Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition.
We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete Buttigieg (currently leading in the delegate count) and Bernie Sanders. Elizabeth Warren, Amy Klobuchar, and Joe Biden round out the top 5.
Health care remains the leading priority for voters. It occupies top billing in almost every stump speech. Each Democratic candidate has argued for health care in moral terms as a human right, and each has proposed to increase the role of government. The divide between candidates is mostly about how much government involvement and how to reduce costs.
President Trump looks set to be the Republican candidate, despite some challengers. He has decried drug prices, and yet he backs efforts to reduce coverage for millions. The administration is not defending current legal challenges to the Affordable Care Act (ACA). Moreover, his recent budget proposal includes $1.5 trillion in cuts over 10 years to Medicaid, mostly by adding new work requirements and getting rid of the ACA’s Medicaid expansion.
The Democratic candidates are talking about health care, but in different ways
In order of current delegate counts, here is a brief synopsis of the health care proposals of the top 5 candidates.
Pete Buttigieg
His approach is about choice. If you want private insurance you can have it. If you want a Medicare-like public option plan, you can have that instead. He calls his plan Medicare for All Who Want It. And it’s popular. It’s essentially Medicare-for-More, which I’ve described on this blog previously.
He would automatically enroll the uninsured in the public plan, and would offer greater financial help for people who buy insurance on ACA exchanges. His plan is essentially the same as he described in this helpful NPR interview from 2019. He would control prescription drug costs by allowing Medicare, Medicaid, and his Medicare-like public plan to negotiate drug prices. Private insurers can voluntarily adopt these same negotiated rates, but are not required to. This is combined with caps on out-of-pocket drug spending.
Bernie Sanders
He is arguably the face of the Medicare-for-All movement in the US. He argues for a single universal health insurance plan offered by the US government, much like (but actually not quite identical to) Medicare today. His plan is encapsulated by his refrain:
“We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right. All Americans are entitled to go to the doctor when they’re sick and not go bankrupt after staying in the hospital.”
There would be no copayments, deductibles, or other cost-sharing, and no real private insurance anymore. He would allow Medicare to negotiate prices of drugs, and plans to cap prices by indexing them to other major developed countries.
Elizabeth Warren
She is a Medicare-for-All supporter, but I would call her plan “the two step”. Her health care proposal moves in stages, first shoring up the ACA by increasing subsidies and then creating a public option. It’s like the plan offered by Buttigieg. But it goes further by covering all children and people with lower incomes for free, with freedom to opt-out.
She says this is a plan that could actually pass Congress in the first year. But she also has a plan (her catch phrase and day planner slogan) for how to get to Medicare-for-All. It relies on the public first seeing how good a public option could be before developing legislation for Medicare-for-All.
She also offers a bullish approach to lowering drug prices: letting the government make generic drugs itself when there is too little competition. In short, she has a public insurance plan and a public pharmaceutical company. Her plan starts roughly where Buttigieg’s ends, and may move to Bernie’s position over time.
Amy Klobuchar
Riding a New York Times co-endorsement with Elizabeth Warren, and a wave of enthusiasm that her campaign has branded the “Klobucharge”, her health care plans involve supporting the ACA and creating a public option using Medicare or Medicaid. Like Buttigieg and Warren, she proposes to help more people buy health care through subsidies. But most of her changes are technocratic, such as making it easier for states to have reinsurance programs against unpredictable costs.
She has clear plans to allow Medicare to bargain on drug prices, and she aims to close loopholes that allow drug makers to prevent generics from entering the market. She would also allow and encourage people to buy drugs from other countries. Her answer for whether these changes are sufficiently progressive is blunt: “Being a progressive, the last time I checked, meant that you should make progress, and I have done that and will do that as president.”
Joe Biden
In the original ACA, which Joe Biden helped move through Congress, there were plans for a public option. But that public option would only have been open to people who would buy their insurance on the exchanges. So if you had insurance from your employer, the public option was, well, not an option for you. That part of the law was dropped to get additional support from moderate democrats.
Biden says that bringing the public option back and making it available to everyone would be a big deal (or something to that effect). He too has proposals to increase subsidies for lower and middle-income families to buy insurance and to allow Medicare to negotiate drug prices. Importantly, he is one of the few candidates talking more deeply about limiting surprise medical billing (i.e. being charged for services provided by an out-of-network provider that you had no control over seeing, such as in a hospital).
From the primaries toward the general election
Health care has been on everyone’s mind in the first two primary states. It will be interesting to see how these candidates respond to voters’ concerns and shape their messages to particular voters. Will Buttigieg, Klobuchar, and Biden become more open to Medicare-for-All? Will Sanders be pushed to accept more incremental steps towards his larger goal? And will Warren’s early move to this middle ground work for or against her in the long-run? And when we reach the general election, how big a role will health care continue to play?
Gregory Stevens