The plan consisted of two parts: an estimate of what single-payer, government-run health care would cost and how Warren would pay for it without raising “one penny” of taxes on middle-income Americans.
“That’s right: We don’t need to raise taxes on the middle class by one penny to finance Medicare for All,” Warren wrote.
Warren has been pressed numerous times before on how exactly her administration would plan to pay specifically for her vision of Medicare for All. The senator from Massachusetts has consistently pivoted to the cost for American families, providing nearly identical answers in the last two debates, on late night talk shows and in response to reporters’ questions. On Friday, she addressed the specifics of that cost.
Warren’s plan pulls more than $20.5 trillion in funds for Medicare for All over ten years by calling for budget cuts and increased regulation across far-reaching corners of the U.S. economy. She proposes tightening up tax loopholes on the rich, taxing financial companies more, making money off of comprehensive immigration reform and cutting military spending.
The plan also increases taxes on billionaires, going $3 trillion deeper into the pockets of the wealthy than she has already proposed.
The new proposal includes a tax of six cents on every dollar over $1 billion a person has in wealth, which is double what she previously proposed as part of her wealth tax and would generate another $1 trillion of revenue over ten years, according to the plan. Warren also proposed implementing a yearly capital gains tax, rather than a tax that would have to be paid only once at the time an heir offloads assets, which the campaign estimates would generate another $2 trillion over ten years.
The majority of the funding, however, would come from employers. Warren proposes asking employers to pay slightly less than what they are already paying to provide private health care for their employees and instead pay it to the government, “ensuring that every company paying for health care today will pay less than they would have if they were still offering their employees comparable private insurance.”
This, Warren’s campaign estimated, would generate around $8.8 trillion over 10 years, or about half of her expected cost.
“Existing total private sector employer contributions to health insurance will continue in the form of contributions to Medicare -- but employers would be better off because under the design of my plan, they’d pay less than they would have otherwise,” Warren wrote.
In a nod to labor unions, Warren also proposed that employers give union members back money out of their paychecks that they were previously putting toward health care and allow those employees to then pay less to the government for Medicare contributions.
The plan suggested passing along those savings to workers “in the form of increased wages, pensions, or other collectively-bargained benefits.”
Then, about 5% of the funds necessary in Warren’s plan would come from cutting defense spending and achieving immigration reform -- two revenue streams that would be contingent upon making their way through Congress. Immigration reform, in particular, has faced years of back-and-forth on Capitol Hill without much movement.
The plan, though 20 pages long, leaves some questions still to be answered.
For example, while Warren estimates that cutting tax loopholes and cracking down on fraud would generate trillions in revenue, she also acknowledges it would require the government to “substantially increase funding for the IRS,” but does not provide a figure.
Some of Warren's competitors in the 2020 Democratic primary field were quick to dissect the numbers behind the plan Friday, deeming it "unrealistic" and "not believable."
Former Vice President Joe Biden's campaign called the plan "mathematical gymnastics" in a statement from deputy campaign manager Kate Bedingfield. The campaign also painted the $8.8 trillion in revenue that would come from employers as essentially a tax that would be passed on to employees.
“For months, Elizabeth Warren has refused to say if her health care plan would raise taxes on the middle class, and now we know why: because it does. Senator Warren would place a new tax of nearly $9 trillion that will fall on American workers,” Bedingfield said.
Sen. Michael Bennet, a Democratic 2020 candidate from Colorado, has also been a frequent critic of Warren and Sanders over Medicare for All and called the numbers in Warren's plan "simply not believable."
"Voters are sick and tired of politicians promising them things that they know they can’t deliver. Warren's new numbers are simply not believable, and have been contradicted by experts. Regardless of whether it's $21 trillion or $31 trillion, this isn't going to happen, and the American people need health care," Bennet said in a statement.
But as Warren faced criticism for the plan, she also had backing from advocates of Medicare for All like Rep. Pramila Jayapal, D-Wash., who introduced a Medicare for All bill on the House side.
Warren "puts all the #MedicareForAll naysayers to shame by outlining a financing plan that shows we CAN & MUST provide quality guaranteed healthcare to everyone while reducing costs," Jayapal tweeted.
Ady Barkan, a friend of Warren's and an outspoken advocate for Medicare for All, called the plan "the greatest piece of public policy jiu-jitsu that I have ever seen."
"But more importantly, it is a landmark moment in our multigenerational struggle for health care justice," he tweeted Friday.
Warren, who has had her name on the Medicare for All bill since its inception two years ago and who has been campaigning on the promise of Medicare for All for nine months, has been asked increasingly by journalists and voters over the steady rise of her campaign about how she would pay for an overhaul of the nation’s health care system and whether it would mean a tax hike for America’s middle class.
As recently as Wednesday, a retired school teacher from Warren’s own state of Massachusetts took the microphone during a Q&A portion of a campaign stop in New Hampshire to tell Warren that she and her friends “came up here looking for more specifics on your health care plan.”
“You asked the question quite reasonably … how much is it going to cost and how are we gonna pay for it? Something I’ve been working on for a while, and I’m gonna put out a plan on it. You can see all the numbers,” Warren said then.
Warren first announced that she would be putting a plan out to specifically address those two questions about two weeks ago. She made the announcement on the heels of last month’s Democratic debate, when she was attacked by multiple candidates on stage for her ambiguity about being “with Bernie [Sen. Bernie Sanders]” on Medicare for All but not saying that taxes would go up, which is part of his plan.
Though Sen. Bernie Sanders, the 2020 candidate from Vermont who wrote the Senate bill outlining Medicare for All, so far has only released “options” and not the exact details of how it would be funded, he has been open about the fact that Americans are “going to pay more in taxes.”
Sanders, like Warren, argues that eliminating premiums, deductibles and co-pays would mean that total spending on health care for American families would go down, but noted in the fourth Democratic primary debate that it’s "appropriate to acknowledge that taxes will go up."
"Well at least that's a straightforward answer,” South Bend, Indiana, Mayor Pete Buttigieg, who supports a health care plan with both public and private options, responded.
The following day, Biden called Warren out for having a plan for everything but Medicare for All funding. Biden, like Buttigieg, has called his idea for health care reform “Medicare for all who want it.”
Addressing her 2020 competitors' doubts, Warren’s new pay-for plan includes a direct clap-back to those who have criticized her for both supporting Medicare for All and for withholding details.
“Not every candidate for president supports moving to a system of Medicare for All,” Warren wrote. “But you don’t get what you don’t fight for -- and my view is clear.” Warren devotes five paragraphs to it in the 20 page plan, going on to challenge her fellow 2020ers to ante up their own ideas, if they don’t agree with hers.
“Or, if they are unwilling to do that, concede that their half-measures will leave millions behind,” she wrote.
“And make no mistake -- any candidate who opposes my long-term goal of Medicare for All and refuses to answer these questions directly should concede that they have no real strategy for helping the American people address the crushing costs of health care in this country. We need plans, not slogans.”
Warren and Sanders make up the small minority of the 2020 field that supports Medicare for All full-throatedly. Sens. Amy Klobuchar of Minnesota, Kamala Harris of California and Cory Booker of New Jersey, along with Buttigieg and Biden, have put their support behind health care plans that would not fully eliminate the private insurance market.
Biden’s plan, for example, relies heavily on building off of the Affordable Care Act, which was implemented under his and former President Barack Obama’s administration. His plan would cost $750 billion over 10 years and would be covered by reversing President Donald Trump’s tax cuts for the wealthy, increasing taxes on the wealthy, and getting rid of the capital gains tax loophole for wealthy families with incomes greater than $1 million a year.
Buttigieg has said a single-payer health care system is “the right place for us to head as a country” but stops short of the vast restructuring called for by Sanders and Warren. Buttigieg emphasizes individual preference, allowing for both employer-sponsored and individual private insurance, and an optional government plan in which uninsured people would be automatically enrolled.
All of the candidates will be in the same place on Friday when they attend the Iowa Democratic Party’s largest event yet. For Warren, she will debut her plan in the same state in which she initially announced she would be releasing it -- a politically divided state that polls show is not yet sold on the idea of Medicare for All.
ABC News' Molly Nagle contributed to this report