The fact that the 10 Democratic candidates who sparred in Tuesday night’s debate spent the most amount of time talking about health care is no accident.
With tens of millions of Americans uninsured or underinsured, and costs growing at a faster rate than people’s paychecks, health care ranks among the top three issues on American’s minds for the 2020 presidential election.
It’s an issue that “cuts through the fabric of every community, whether you’re a Democrat or Republican,” said Antjuan Seawright, a Democratic strategist.
Democratic contenders have released an array of plans to improve access to health care — with several championing Medicare for All, or another single-payer option — and President Donald Trump and Republicans are eager to knock them down.
But that eagerness to criticize Democrats could backfire, strategists say, in the continued absence of a comprehensive GOP plan to overhaul care for Americans.
What the Democrats are pitching
Early in CNN’s Democratic debate — the second round of matchups this presidential season — Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., vigorously advocated for a national health care plan that replaces private insurance, also known as Medicare for All.
More moderate candidates pitched more incremental policies to expand access to health care and make it more affordable. When Rep. Tim Ryan, D-Ohio, suggested Sanders’ didn’t know if his plan would offer commensurate or even better benefits, Sanders shot back: “I wrote the damn bill!”
Former Rep. John Delaney, D-Md., another moderate, pushed back on tying Democratic hopes for the White House to any version of Medicare for All that eliminated private insurance, saying these plans amounted to “political suicide.”
That criticism is not unfounded. In a recent poll from PBS NewsHour, NPR and Marist, 70 percent of U.S. adults that they were in favor of Medicare for All if it allowed them to choose between keeping their existing private insurance plan or enrolling in a national health care program. By comparison, only 41 percent of Americans said they wanted to replace their private insurance with a national health program.
Earlier this week, Senator Kamala Harris, D-Calif., unveiled a health care proposal that would cover 330 million Americans under a single government plan. During Wednesday’s debate, Former Vice-President Joe Biden claimed her plan would be too costly and cause people to lose their private, employer-based insurance coverage. Harris pushed back, saying Biden’s statement was “simply inaccurate.”
The differences in the Democrats’ plans “are the differences within the party right now,” said Seawright.
For Democrats to connect with voters, there are two things that their plans need to do, according to Seawright. They must improve access to health care and make it more affordable, such as by helping keep rural hospitals open and reducing drug prices.
Progressive or moderate, the three goals that run through all of the Democrats’ 2020 health care proposals that Democrats have put forward are expanding coverage, improving affordability and slowing down the growth of health care costs, said Sara Collins, vice president for health care access and coverage for the nonpartisan Commonwealth Fund.
It is “less clear what the Republican goals are,” Collins said, considering that the Trump administration supports Republican attorneys general in a lawsuit that could render the Affordable Care Act unconstitutional. If Republicans are successful, 20 million Americans could lose the health care coverage they gained under the Affordable Care Act.
How Republicans are pushing back?
On Wednesday, Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, scrutinized the Democratic health care plans at an event in Washington. The Heritage Foundation had invited her and other conservative policymakers to make the case against Medicare for All.
Under her leadership, the Trump administration has encouraged states to develop Medicaid work requirements that recipients must meet to earn care or lose their coverage. Federal judges have hamstrung many of these state proposals that could cut thousands of people from Medicaid, most recently in New Hampshire.
Assessing the system that she is in charge of, Verma said Medicaid and Medicare already don’t deliver the best quality and most innovative care to patients and that these plans are cheaper because they pay providers less. If Democratic plans go through, Verma said, approval of new treatments and medications would be slow-moving, blunting innovation.
Verma said taxes will go up, doctors will be reimbursed less, have more paperwork and administrative overhead and burn out faster on the health care profession.
“The best and brightest young people will not pursue a career in medicine,” she said.
A government-run health care program would be unable to meet demand and would be unsustainable, according to Verma, even under a Democratic-proposed public option plan that would allow people to choose their private insurance or a national health program.
And Verma twice said Medicare would run out of money in seven years — a claim that has been refuted in the past.
What do Republicans offer on health care?
Verma said the Trump administration has targeted the underlying factors that boost health care costs. She nodded to White House-backed efforts to lower prescription drug prices. What she didn’t mention was that the administration had promoted, then walked back, uprooting the rebate system that inflates the cost of prescription medications.
Instead, Verma pointed to a plan that Health Secretary Alex Azar unveiled early Wednesday. On a call with reporters, Azar said the government would allow the import of cheaper prescriptions into the U.S. Azar said that innovation has eased previously held concerns about the safety of prescription drugs imported from other countries.
Verma also cited a move by the Trump administration to make hospital services more transparent and competitively priced by requiring all hospitals to post their rates.
Despite Verma’s points, conservateive strategist Stuart Stevens said that going into the 2020 election, Republicans have nothing to gain in the health care debate and should steer clear.
Stevens, who worked on Sen. Mitt Romney’s 2012 presidential campaign, said that if Trump tries to engage on the issue, said the president will only remind voters that Republicans failed legislatively to dismantle the Affordable Care Act, also known as Obamacare, despite having control of Congress and the White House during Trump’s first two years in office.
“Republicans have promised a plan better than Obamacare since 2009, and they haven’t come up with it,” Stevens said. If Republicans can do better, he said, “they ought to put together a plan and vote on it.”