Health Care 2020

Health Care 2020

In this section, Tarbell offers a guide to the key ideas in the health care debate today, as well as presidential candidates’ records and stances. 

Below are some of the most important concepts in health care that are up for debate this election, as well as some links to other comprehensive resources. If you would like to see additional definitions or resources on this page, send your thoughts to

Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).

The law has 3 primary goals:

  • Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
  • Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. 33 states have accepted federal funding under the ACA to expand Medicaid, and another three are expected to do so in the coming years. 
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

Health Insurance Marketplace: The Health Insurance Marketplace, also known as the “Marketplace” or “exchange,” provides health plan shopping and enrollment services through websites, call centers and in-person help. The Marketplace is operated by the federal government and is available at Some states run their own Marketplaces. 

Medicare for All:  Medicare for All is the term for Universal Health Care used by many democratic candidates. The Medicare for All Act will provide comprehensive health care to every man, woman and child in our country – without out-of-pocket expenses. No more insurance premiums, deductibles or co-payments. Further, this initiative would improve Medicare coverage to include dental, hearing and vision care.

Medicare for All Act of 2019: The latest endeavor to create a national health care system in the House and Senate. The bills both prohibit cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program.

Rep. Pramila Jayapal (D-WA) introduced the House version on Feb. 27, 2019, while Sen. Bernie Sanders (I-VT) introduced his own piece of legislation on April 10.  Jayapal’s bill would begin enrollment sooner and provide more benefits than Sanders’ edition, but the bill provides less details on how the country would pay for M4A. Sanders’ bill also has conditional cost-sharing for pharmaceuticals and would not fully replace Medicaid. Kaiser Family Foundation has a full guide on the differences in plans. 

Medicare Buy-In: As another option for expanding Medicare coverage, this would allow people who were not previously eligible for Medicare to purchase their own plan from the government. This might include people who are between 50 and 64 years old, or individuals who don’t receive health coverage through their employers. 

Medicare for More: This is a general term for expanding Medicare coverage to include more individuals. Policymakers’ suggestions range from including a larger age range – e.g. starting from 50 years old – or setting up a pathway to gradually expand Medicare to cover all U.S. citizens.

Open Enrollment: Open enrollment is a window during which individuals and employees may add or drop their health insurance or make changes to their coverage. Open enrollment applies both in and out of the Marketplaces. Some state-run Marketplaces may have differing enrollment dates than the Federal Marketplace. This year’s Federal Marketplace enrollment begins November 1, 2019 and runs through December 15, 2019. 

Pre-Existing Conditions: A health problem, like asthma, diabetes, or cancer, that a patient had before the date that their new health coverage starts. Insurance companies cannot refuse to cover treatment for pre-existing conditions or charge patients more as a result of these conditions.

Public Health Insurance Option: The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with private health insurance companies that are already operating in the United States.

Single Payer Health Care: Singlepayer health care is a type of universal health care financed by taxes to fund essential health care for all residents. Costs are covered by a single public system (hence ‘singlepayer‘).

State Marketplace: Some states run their own Marketplace. If this is the case, you will use the state’s website to enroll in individual, family or small business health coverage instead of 

States with their own Marketplaces are: California, Colorado, Connecticut, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington. 

Universal Health Care:  Universal Health Care is a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay. When policymakers discuss expanding health care access, this is the broadest concept that they consider, i.e. Medicare for All is an example of universal health care.