Joe Biden is apparently taking the argument put forward by President Obama and fellow Democrats in 2010 that the Affordable Care Act was just a first step to build on quite literally, because he’s introducing a health plan that is the ACA with some stuff tacked on. Some very good stuff, but it definitely lacks imagination and ambition and, most dangerously, maintains all of the elements that the opposition has centered in on in court challenges.
Biden's plan would cost $750 billion over ten years, his campaign says, paying for it by repealing some of Trump's tax cuts. He would add the public option that Obama and fellow Democrats jettisoned over strong opposition from the industry in 2010. He would also allow Medicare to negotiate drug prices and allow for importation of prescription drugs. He would eliminate the income cutoff for the tax credits, meaning everyone would be eligible for subsidies. For the states that refused to take Medicaid expansion, he'd enroll everyone who would be eligible for Medicaid in the public option and exempt them from premiums. He'd seek to expand access to abortion and contraception by pushing to have Roe v. Wade enshrined in federal law and restore federal funding for Planned Parenthood.
He centers his argument in a video released Monday in keeping the achievement of President Obama. It's centered in preserving the Obama-Biden ACA legacy, arguing that preserving the accomplishment is paramount. He takes a veiled hit at Kamala Harris in his video, showing her raising her hand to say she'd be willing to give up private insurance, and seems more focused on protecting the Obama legacy rather than crafting a plan that would address the problems that we've still got in private health insurance. It doesn't address issues like ballooning deductible costs and other out-of-pocket expenses. He also doesn't address the individual mandate. It also ignores the big problem that all of these market interventions were what opened the law up to Republican challenges, where as Medicare for All would be much, much harder to chip away at.
One argument in his favor is that his plan would be the least disruptive way forward in the short term. The problem is the long-term outlook for the existing system is not rosy. Then there’s Republicans. His staff explains, with the same questionable argument we've seen before, that somehow Biden will be able to work with Republicans and make it work. "We’re starting with the Affordable Care Act as the base and going to insist on the elements that we sought last time," a senior Biden campaign official told Politico. "And we'll get them this time."
That's certainly optimistic of him, which is good. The bad part is that it reinforces the sense that he's delusional, having not recognized the defining feature of the Republican party of the 21st century: there are no depths to which they will not plunge to stop Democrats from accomplishing anything. His health plan is emblematic of the larger problem Biden's got running in 2020—it seems like he's stuck in the past and incapable of grasping just how effectively Republicans have broken everything.