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WASHINGTON, D.C. — America’s much-maligned health care system is covering 9 out of 10 people, a fact that hasn’t stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders’ call for replacing private insurance with a government plan to President Donald Trump’s pledge  to erase the Affordable Care Act and start over.

The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced.

Government surveys show that about 90% of the population has health insurance coverage, largely preserving gains from President Barack Obama’s years. Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.


Lack of coverage was a growing problem in 2010 when Democrats under Obama passed his health law. Now the bigger issue seems to be that many people with insurance are struggling to pay their deductibles and copays.

“We need to have a debate about coverage and cost, and we have seen less focus on cost than we have on coverage,” said Colorado Sen. Michael Bennet. He is among the Democratic presidential candidates who favor building on the current system, not replacing it entirely, as does Sanders. “The cost issue is a huge issue for the country and for families,” Bennet said.


A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are “underinsured,” a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes. The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That’s about a 50% increase, with the greatest jump among people with employer coverage.

“When you have 90% of the American people covered and they are drowning in their health care bills, what they want to hear from politicians are plans that will address their health care costs, more than plans that will cover the remaining 10%,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan research organization that tracks the health care system. “When Democrats talk about universal coverage more than health care costs, they are playing to the dreams of activists and progressives … much less to the actual concerns of the 90% who have coverage today.”

Sanders’ office responds that the Vermont senator’s “Medicare for All” plan would solve both the coverage and cost problems for individual Americans. Medical care would be provided with no deductibles or copays. No one would be uninsured or underinsured.

“The simple answer is that our health care system becomes more unmanageable for more and more Americans every year,” Sanders spokesman Keane Bhatt said in a statement. “This is not a system that needs a few tweaks. This is a system that needs a complete overhaul.”

But other countries that provide coverage for all and are held up by Sanders as models for the U.S. don’t offer benefits as generous as he’s proposing. If he is elected president, there’s no way of telling how his plan would emerge from Congress, or even whether something like it could pass.

Four other 2020 Democrats are co-sponsors of Sanders’ bill: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts.

On the other side of the political spectrum, Trump is talking about big changes. His administration is seeking to have federal courts declare the entire Obama-era health care law unconstitutional, jeopardizing coverage for 20 million people, jettisoning protections for patients with preexisting conditions, and upending the rest of the 970-page statute, now nearly 10 years old.

The president says there’s nothing to worry about. Earlier this summer Trump told ABC News that he was working on a plan that would provide “phenomenal health care,” protect people with preexisting conditions, and would be “less expensive than ‘Obamacare’ by a lot.”

White House spokesman Judd Deere said in a statement that the Obama law was “sold and passed on a litany of broken promises” and now “Democrats are proposing even more radical government takeovers of our health care system.”

As president-elect, Trump promised a health plan but never offered one upon taking office. Instead he backed bills from congressional Republicans, including one he called “mean” during a private meeting.

Trump says he might come out with his new plan within months, but that passing it would hinge on his getting reelected and Republicans winning back the House in 2020 while keeping control of the Senate.

That’s a bit of political deja vu.

Republicans controlled Washington back in 2017 when Trump, then-Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky., tried for months to repeal and replace the Obama law, only to fail. The repeal effort was widely seen as contributing to Republicans losing the House in 2018.

Since then, many GOP lawmakers have tried to avoid the issue altogether.

Economist Sara Collins of the Commonwealth Fund, who led the study about underinsured Americans, says cost and coverage problems are intertwined. Citing the Democrats’ debate over Medicare for All, she says what’s missing from that discussion is that “one doesn’t have to go that far in order to improve the financial situation for millions of people — you can do that with much more targeted, incremental policies.”

  • Unfortunately it appears most Trump supporters do not understand Trump has NOTHING to do with today’s U S economy, he inherited today’s economy from Obama. Please review the latest major economic indicators report from the U S Bureau of Labor Statistics: . Show us a graph line that is NOT following the now 10 year Obama recovery line, or weakening, from the Republican Great Recession? Hint there are none. Obama inherited a collapsed Republican economy and Bush’s last budget $1.4 trillion in deficit. Over his 8 year term Obama reduced the annual deficit an average 11% per year while putting the collapsed American economy back on its feet. Now Trump and Republicans, due mainly to their always failed one horse economic idea, massive tax breaks for the rich, for average Joe, Jane, and now their family to repay, have increased the national deficit an average 15% year which appears to be increasing into the future. This despite their trillion dollars a year deficit increase, as anyone that took Econ 101 knows, that stimulates the economy. Where would the Republican economy be if they were not artificially juicing it with a trillion dollars a year deficit? It’s not just that Trump, the proven Presidential serial liar of all time is lying, but that he and most Republicans have absolutely no clue about the history or the how and why of today’s economy.

    • What a bunch of hogwash that is. President Trump has improved on the condition of just about everything since he was elected, despite the overwhelming opposition to everything he does. He and the republicans have amazingly brought in business, jobs, choice of healthcare, a rebuilt military, protections for veteran care, lowered prescription price some, while trying to keep us safe from the sloppy immigration rules and open borders under Obama.

  • I’m still waiting for Trump’s fantastic, awesome, amazing plan that’ll protect people with preexisting conditions and lower costs that he’s been promising for years. I’m not holding my breath.]

    The ACA is far from perfect. But it’s better than the train wreck we had before. I’m sure if Trump had come up with the ACA, it would have been amazing and fantastic and all the other adjectives he uses. It come down to the fact he hates Obama and the democrats. It has nothing to do with the law.

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