Universal Health Care Was Big on the 2020 Democratic Platform. Where Is It Now?

Part of the Series

Fighting for Our Lives: The Movement for Medicare for All

The last time the Democratic Party released a platform, mass death and illness were haunting the political landscape. By mid-August 2020, more than 160,000 United States citizens had died from COVID-19, and the daily mortality rate had just climbed above 1,000. Vaccines were still months away from being available, and nationwide cases exceeded 5.4 million. Inundated with corpses, hospitals around the country deployed “mobile morgues.”

That summer, against a backdrop of global crisis, the Democratic National Committee unveiled bold new language on health care, pledging to “at last build the health care system the American people have always deserved.” A special chapter of the platform, titled, “Achieving Universal, Affordable, Quality Health Care,” was devoted to outlining a slew of reforms, including a plan to introduce a universal public insurance option through the marketplace set up in the Affordable Care Act.

That platform was itself a compromise with progressives, such as Sen. Bernie Sanders (I-Vermont), who had pushed for a single-payer system and the elimination of private insurance through Medicare for All during his popular campaign for the Democratic presidential nomination that year. In 2024, however, it appears that the Democratic Party has abandoned even its watered-down ideals.

The draft Democratic platform for this election cycle, obtained by Politico in July, contains no mention of the phrases “public option” or “universal health care.” In fact, although polls have shown that health care affordability remains a top concern for voters, the issue does not even receive its own chapter. Instead, “Health Care & Prescription Drugs” is just one of several bullet points under a chapter with the milquetoast title, “Lowering Costs.”

The platform obtained by Politico is not set in stone. Notably, it was written when President Joe Biden was still the presumptive nominee, and much of the text focuses on his record as president. While Vice President Kamala Harris signed on to the Sanders-sponsored Medicare for All Act as a senator in 2017, her current position on health care remains vague. Harris campaign aides recently told reporters that she no longer backs Medicare for All, and it seems unlikely that her platform will deviate substantially from the Biden administration’s positions. As a result, the draft offers the best insight into what we can expect to see next week, when delegates convene at the Democratic National Convention to vote on an ​​official party platform.

The 2024 platform is heavy on fluffy language — mostly touting the Biden administration’s past accomplishments — but light on specifics.

“Health care should be a right in America, not a privilege. Every American deserves the peace of mind that quality, affordable coverage brings,” the 2024 platform states. Democrats pledge to continue to fight for the expansion of the Affordable Care Act (ACA), noting that, today, “more Americans have health insurance than ever in history.” A record number of people signed up through the ACA after the passage of the American Rescue Plan Act of 2021, in which the Biden administration made more Americans eligible to receive tax credits to offset the costs of premiums. These temporary enhanced subsidies were renewed once, in the Inflation Reduction Act, but are now set to expire in 2025. In the platform, Democrats pledge to renew the tax credits and fight Republican efforts to let them end.

These perpetually precarious subsidies are a far cry from Medicare for All or a real public option. And while it’s true that the United States has seen a streak of record-low uninsured rates since Biden took office, earlier this month, the Centers for Disease Control and Prevention announced the number of uninsured Americans rose during the first months of 2024, bucking the trend.

“Low-income Americans will be automatically enrolled in the public option at zero cost to them, though they may choose to opt out at any time,” Democrats promised in their 2020 platform. That public option was supposed to include “at least one plan choice without deductibles” and would “cover all primary care without any co-payments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people.” There is no mention of such an option in the 2024 plan.

“Whatever Happened to Biden’s Public Option?” KFF Health News asked in article published this April. The piece noted that, despite coming out strong for a “public option” on the campaign trail, Biden didn’t utter the phrase once after December 2020.

There are some promises from the 2020 platform that held true. The Biden administration announced new actions to prevent surprise medical bills, negotiated lower Medicare prices for 10 prescription drugs, and capped insulin co-pays at $35 for Medicare recipients.

Nevertheless, exorbitant health care costs continue to trouble most Americans: Average premiums for an employer-provided family health insurance plan reached $23,968 in 2023, a 7 percent increase that outpaced the rise of both wages (5.2 percent) and inflation (5.8 percent). According to a February 2024 KFF Health Tracking Poll, 74 percent of adults are worried about affording unexpected medical bills.

Medical debt, which is associated with poorer health and increased mortality rates, declined from 2020 to 2022, but 41 percent of adults still report having it. Americans owe an estimated total of $220 billion in medical debt, with about 3 million people owing more than $10,000. And even though Democrats’ sense of urgency has evidently waned, COVID-19 is far from eradicated, with roughly 600 people still dying from the virus every day.

The 2024 draft platform is a depressing reversal from what was already a modest concession for progressives. Still, it was popular pressure that got a nod to universal health care on the 2020 platform in the first place. As Harris fine-tunes her campaign messaging, now is the time for a renewed, sustained push to remind Democrats of their own words: “Health care should be a right in America, not a privilege.”