Where 2020 Democrats stand on Medicare-for-all and other health-care issues

Where 2020 Democrats stand on Medicare-for-all and other health-care issues

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Supports some version of it

Not all have been specific about how far they’re willing to go in support of single-payer health care.

Booker

Buttigieg

Castro

Gabbard

Gillibrand

Harris

Sanders

Warren

Williamson

Yang

Prefers something else

Others have proposed different plans to reach universal coverage, such as providing a public option.

Delaney

Hickenlooper

Inslee

Klobuchar

The major Democratic presidential contenders have been vocal about the need to expand health-care coverage for more Americans. But they are split on how, opening a key policy rift in the 2020 presidential campaign, particularly over the most ambitious of these plans: Medicare-for-all.

Some Democrats have called for the United States to achieve Medicare-for-all through a single-payer system, in which all Americans would be enrolled automatically on a government plan. Other candidates have said that they believe Medicare-for-all is a good long-term goal, while stopping short of calling for a single-payer system. Others still believe in more modest measures to expand health insurance, believing Medicare-for-all could trigger a political backlash.

The debate over these plans — as well as their objective, details and impact on the health-care industry — is expected to play a major role animating the race for the Democratic presidential nomination.

What is Medicare-for-all?

Some versions would dramatically rethink how the nation’s insurance system works by replacing the current health insurance system with a single government-run system that provides insurance for all Americans.

Medicare-for-all would move the United States in the direction of a single-payer system, where the government steps in (rather than insurance companies) as the intermediary between patients and providers in health-care transactions.

SINGLE-PAYER PLAN

Government

Patients

Providers

SINGLE-PAYER PLAN

Patients

Government

Providers

SINGLE-PAYER PLAN

Patients

Government

Providers

SINGLE-PAYER PLAN

Pay taxes

Pays for treatment

Patients

Government

Providers

SINGLE-PAYER PLAN

Pay taxes

Pays for treatment

Patients

Government

Providers

For Americans who currently have private insurance through their employers, insurance companies are the intermediaries that pay providers (hospitals and doctors), and patients often cover a part of the cost with a co-pay.

HOW PRIVATE INSURANCE WORKS NOW

Patients

Providers

Pay co-pay

HOW PRIVATE INSURANCE WORKS NOW

Patients

Providers

Pay co-pay

HOW PRIVATE INSURANCE WORKS NOW

Patients

Providers

Pay co-pay

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HOW PRIVATE INSURANCE WORKS NOW

Pay premiums

Pay for treatment

Patients

Providers

Pay co-pay

HOW PRIVATE INSURANCE WORKS NOW

Pay premiums

Pay for treatment

Patients

Providers

Pay co-pay

In some versions of Medicare-for-all, the government would use taxes to pay for most medical services, but would allow private insurance for elective procedures.

MODIFIED SINGLE-PAYER PLAN

Pay for

elective coverage

Supplementary or

complementary insurers

Government

Patients

Providers

MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

Patients

Government

Providers

MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

Pay taxes

Pays for treatment

Government

Patients

Providers

MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

Pay taxes

Pays for treatment

Government

Patients

Providers

MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

Pays for treatment

Pay taxes

Government

Patients

Providers

Many suggestions fit somewhere between the existing health system and a nationalized health-care program. Some candidates have embraced bills that would take more incremental steps toward universal coverage, like lowering the age of eligibility for Medicare, or a Medicaid-type plan that would allow states to sell government-backed Medicaid plans on individual insurance marketplaces.

Where the candidates stand

Here’s where 2020 candidates stand on Medicare-for-all and other health-care issues, based on candidate statements, voting records and answers to a questionnaire we sent every campaign.

Question 1 of 7

What should happen to private insurance?

Essentially get rid of it

Sanders

Buttigieg

Gillibrand

Williamson

Yang

We don’t need to get rid of it

Booker

Castro

Delaney

Gabbard

Hickenlooper

Inslee

Klobuchar

Harris

Warren

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Background

Some current Medicare-for-all proposals, including those from Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.) virtually eliminate private insurance by providing basic coverage for prescriptions, medical, vision, dental and mental health care. Private insurance would exist only for supplemental care outside of these basic provisions.

Question 2 of 7

Do you support creating a public option to expand health care, such as allowing people to buy into a state Medicaid program regardless of income?

Booker

Buttigieg

Delaney

Gabbard

Gillibrand

Harris

Hickenlooper

Inslee

Klobuchar

Sanders

Warren

Williamson

Yang

Castro

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Background

As it exists now, state Medicaid programs are public health insurance programs for low-income individuals. In our questionnaire, we asked campaigns about a proposal from Sen. Brian Schatz (D-Hawaii) that would expand Medicaid by authorizing states to offer a buy-in option to anyone who wants the coverage, not just low-income people. Other candidates have also expressed support for creating a public option, such as a Medicare buy-in.

A January 2019 poll from the Kaiser Family Foundation found 75 percent of the public favors allowing people who don’t get insurance at work to buy insurance through a state Medicaid program.

Question 3 of 7

Do you believe all undocumented immigrants should be covered under a government-run health plan?

Booker

Gillibrand

Harris

Sanders

Warren

Williamson

Buttigieg

Yang

Delaney

Castro

Gabbard

Hickenlooper

Inslee

Klobuchar

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Background

Some single-payer health-care plans call for the federal government to fund the health insurance of the approximately 11 million undocumented people living in the United States.

Question 4 of 7

Do support partially expanding Medicare by allowing people ages 50 to 64 to buy into Medicare?

Booker

Buttigieg

Delaney

Gillibrand

Harris

Klobuchar

Sanders

Williamson

Yang

Castro

Gabbard

Hickenlooper

Inslee

Warren

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Background

Some lawmakers have proposed taking incremental steps to expanding health coverage by lowering the eligibility age and giving more people the option of buying into Medicare, the federal health insurance program for seniors – essentially, offering “Medicare-for-more.” Sen. Debbie Stabenow (D-Mich.) introduced the Medicare at 50 Act in February, legislation that was co-sponsored by a number of the Democratic contenders.

According to a Kaiser Family Foundation tracking poll from January 2019, 77 percent of the public favors allowing people ages 50 to 64 to buy insurance through Medicare.

Question 5 of 7

Do you support giving the federal government the ability to negotiate drug prices for Medicare?

Booker

Buttigieg

Delaney

Gabbard

Gillibrand

Harris

Klobuchar

Sanders

Warren

Williamson

Yang

Castro

Hickenlooper

Inslee

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Background

By law, the federal government is not allowed to negotiate lower prescription drug prices for seniors on Medicare, but lawmakers have pushed for legislation to give federal officials that ability, such as the Medicare Prescription Drug Price Negotiation Act in the House and the Affordable Medications Act in the Senate.

A February 2019 poll from the Kaiser Family Foundation found 86 percent of the public favors allowing the government to negotiate with drug companies to lower drug costs under Medicare.

Question 6 of 7

Do you support importing drugs from other countries?

Booker

Buttigieg

Delaney

Gabbard

Gillibrand

Harris

Klobuchar

Sanders

Warren

Yang

Williamson

Castro

Hickenlooper

Inslee

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Background

Some lawmakers have proposed allowing Americans to purchase medications from other countries as a way to lower consumer costs.

A February 2019 tracking poll from the Kaiser Family Foundation found 80 percent of the public favors allowing Americans to buy imported drugs from Canada.

Question 7 of 7

Do you support having the federal government produce and sell generic drugs to lower drug prices?

Sanders

Warren

Williamson

Yang

Buttigieg

Delaney

Booker

Castro

Gabbard

Gillibrand

Harris

Hickenlooper

Inslee

Klobuchar

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Background

Sen. Elizabeth Warren (D-Mass.) and Rep. Jan Schakowsky (D-Ill.) have introduced legislation that, if passed, would have the government manufacture cheap generic drugs if prescription drug costs rise too high.

How we compiled candidate positions

The Washington Post sent a detailed questionnaire to every Democratic campaign asking whether they support various health-care policies. We organized candidates with similar stances into groups using a combination of those answers, legislative records, action taken in an executive role and other public comments, such as policy discussion on campaign websites, social media posts, interviews, town halls and other news reports. See something that we missed? Let us know.

The page will update to reflect candidates’ positions as they become more clear. We expect candidates to develop more detailed policy positions throughout the campaign, and this page will update as we learn more about their plans. We will also note if candidates change their position on an issue. At initial publication, this page included major candidates who had announced a run for president or an exploratory committee by March 13. The Post will reach out to additional candidates as they enter the race and then include them here.

Recent changes on this page

March 15 Added polling data from Kaiser Family Foundation

March 14 Updated with additional information on Buttigieg positions from his campaign

March 14 Page published

Kevin Uhrmacher

Kevin Uhrmacher is a graphics editor for politics at The Washington Post. His work includes mapping trends in election results, analyzing data about President Trump’s political appointees and explaining the impact of congressional policies. He joined The Post in 2014 as a news designer.

Kevin Schaul

Kevin Schaul is a senior graphics editor for The Washington Post. He covers national politics and public policy using data and visuals.

Paulina Firozi

Paulina Firozi is a researcher helping to produce and write The Health 202 and The Energy 202. Before joining The Post in 2017, she was a social media curator at The Hill and previously interned for NPR Politics, USA Today, the Chicago Tribune and with The Post’s local desk.

Jeff Stein

Jeff Stein is a policy reporter for The Washington Post. Before joining The Post, Stein was a congressional reporter for Vox, where he wrote primarily about the Democratic Party and the left. In 2014, he founded the local news nonprofit the Ithaca Voice in Upstate New York.

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