1. 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

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

3. 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

4. …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

5. (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

6. 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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. 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