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Health politics: 2020 hopefuls differ on more than insurance coverage

‘Medicare for All’ debate dominates, but candidates also vary on other issues, especially drug prices

The health care debate in the 2020 Democratic primary has focused primarily on the candidates’ plans for health insurance coverage. The issue, a top priority for voters, has been one of the most obvious differences between the candidates.

But the 2020 presidential contenders have introduced a wave of other health care plans, outlining proposals to lower prescription drug prices, help with long-term care and curb infectious disease outbreaks.

President Donald Trump has argued that his health care agenda is more wide-reaching than his approach to the 2010 health care law. The administration has proposed several plans meant to lower drug prices, although most of those proposals were stalled by the courts or later abandoned. The president also has put forward plans to slow the spread of HIV, and the administration has touted a decline in drug overdose deaths beginning in 2018.

While the “Medicare for All” debate over whether to shift the nation toward government-run health care has been the mainstay of the presidential debate so far — and an issue Trump is expected to stoke throughout his own campaign — other issues, especially drug prices, are also dominant themes on the campaign trail this year.

On issues such as drug pricing, it’s hard to find real differences between the Democratic candidates’ proposals, so that’s not an issue they stress as they compete for voters in party primaries, Democratic pollster Celinda Lake said.

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“They’re all essentially in the same place,” Lake said. “I think in the general election, Democrats will try to run hard on it.”

Prescription drug prices

Democrats are largely united on giving Medicare the power to negotiate prices with drug companies, but there are differences about other changes beyond that.

Vermont independent Sen. Bernie Sanders, for example, would set an annual $200 out-of-pocket maximum for pharmaceuticals. Former South Bend, Indiana, Mayor Pete Buttigieg’s plan would limit seniors’ out-of-pocket spending for drugs to $200 a month.

In 2018, Massachusetts Sen. Elizabeth Warren introduced a bill that would create a government agency to manufacture generic alternatives of high-cost drugs.

Minnesota Sen. Amy Klobuchar said in a January debate that she was open to looking at that option, but she would first take steps like allowing the reimportation of drugs from foreign countries. Sanders has also backed that step, and even made a campaign trip to buy insulin in Canada, where it is cheaper than it is in the United States.

The Trump administration also moved to allow states to import drugs from abroad. The Food and Drug Administration proposed a rule late last year, and a handful of states have expressed interest if the rule is finalized.

Warren and Klobuchar also said they would use existing executive power to lower drug prices immediately upon taking office. Warren has specifically pointed to using the government’s compulsory licensing authority to bypass patents and using the government’s “march-in” rights to relicense patents that were awarded to products developed with government financing.

Similar to Trump’s efforts, executive actions a Democratic president were to take to lower drug prices would likely be challenged in court.

Long-term care

Long-term care for severely ill and elderly Americans, often in nursing homes or other settings, has long vexed lawmakers. Congress in 1988 created a new benefit in Medicare to pay for it, but it was repealed just a year later after a backlash as some seniors said the costs outweighed the benefits. A part of the 2010 health care law that was meant to help people afford long-term care was one of the first parts of the law to be abandoned after its passage. When Washington Democratic Rep. Pramila Jayapal introduced the House Medicare for All bill last year, it was the first time a single-payer bill in Congress would cover long-term care.

Sanders and Warren’s Medicare for All plans would cover long-term care, but the candidates who haven’t backed Medicare for All are also talking about how they would tackle the issue.

Klobuchar has brought up the issue frequently, often referring to decisions she was involved in for her father’s care. She would create a refundable tax credit to make long-term care more affordable and allow a tax credit of up to $6,000 a year for family members or others who care for an aging or disabled relative. Similarly, former Vice President Joe Biden proposed a $5,000 tax credit for informal caregivers.

Buttigieg has proposed creating a benefit that would provide eligible seniors $90 per day for long-term care and said he would establish a government-run marketplace for private long-term care insurance and standardize long-term care plans.

Disease outbreaks

The outbreak of the coronavirus in China and concern about its spread in the United States prompted Klobuchar and Warren to release plans for combating the spread of infectious diseases. Both candidates called for recommitting to the Global Health Security Agenda, an initiative against infectious diseases that the Obama administration launched, and to “fully fund” agencies like the Centers for Disease Control and Prevention. Both also said they would work with allies and the World Health Organization to improve the infrastructure for beating infectious diseases.

Warren tied her plans targeting infectious disease outbreaks to broader proposals she’s put forward, like noting that fighting climate change could slow the spread of such diseases and that her Medicare for All blueprint would help incentivize the development of new drugs and vaccines to prevent and treat diseases.

Sanders’ campaign said in a statement to CQ Roll Call he also would fully fund the CDC and the National Institutes of Health.

In a January USA Today op-ed, Biden criticized Trump’s response to the coronavirus, noting that the president proposed budget cuts to agencies that fight infectious diseases and shut down a White House team focused on pandemics.

“As president, I will reassert U.S. leadership in global health security. My policies will always uphold science, not fiction or fearmongering,” Biden wrote.

Coverage plans

The candidates’ proposals for moving toward universal health insurance coverage differ primarily in how large a role the federal government would play in administering health insurance. Broadly, the candidates fall into two camps: those who support a single-payer system and would essentially eliminate private health insurance, and those who support establishing a government-run public option that would compete with private insurance.

Even so, the candidates in each camp have proposed unique plans. Sanders has vowed to introduce a Medicare for All bill in the first week of his term that would provide government-run insurance for everyone in the country. Warren says she would pass a generous public option in her first 100 days, but wait until the third year of her first term to enact single-payer legislation.

Biden, Buttigieg and Klobuchar have proposed similar plans to set up a public option insurance plan that would compete with private insurers. Klobuchar says her public plan would be based on either Medicare or Medicaid.

Both Buttigieg and Biden say they would allow people to opt out of coverage offered by their employer in favor of buying into the public plan, as could people who currently get their insurance on the individual marketplaces. Both also say they would increase the financial assistance that lower-income people receive to help make insurance coverage more affordable.

Buttigieg has said that people who don’t actively choose a plan would be automatically enrolled in the public plan.

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