By Abigail Abrams
Updated: July 31, 2019 9:53 PM ET | Originally published: June 28, 2019

The second Democratic primary debate on Thursday night saw an extended period of serious policy discussion on the future of the nation’s health care. While Medicare-for-all has been the rallying cry of those on the party’s left flank, the candidates on the stage were split, with most arguing against an immediate switch to a single-payer, national government health care program.

Early in the night, the debate moderators asked the candidates to raise their hands if they would eliminate private insurance. Only two hands went up: Vermont Senator Bernie Sanders and California Senator Kamala Harris. (Though Harris softened her stance on Friday, underlining the sensitivity with which Democrats are treating their positions on Medicare-for-all.)

As the candidates dug in to their positions, nuanced divides emerged and many challenged their competitors on the practicality of their various proposals. Here is everything we learned about the 2020 Democratic candidates’ health care plans from the debate.

Joe Biden

Before the debate: Before Thursday’s debate, Biden had not spoken as extensively about his plan for health care as many of his opponents had done. Early in his campaign, he said he supports a public option, and then this month his campaign said his plan would be free for low-income people in states that refused to expand Medicaid under the Affordable Care Act.

After the debate: The former Vice President spoke about his family’s tragic personal stories to underscore the importance of having health care during the debate. He did not dig deep into policy specifics, instead focusing on defending the Affordable Care Act. “The fact of the matter is that the quickest, fastest way to do it is build on Obamacare, to build on what we did,” Biden said. He also made clear that under his plan, everyone would have a choice to either buy private insurance or ” buy into the exchange to a Medicare like plan.”

Bernie Sanders

Before the debate: Sanders has been very clear on his Medicare-for-all plan, which would effectively eliminate private insurance and enroll all U.S. residents in a government-run health care program.

After the debate: Unsurprisingly, Sanders raised his hand when the moderators asked who would get rid of private insurance under their health care plan. He aggressively defended his plan when other Democrats criticized it during the debate, telling Colorado Senator Michael Bennet, who advocated for allowing people to keep private insurance, that “people don’t like their private insurance companies, they like their doctors and hospitals. Under our plan, people go to any doctor they want, any hospital they want.”

When the moderators asked Sanders at the beginning of the debate whether his plan would raise taxes on the middle class, he initially talked around the question, but then said yes. “People who have healthcare under Medicare-for-all will have no premiums, no deductibles, no copayments, no out-of-pocket expenses. Yes, they will pay more in taxes but less in healthcare for what they get,” Sanders said.

Kamala Harris

Before the debate: Harris is a co-sponsor of Sanders’ Medicare-for-all plan, and said during a CNN town hall earlier this year that she would like to eliminate private insurance. However, she has also co-sponsored other more moderate proposals, including ones that would create a public option for people to buy into Medicaid and that would lower Medicare’s eligibility threshold to 50 years old.

After the debate:

After equivocating on her health care stance during the first round of debates in June, Harris released a new health care proposal in July just ahead of the second set of primary debates. While still called “Medicare for all,” the Senator’s proposal tries to strike a more middle approach and separates her from Sanders’ plan in a few key ways, most notably in how she would handle private insurance.

Rather than eliminating private insurance, Harris would reach universal health care by creating a government-run system that still allows private insurers to compete with it. Under her plan, which would transition in over 10 years instead of the four years in Sanders’ plan, private insurers could offer plans if they met tightly regulated requirements, similar to how private insurers function in the current Medicare Advantage system.

The third major difference is that Harris says she would not use taxes on middle-class Americans to pay for her plan. While both Harris and Sanders have talked about using methods such as capital gains taxes, Sanders’ plan would tax households making $29,000 or more to pay for his plan, but Harris would only tax households making $100,000 or more.

Harris’ new plan immediately received criticism from all sides. Sanders’ campaign has said she should not be using the “Medicare for All” framing if she wants to keep private insurance while Biden and other moderates argued Harris is still trying to have it both ways and is avoiding taking a strong position on health care. During the second debate, Biden criticized Harris’ plan as too expensive while Harris focused on her goal of achieving health care for all Americans.

Pete Buttigieg

Before the debate: The South Bend, Indiana Mayor has said he supports “Medicare-for-all who want it.” While his preference is for a public option program, Buttigieg said in a response to the New York Times health care survey that he views Medicare-for-all as the ultimate goal. Even then, though, he sees a role for private insurance “on a supplemental basis.”

After the debate: Buttigieg stuck with his “Medicare-for-all who want it” phrasing during the debate and said offering a public option would create a “very natural glide path” to a single-payer health care system. He also doubled down on his support for maintaining private insurance.

“Let’s remember even in countries that have outright socialized medicine, like England, even there there’s still a private sector, that’s fine,” Buttigieg said. “It’s just that for our primary care we can’t be relying on the tender verses of the corporate system.”

Kirsten Gillibrand

Before the debate: Like several of her Senate colleagues running for president, Gillibrand is a co-sponsor of Sanders’ Medicare-for-all plan as well as other more moderate proposals. She has often said she believes a single-payer system is the best way to ensure universal health care, but believes private insurance will naturally be driven out of the market because it will not be able to compete with Medicare-for-all.

After the debate: When the debate moderators asked candidates to raise their hands if they would abolish private insurance, Gillibrand notably did not. The New York Senator explained that she supports Medicare-for-all, but as she has said in the past, she views the four years of transition in Sanders’ bill as vital to its success.

“The plan that Senator Sanders and I and others support, Medicare-for-all, is how you get to single payer. But it has a buy-in transition period, which is really important. In 2005 when I ran for Congress in a two-to-one Republican district, I actually ran on Medicare-for-all and I won that two-to-one Republican district twice. And the way I formulated it was simple: Anyone who doesn’t have access to insurance they like, they could buy it in a percentage of income they could afford,” she said.

“What will happen is people will choose Medicare. You will transition. We would get to Medicare-for-al. And then your step to single payer is so short,” she added.

Michael Bennet

Before the debate: The Colorado Senator has proposed a public option plan known as Medicare X, which he drafted with Virginia Senator Tim Kaine. It would allow people to buy into a public option program, which would expand over time, or keep their private insurance. Bennet has emphasized that polling shows many Americans are satisfied with insurance through their employer and would like the option to stick with that.

After the debate: Bennet remained consistent at the second debate and clashed with Sanders as he criticized the Vermont Senator’s Medicare-for-all plan and promoted the idea of choice.

“I feel very strongly that families ought to be able to have this choice. I think that is what the American people want,” Bennet said, noting that most private insurance would not exist under Sanders’ plan.

“I will say Bernie is a very honest person. He has said over and over again unlike others that have supported this legislation over and over again that this will band making it illegal all insurance except cosmetic, except insurance for I guess that’s where plastic surgery,” Bennet continued. “Everything else is banned under the Medicare-for-all proposal.”

Andrew Yang

Before the debate: Yang favors moving to a Medicare-for-all system. Similar to Gillibrand, Yang doesn’t want to eliminate private insurance, but believes it would no long be “economically viable” once it was competing with Medicare-for-all. The entrepreneur also said that he sees a public option as a positive step in the transition toward Medicare-for-all.

After the debate: Yang did not talk about health care during the debate.

John Hickenlooper

Before the debate: Hickenlooper supports universal health care, but he does not think Medicare-for-all is the best way to get there. While on the campaign trail, he has said he does not believe backing Medicare-for-all should be a litmus test for candidate viability and has pointed out that many Americans are happy with the private insurance they have now.

After the debate: Hickenlooper did not delve deeply into health care during the debate, but did stick with his view that universal health coverage can be achieved without committing to Medicare-for-all. When the moderators asked Hickenlooper about his previous comments warning the Democrats against embracing socialism, he said that he was wary of policies that would allow Republicans to call a Democratic candidate a socialist. “We can’t promise every American a government job if you want to get universal healthcare coverage. I believe that healthcare is a right and not a privilege, but you can’t expect to eliminate private insurance for 180 million people, many of whom don’t want to give it up.”

Eric Swalwell

Before the debate: Similar to Buttigieg, Swalwell has said he supports “Medicare-for-all who want it.” He has said he does not want to get rid of private insurance, but would use the public option to put pressure on private insurers to offer more affordable plans. “Americans should have a choice between coverage provided by private companies and that provided by the government,” he told the Times.

After the debate: Swalwell did not talk much about health care during the second debate. He did weigh in on one question, saying he wanted to stand up to insurance companies and ensure people could access care, without going broke.

Marianne Williamson

Before the debate: Williamson had said she wants “high-quality universal health coverage for every American” and supports a public option. “Those who wish to keep their private insurance may do so,” she said on her website.

After the debate: During the debate, Williamson stuck with her support for a public option, but she also dismissed the detailed plans that many of her fellow candidates were debating.

“It’s really nice if we got all these plans but if you think we are going to beat Donald Trump by just having all of these plans, you’ve got another thing coming because he didn’t win by saying he had a plan. He won by simply saying make America great again,” she said.

Write to Abigail Abrams at abigail.abrams@time.com.

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