Achieving Universal, Affordable, Quality Health Care (Pages 28-37)
We are going to at last build the health care system the American people have always deserved: One that finally provides universal health care coverage; reduces prescription drug prices, premiums, and out-of-pocket costs; reins in overall health care expenses; and tackles the deep-seated inequities in our health care system. We will build a health care system that is driven by the needs of patients and the people who care for them, instead of the profit motives of big corporations.
Democrats will always fight to save Americans’ lives by making it easier and more affordable to go to the doctor, get prescription medicines, and access preventive testing and treatments. Our policy agenda is designed to produce real results for the American people—not hollow platitudes. As Democrats, we fundamentally believe health care is a right for all, not a privilege for the few.
Responding to the Coronavirus Pandemic
We must start by making COVID-19 testing widely available, convenient, and free to everyone. That includes expanding programs to proactively extend testing services to populations we know are especially vulnerable, including the homeless and those living in nursing homes and long-term care facilities. We must also expand funding so state and local public health departments can hire sufficient staff to adequately conduct contact tracing for everyone who tests positive for the novel coronavirus. Only through testing, tracing, and targeted quarantining can we hope to fully understand the scope of the pandemic, contain it, and stop it.
In a public health crisis, we all have to rely on each other. That’s why Democrats support making COVID-19 testing, treatment, and any eventual vaccines free to everyone, regardless of their wealth or their immigration status.
In the midst of this pandemic, we will provide direct, increased support to states to enroll eligible adults in Medicaid, have the federal government cover a higher percentage of the bill, and add incentives for states which have not yet expanded Medicaid to do so.
For people who risk losing their insurance coverage if they lose their jobs in this pandemic, Democrats believe the federal government should pick up 100 percent of the tab for COBRA insurance, which keeps people on their employer-sponsored plans. For those who are still unemployed or do not have access to employer-sponsored health care when their COBRA eligibility period expires and are eligible for premium-free coverage, we will take action to automatically roll them over to other coverage options, so they do not experience any gap in health care. We will also re-open the Affordable Care Act marketplaces, even outside of the normal open enrollment season, and expand subsidies to make it easier for people to buy coverage.
Democrats will also make available on the marketplace a platinum-level, federally administered health insurance option with low fees and no deductibles, so that everyone will have access to this high-quality, low-cost plan. Low-income Americans will be automatically enrolled in this federally-administered option at zero cost to them.
We will keep these emergency measures in place until the pandemic ends and unemployment falls significantly.
Democrats will direct the federal government to work with private-sector manufacturers to dramatically scale up the United States’ domestic manufacturing capacity for both personal protective equipment and essential medicines.
Reinvesting in Public Health
Democrats will act swiftly to stand up a comprehensive, national public health surveillance program for COVID-19 and future infectious diseases, including recruiting 100,000 contact tracers to help state and local health departments identify people at risk of contracting or spreading the coronavirus.
We will substantially increase funding for the Centers for Disease Control and Prevention and for state and local public health departments, many of which suffered deep budget cuts during the Great Recession. And we will restore American leadership on global public health by working with our allies and partners around the world, including through the World Health Organization.
Securing Universal Health Care Through a Public Option
We will give all Americans the choice to select a high-quality, affordable public option through the Affordable Care Act marketplace. The public option will provide at least one plan choice without deductibles, will be administered by the traditional Medicare program, not private companies, and will cover all primary care without any co- payments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people. The lowest-income Americans not eligible for Medicaid will be automatically enrolled in the public option at no cost to them, although they may choose to opt out at any time. Everyone will be eligible to choose the public option or another Affordable Care Act marketplace plan, even those who currently get insurance through their employers, because Democrats believe working people shouldn’t be locked in to expensive or insufficient health care plans when better options are available.
For the 4.8 million adults who should be eligible for Medicaid, but who live in states where Republican governors have refused to expand the program, Democrats will make the public option available without premiums. And we will enable millions of older workers to choose between their employer-provided plans, the public option, or enrolling in Medicare when they turn 60, instead of having to wait until they are 65.
Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches.
We also know that finally covering every American through the public and private insurance system alone is not enough to guarantee universal access. That is why Democrats support doubling investments in community health centers and rural health clinics, including increased support for dental care, mental health care, and substance use services like medication-assisted treatment. We will expand the National Health Service Corps to address critical shortages of health care providers in rural areas, including primary care nurses, dental professionals, and mental health and substance use counselors.
Bringing Down Drug Prices and Taking on the Pharmaceutical Industry
Democrats will take aggressive action to ensure that Americans do not pay more for prescription drugs than people in other advanced economies. We will empower Medicare to at last be able to negotiate prescription drug prices for all public and private purchasers—for families and businesses, as well as older Americans—no matter where they get their coverage. We will also ensure and enforce that the price of brand-name and outlier generic drugs cannot rise faster than the inflation rate. We will cap out-of-pocket drug costs for seniors, and ensure that effective treatments for chronic health conditions are available at little or no cost.
Reducing Health Care Costs and Improving Health Care Quality
We will make it easier for working families to afford high-quality insurance in the Affordable Care Act marketplaces by ensuring that no one pays more than 8.5 percent of their income in premiums and eliminating the cap on subsidies.
We will work to increase price transparency in the health care system across all payers, and reduce paperwork through uniform medical billing.
Democrats will support policies that increase the number of primary care practitioners, registered nurses, dentists, and dental therapists, especially in rural and low-income metropolitan areas, so it’s easier for every American to access preventive and primary health care.
Expanding Access to Mental Health and Substance Use Treatment
Democrats will aggressively enforce the federal mental health parity law and ensure that health insurers adequately cover mental health and substance use treatment.
Expanding Long-Term Care Services and Supports
Democrats support measures to eliminate state waiting lists for home and community based care, including through a significant expansion of the home care workforce, and will work to develop a broader approach to eliminate the institutional bias within Medicaid.
Eliminate Racial, Gender, and Geographic Health Inequities
Democrats are committed to eliminating health disparities by race, ethnicity, gender, and geography. We recognize it is not enough to have a commitment: We must have a plan. That is why Democrats will launch a sustained, government-wide effort, with leadership at the highest levels, to eliminate racial, ethnic, gender, and geographic gaps in insurance rates, access to quality care, and health outcomes. That includes tackling the social, economic, and environmental inequities—the social determinants of health like poor housing, hunger, inadequate transportation, mass incarceration, air and water pollution, and gun violence—that contribute to worse health outcomes for low-income Americans and communities of color.
(More on Black people and Latinos, pollution, maternal mortality, data collection to understand disparities, Indian Health Service, reproductive health care services, sexual assault and domestic abuse, LGBTQ+ discrimination, and HIV/AIDS treatment and prevention.)
We will expand access to health care for people living and working across the United States by extending Affordable Care Act coverage to Dreamers, and working with Congress to lift the five-year waiting period for Medicaid and Children’s Health Insurance Program eligibility for low-income, lawfully present immigrants.
Democrats believe that gun violence is a public health crisis. We believe that expanding access to mental health care is key to confronting the epidemic of suicides-by-firearm, including among veterans. Democrats will ensure the Centers for Disease Control and Prevention have sufficient resources to study gun violence as a public health issue and support evidence-based programs for preventing gun violence.
Strengthening and Supporting the Health Care Workforce
We will invest in community health worker care-forces around the nation proven to prevent, manage and better treat chronic illness now burdening tens of millions of Americans, and empower first-time mothers with nurse home visiting. We will close provider gaps and increase diversity in the health care profession by creating a robust pipeline of talent with career ladders for work advancement. And we will also increase opportunities for community health workers to come from the communities they serve.
Investing in Health Science and Research
We will support increased and sustainable funding for federal health and medical research across agencies, including at the National Cancer Institute and other components of the National Institutes of Health, the Centers for Disease Control and Prevention, and the Agency for Health Care Research and Quality. We will increase the federal investment in research and development for new medications through the National Institutes of Health, and make sure that there is a return on that investment for taxpayers.
Democrats also support increasing funding for research into health disparities by race, gender, age, geographic area, and socioeconomic status, with a particular focus on how the social determinants of health contribute to differences in health outcomes.
Rep. Pramila Jayapal, Co-chair
Vivek Murthy, Co-chair
Mary Kay Henry
Rep. Robin Kelly
By Don McCanne, M.D.
When the neoliberals commandeered the Democratic primary process and bumped Bernie Sanders out of the running, it was recognized that Joe Biden would have to do something to reunite the Democrats since the flame of the popular progressive revolution had been extinguished, and the Democrats were left with a candidate basically representing the status quo. Perhaps the greatest disappointment was that single payer Medicare for All had been removed from the agenda.
The report of the recommendations of the Biden-Sanders Unity Task Force(s) is 110 pages long and covers many areas of policy. The ten page section on health care basically perpetuates the current health policies, led by the Affordable Care Act, while adding a public option and reducing Medicare eligibility age to 60. The most glaring feature is invisible – the total lack of any mention of single payer Medicare for All.
Single payer Medicare for All is not simply an expansion of Medicare to cover everyone. It is a comprehensive revision of the financing of health care making it universal, comprehensive, efficient, effective, equitable, accessible, and affordable for everyone, for life. The Biden-Sanders Unity Task Force proposal meets none of those criteria.
Biden has said that we cannot afford single payer Medicare for All, yet his model perpetuates much of the excessive spending in health care, failing to recover hundreds of billions of dollars in administrative waste. For administrative efficiency he suggests reducing paperwork through uniform medical billing, but we already have that in Form 1500. He also suggests price transparency as if Nobel laureate Kenneth Arrow never explained why health care markets don’t work. Biden’s proposals would significantly add to our health care spending, and thus would be much more expensive than an efficient single payer Medicare for All.
The goal of the Unity Task Force is to bring disappointed progressives back into the fold. It is likely that President Trump is going to orchestrate his own defeat, and Joe Biden will be elected by default. Regardless, it is important that progressives not give up on single payer. Assuming Biden is elected, it is imperative that we continue to educate everyone on the virtues of the single payer model. If President Biden truly understood the single payer model (and he doesn’t), he would certainly sign legislation enacting it.
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