Democratic Sen. Bernie Sanders has a new and improved version of his Medicare for all plan. His vision for government-run health care for every American now includes long-term care for seniors and the disabled, and a few other tweaks. The 2020 presidential candidate also proposes some general ways to pay for the costly plan, such as new taxes on the wealthy, big banks and some other businesses.

The bigger news, however, is that Medicare for All now has a lot of competition. With health care continuing to be a top voter concern, Congressional Democrats have rolled out a range of proposals for making care cheaper and easier to obtain, without the huge tax hikes and massive disruption – and voter heartburn – Medicare for all would entail.

Sanders’ MFA plan—supported by at least 7 other presidential candidates—would eliminate the private insurance system through which 175 million Americans get coverage. Employers would no longer provide insurance for their workers, with everybody moving into the government plan. A surge of newly covered patients could stress the system and create long waits for some care. Doctors would get paid less, which might draw some would-be caregivers into other fields. Nobody knows if patients would be able to keep their doctors or be forced to see whoever’s available.

A Sanders-style plan would boost federal health care spending from $1.1 trillion per year to 3.5 trillion per year, according to a new analysis from Rand. That would require big tax hikes. But employers and individuals would no longer pay for health care, and it’s possible the nation might get more bang for the buck from a single national program with enhanced purchasing power. Still, the transition to a national program would produce many losers—starting with millions of insurance-company workers and others who’d lose their jobs—which makes the idea politically explosive and probably untenable.

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But there’s also a bill called the Medicare X plan that would establish a new federal plan for people who can’t find affordable private-sector coverage, while leaving the employer-sponsored market alone. Enrollees would pay premiums covering most of the cost, with no need for major tax hikes. The Choose Medicare Act would create a new program called Medicare Part E for anybody who doesn’t currently qualify for a federal program, which would also leave the private system in place and require enrollees in the new program to pay premiums. Another plan would let states offer Medicaid to anybody, with enrollees above certain income threshold paying premiums.