition to Mr. Trump and his Republican allies if she became the Democratic nominee. Mr. Trump is already fond of equating Democratic approaches to health care with socialism.
Ms. Warren is a co-sponsor of Senator Bernie Sanders’s Medicare for all legislation, which includes a four-year transition. Though Mr. Sanders typically emphasizes the endpoint of his plan, a form of generous government insurance that would cover all Americans, his bill includes a detailed plan for moving from the current health care system to that final goal.
But Mr. Sanders’s transition relies on passing his entire plan. Ms Warren, by contrast, has suggested splitting the process in two: starting with the transition plan, and only later passing a full Medicare for all bill. And Mr. Sanders, unlike Ms. Warren, has declined to specify a detailed financing plan for his proposal.