Elizabeth Warren has struggled to explain her healthcare overhaul's impact on the middle class. That's because key details are still missing.

AP Photo/John LocherDemocratic presidential candidate Sen. Elizabeth Warren, D-Mass., speaks during a gun safety forum Wednesday, Oct. 2, 2019, in Las Vegas
  • Democratic candidate Sen. Elizabeth Warren has championed Medicare for All on the campaign trail, repeatedly saying she’s “with Bernie” on a plan that would extend universal healthcare coverage to every person in the United States and virtually abolish private insurance.
  • Though detail-oriented on the campaign trail, Warren has struggled to explain her version of Medicare for All’s impact on the middle class, particularly whether taxes would be raised and how that would be structured.
  • She’s consistently declined to elaborate whether she would raise middle class taxes to help finance her proposed overhaul.
  • Sensing weakness in a robust fundraiser gaining momentum as a frontrunner, Warren’s primary rivals are pouncing and attacking her lack of specificity on a key issue for Democratic voters.
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Democratic candidate Sen. Elizabeth Warren has championed Medicare for All on the campaign trail, repeatedly saying she’s “with Bernie” Sanders on a plan that would extend universal healthcare coverage to every person in the United States and virtually abolish private insurance.

The Massachusetts senator also fended off criticism for not rolling out a healthcare plan of her own.

Though detail-oriented on the campaign trail, Warren has struggled to explain her version of Medicare for All’s impact on the middle class, particularly whether taxes would be raised and how that would be designed.

She’s consistently sidestepped questions on whether she would raise middle class taxes to help finance her proposed overhaul, as she did at Tuesday night’s fourth Democratic debate.

Read more: Democratic candidates go after Elizabeth Warren over how much her Medicare for All plan will cost at Ohio debate

“I have made clear what my principles are here. Costs will go up for the wealthy and for big corporations,” Warren said in response to a yes-or-no question about a middle-class tax hike. “And for hardworking middle-class families, costs will go down.”

Sensing weakness in a robust fundraiser gaining momentum as a frontrunner, Warren’s primary rivals are pouncing and attacking her lack of specificity on a key issue for Democratic voters.

“I don’t want to pick on Elizabeth Warren but this is ridiculous, absolutely ridiculous,” former Vice President Joe Biden told reporters in Ohio Wednesday. “It’s fascinating that the person who has a plan for everything has no plan for the single most consequential issue in this election in the minds of the American people across the board.”

Read more: Elizabeth Warren says she’s got a detailed plan for almost everything, but she still lacks specifics on Medicare for All

Warren characterised Medicare for All as “a framework” that “doesn’t have the details” during a New Hampshire campaign swing, the Wall Street Journal reported. How she goes about crafting a structure around that framework will ultimately determine whether the middle class ends up paying more for their healthcare.

“A Medicare for all plan could be designed so that many people, including those who are middle class, pay less in taxes than they are paying now in premiums, deductibles, and copays,” Executive Vice President for Health Policy at the Kaiser Family Foundation Larry Levitt recently tweeted. “It depends entirely on the details.”

Then Levitt said in a follow-up tweet, “The key details that determine whether a Medicare for all plan would lead to middle class people paying less: How much health care prices are driven down and which taxes go up to pay for the plan.”

Tax hikes are likely needed to pay for Medicare for All

Many experts agree that such an expansive proposal would require a tax hike to pay for its significant cost.

John Holahan, a health policy expert at the nonpartisan Urban Institute, told the Washington Post that “even though high-income people are going to pay a lot more, this has to hit the middle class.”

The Urban Institute published a report Wednesday estimating that Medicare for All would ramp up federal spending by $US34 trillion over a decade.

The report concluded that in a plan that resembles universal coverage, “higher-income people will likely face the greatest increases in taxes, meaning their new tax burdens would likely exceed their savings; the reverse is likely true for lower-income populations.”

Read more: A new poll found the aggressive Medicare for All plan Bernie Sanders has championed is getting less popular as time goes on

Sanders – Warren’s main progressive rival – readily acknowledges that he would raise taxes on the middle class to finance Medicare for All. He’s floated among the financing options a four per cent income-based premium on employees and exempting the first $US29,000 of income for a family of four, and a 7.5 per cent payroll tax that employers would pay.

But the Vermont senator tempers that by arguing overall healthcare costs would go down as a result of doing away with premiums, deductibles, or other out-of-pocket costs. Warren echoed that point as well.

The Kaiser Family Foundation estimates that American families pay around $US6,000 a year in annual premiums alone.

Bernie SandersMatthew Putney/AP2020 Democratic presidential candidate Sen. Bernie Sanders pauses as he speaks during a rally, Saturday, March 9, 2019, at the Iowa state fairgrounds in Des Moines, Iowa.

Yet key details are still missing from his plan. The Sanders Medicare for All plan doesn’t indicate how it would pay hospitals, doctors and other key providers of medical care. It also depends whether more people use health care services, which would increase the program’s price tag, and whether it streamlines billing and administering duties – and reduce costs.

Support is softening for Medicare for All, according to an ongoing poll from Kaiser, which helps explain why some other candidates such as Sen. Kamala Harris who previously embraced the plan have turned away from it. Voters have grown sceptical of some of the possible trade-offs involved, particularly on ending private health insurance.

But in the end, candidates like Warren bear the burden explaining a plan that does draw support among a substantial chunk of voters.

“Medicare-for-all does appeal. It’s just how we’re going to pay for it,” 37-year-old voter Yul Owens told the Post. “As long as somebody has a plan for how we’re going to fund these things, there’s not a problem at all.”

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