Healthcare

Healthcare policy is increasingly one of the most contentious issues in American politics. The major parties are far from aligned - and even within the parties, there is a wide spectrum of thought on who should pay for healthcare, how much they should pay, how people should access care, and how to expand coverage.

Broadly speaking, differences in healthcare policy run the gamut on the spectrum of free market vs. government intervention. Traditionally, Republicans have favored a free market approach, and Democrats have advocated for government intervention. But this simple party breakdown is becoming increasingly complex as the Democratic Party fractures into a “moderate” segment (the Joe Bidens of the Demcratic Party), and their more “progressive” counterpart (think the AOCs and Bernie Sanders’).

We're breaking down the top issues in healthcare to know in 2020.

The Basics

1. Medicare for All

At the most basic level, Medicare is a government-run health care program for Americans aged 65 and older and those with disabilities, with low or no monthly premiums. It allows for those in Medicare to buy into government-subsidized, private insurance plans.

"Medicare for All" typically refers to a single-payer health care program in which all Americans are covered by a more generous version of Medicare, the health-insurance program for the elderly. It would replace all other existing public and private plans, with few exceptions. In the bill proposed by Sen. Bernie Sanders, all Americans would be covered with no deductibles or premiums, and private insurance companies would be phased out of the marketplace.

- How much would Medicare for all cost?

According to an Urban Institute study, Medicare for All would require $32 trillion in new government funding. This large ticket price is what has so many politicians, Democrats and Republicans alike, against the proposal. Medicare for All is not championed by either 2020 presidential candidate.

Conservatives

Medicare-for-All will result in a massive uptick in federal spending, at the expense of quality healthcare. Medicare-for-All is extremely unpopular amongst conservatives for both public health and fiscal reasons.

Liberals

Liberals are fractured into two main camps. Progressives support Medicare-for-All, as the only way in which to ensure quality healthcare for all Americans. Senator Bernie Sanders is probably the most well known champion of the policy, and Senator Elizabeth Warren is in favor of it as well. More moderate liberals oppose Medicare-for-All, based on arguments of cost and lack of individual choice. For instance, Democratic nominee Former Vice President Joe Biden is running on a platform for a public option. Note that the option is not compulsory and would not rule out private insurance options.

2. Expanding Healthcare Coverage

Although it gets a lot of media coverage, you might ask yourself, what did the Affordable Care Act do? At a high level the Affordable Care Act expanded insurance coverage for Americans, but there are currently 13.7% of Americans without health insurance, as of the last quarter of 2018. Republicans and Democrats disagreeon how to insure Americans and whether Americans should be mandated to have health insurance.

Conservatives

Conservatives are generally not in favor of individual mandates that require individuals to be insured, and lean towards giving states the freedom to decide how to spend their federal dollars.

Liberals

Liberals are advocating for a public option so those without coverage through an employer can buy into a lower cost public system like Medicare.

Tackling healthcare costs:

Healthcare costs in the U.S. increased 3.9% in 2017, reaching a total of $3.5 trillion, or $10,739 per person. High costs impact everyone, making this topic the focus of much policy debate surrounding healthcare.

Conservatives

The Heritage Foundation, a conservative think tank, advocates for block grants to states and to repeal the Affordable Care Act (ACA) so states are burdened with fewer regulations. Their idea is that states would use a portion of their grant to establish high-risk pools to protect those with burdensome medical care costs without saddling the healthy with unaffordable premiums. By focusing on consumer choice, conservatives believe that the market will provide more private insurance options for people to choose from.

Liberals

Liberals believe that government intervention is needed to decrease healthcare costs. This means expanding tax credits for families to help them pay for their insurance premiums and counter healthcare consolidation, the concentration of market power in the hands of a few corporations.

Drug pricing:

The U.S. spends more on prescription drugs than anywhere in the world. Drug pricing continually comes up in the healthcare policy debate, since certain lifesaving, necessary drugs, like EpiPens and cancer treatments, are simply out of budget for many. There is discourse even among the parties on how to solve this problem.

Conservatives

While President Trump has stated he would like to lower drug prices, many elected Republicans see government attempts to control pricing as efforts that would stifle innovation. Conservatives tend to be ideologically opposed to the government price setting a market. Sen. Chuck Grassley introduced a bill that would limit drug price increases, but it has not been brought to a vote in the Republican-led Senate, showcasing the party’s disagreement on the issue.

Liberals

Former Vice President Biden’s plan to take on the drug manufacturers includes making manufacturers negotiate with Medicare over drug prices, allowing consumers to buy prescription drugs from other countries, and limiting price increases for all brand, biotech, and generic drugs to inflation.

The Legislation

1935
National Health Insurance
1965
Medicare Act
1996
Health Insurance Portability and Accountability Act (HIPAA)
2003
Medicare Drug Improvment and Modernization Act
2010
Affordable Care Act

The Jargon

Affordable Care Act: The comprehensive health care reform law enacted in March 2010 (AKA: ACA, PPACA, “Obamacare”) with the goal of making affordable health insurance available to more people. It expanded the Medicaid program to cover all adults with income below 138% of the federal poverty level.
CHIP: Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. For example: with a $2,000 deductible, you pay the first $2,000 of covered services yourself.
Pre-existing condition: A health problem, like asthma, diabetes, or cancer, you had before the date when new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.
Single-payer: Also known as “Medicare for All.” In a single payer healthcare system, a single public or quasi-public agency takes responsibility for healthcare for all residents, instead of competing health insurance companies.
Public-option: A compromise between our current system and “Medicare for All”, public-option plans would allow middle-income, working-age adults to choose a public insurance plan — like Medicare or Medicaid — instead of a private insurance plan.

The Chatter

LiberalConservative

We've gathered some voices on this issue from across the political spectrum. The views reflected here are not those of KnowYourVote, but rather reflect the opinions of the authors and publications. We're using Pew Research Center's Ideological Placement to indicate the publication's known slant below. (Not all publications are included on this tracker).

The New York Times

How the Health Insurance Industry (and I) Invented the ‘Choice’ Talking Point

Wendall Potter

June 14, 2020

Liberal

The New York Times

Will 2020 Be the Year That Medicine Was Saved?

Ezekiel J. Emanuel and Amol S. Navathe

April 14, 2020

Liberal

Fox News

Coronavirus deregulating health care — this should continue after pandemic is beaten

Sally Pipes

April 7, 2020

Conservative

The Washington Post

Will 2020 Be the Year That Medicine Was Saved?

Paul Waldman

April 3, 2020

Liberal