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

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

3. 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

4. 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

5. 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.

6. 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:

7. 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.

8. 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.

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
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.

10. 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.

11. 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. 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