Where do the Democratic Candidates Stand on Health Reform? A quick primer for the September 12th Debate Tricia Neuman, ScD Senior Vice President and Senior Advisor to the President Director, Program on Medicare Policy

Where do the candidates stand on health reform? Ten democratic candidates in the September 12th debate

A few caveats... These slides focus solely on the 10 candidates who qualified to be on the debate stage September 12th Some of the candidates’ positions are more detailed than others Positions are based on campaign websites, public co-sponsorship of legislation introduced in the 116th Congress and public statements

…It’s easy to understand why the general public is confused Many health reform proposals sound alike... …It’s easy to understand why the general public is confused Medicare-for-all (Sanders) ≠ Medicare-for-all (Harris) Medicare-for-all-who-want-it Medicare for America Medicare-X Choice Act Choose Medicare Act Medicare at 50

(Medicare for America) Public Plan Option with ACA Improvements Which candidates are for Medicare-for-all versus a public plan option with ACA improvements, or something in between? Public Program with Opt Out (Medicare for America) Public Plan Option with ACA Improvements Medicare-for-all Has also supported a public plan option: NOTE: Castro supports universal coverage but has not endorsed a specific proposal

The scope of the public program or plan varies across proposals supported by the candidates More people All US residents ACA marketplace-eligible people plus people with employer coverage, and others ACA marketplace-eligible people ACA marketplace-eligible, ages 50-64 Option for states (Medicaid buy-in) Less people NOTE: Castro supports universal coverage but has not endorsed a specific proposal

Would Medicare-for-all eliminate private insurance? Yes, eliminates virtually all private insurance No, retains significant role for insurers to offer private Medicare Advantage plans NOTE: Among candidates with their own proposal.

What happens to employer coverage? Employer-sponsored coverage is replaced by public program Employers can choose to offered a qualified Medicare Advantage plan No change, but employees could choose coverage under public plan option NOTE: Among candidates with their own proposal.

What happens to the current Medicare program? Enhances Medicare benefits and lowers out-of-pocket costs No change to Medicare, other than for drug prices Enhances Medicare provider payment rates in underserved areas Sanders, Harris, and Biden would give the Secretary the authority to negotiate drug prices for people covered by Medicare. NOTE: Among candidates with their own proposal.

What happens to the current Medicaid program? Replaces Medicaid Modifies Medicaid Sanders includes a maintenance of effort for state institutional long-term care spending. Harris includes a maintenance of effort that is tied more broadly to state Medicaid and CHIP spending Biden allows low-income adults in the coverage gap, in states that did not elect the Medicaid expansion, to enroll in the public program; also permits Medicaid expansion states to move covered adults into the public program with a maintenance of effort Buttigieg increases Medicaid maternal health coverage for one year post-partum; encourages states to increase Medicaid reimbursement rates NOTE: Among candidates with their own proposal.

Would the candidates use Medicare rates to pay hospitals, doctors and other health care providers? The public option, like Medicare, will negotiate prices with providers, providing a more affordable option for many Americans… The Secretary establishes a fee schedule in a manner consistent with the processes for determining payments made under Medicare Increase Medicare reimbursement rates in rural areas, and encourage states to increase Medicaid reimbursement rates—for providers working in medically underserved areas My plan recognizes that doctors, nurses, and your entire health care team… be paid at appropriate rates under my plan NOTE: Among candidates with their own proposal.

Democratic candidates generally agree about moving toward universal coverage, but differ on issues that could get attention in the general election How best to make health care more affordable The size & role of a new government-administered public program or plan The optimal role for private insurers Potential changes to the current Medicare and Medicaid programs Whether providers would be paid Medicare or commercial rates

Ten democratic candidates in the September 12th debate The differences among the Democratic candidates are far narrower than between Democrats and Republicans Ten democratic candidates in the September 12th debate Repeal ACA Block grant Medicaid and reduce federal Medicaid spending Texas v. US: Administration supports striking down most ACA provisions New proposal may be forthcoming