Concerns about how Americans pay for medical care likely will be a dominant theme in the 2020 elections and beyond. While the federal Medicare program provides coverage for those age 65 and older, other Americans worry they will be unable to afford treatment for serious illnesses, even if they have private insurance. As stories spread about high medical costs bankrupting families, lawmakers and policy experts are debating whether the federal government, already the nation's largest purchaser of health care, should expand its role. There is bipartisan interest in finding ways to lower prescription drug costs and protect patients against unexpectedly high hospital charges. But the two parties divide over proposals by Democratic presidential candidates for increased government control, such as Sen. Bernie Sanders' call to replace private insurance with a single-payer plan. Some Democrats suggest more limited approaches, such as creating a public option to compete with private insurers. Republicans defend private insurance, saying it is the most effective way to manage costs.