Where do the Democratic Candidates Stand on Health Reform Where do the Democratic Candidates Stand on Health Reform? Published October 11, 2019

Where do the candidates stand on health reform? 12 democratic candidates in the October 15th debate NOTE: Candidate count as of 10/8/2019

A few caveats... These slides focus solely on the 12 candidates who qualified to be on the debate stage October 15th Some of the candidates’ positions are more detailed than others Positions are based on campaign websites, co-sponsorship of legislation in the 116th Congress

While the debate can be confusing, there are many different proposals with a public program or option Medicare-for-all (Sanders) ≠ Medicare-for-all (Harris) Medicare For All Who Want It Medicare for America Medicare-X Choice Choose Medicare Medicare at 50

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? Medicare-for-all Public Program with Opt Out Public Plan Option with ACA Improvements Has also supported a public plan option: SOURCE: Positions are based on co-sponsorship of legislation introduced in the 116th Congress (among current members of Congress) and campaign websites. Sources are available upon request. Downloaded as of 10/8/2019.

The scope of public programs or plans varies across proposals supported by the candidates More people All US residents ACA marketplace-eligible people plus people offered employer coverage, and others ACA marketplace-eligible people ACA marketplace-eligible, ages 50-64 Option for states (Medicaid buy-in) Less people SOURCE: Positions are based on co-sponsorship of legislation introduced in the 116th Congress (among current members of Congress) and campaign websites. Sources are available upon request. Downloaded as of 10/8/2019. Candidates listed in order of national polling average, available at:https://www.nytimes.com/interactive/2020/us/elections/democratic-polls.html

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

What happens to employer coverage? Employer-sponsored coverage is replaced by public program Employers can choose to offer a qualified Medicare Advantage plan No change, but employees can choose coverage under public plan option NOTE: Analysis 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 Adds out-of-pocket limit for Medicare (Parts A & B); Adds out-of-pocket limit for Part D All 12 candidates support proposals to address Medicare drug prices. NOTE: Analysis among candidates with their own proposal. Buttigieg would also enhance Medicare provider payment rates in underserved areas, eliminate co-payments on all generic and biosimilar drugs for low-income people in Medicare and improve access to mental health and substance use disorder treatment. Klobuchar and Sanders introduced legislation which would allow the Secretary to negotiate drug prices.

What happens to the current Medicaid program? Replaces Medicaid Modifies Medicaid Sanders retains Medicaid for nursing home & other institutional long-term care services and requires maintenance of effort for state institutional long-term care spending Harris includes a maintenance of effort for states that is tied more broadly to state Medicaid and CHIP spending Both would automatically enroll low-income adults in the Medicaid coverage gap into the public option; Biden also permits Medicaid expansion states to move covered adults into the public option with a maintenance-of-effort requirement Buttigieg also auto enrolls eligible individuals into Medicaid; ends Medicaid work requirements; and makes other changes to expand eligibility and covered benefits NOTE: Analysis among candidates with their own proposal.

Candidates do not specify use of 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 Caps out-of-network provider rates up to twice the Medicare rate for public plan; Increases Medicare reimbursement rates in rural areas, and encourages 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: Analysis among candidates with their own proposal.

12 democratic candidates in the October 15th debate Overall, differences among the Democratic candidates are far narrower than between Democrats and Republicans Repeal ACA Texas v. US: Administration supports striking down most ACA provisions Block grant Medicaid and reduce federal Medicaid spending Reduce access to health coverage for legal immigrants 12 democratic candidates in the October 15th debate