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Even though the 2020 election is more than a year away, we’re already getting a glimpse of how healthcare policy will impact the race. Last week, the Democratic Party candidates showed off some of their healthcare plans in two nights of debates hosted by CNN. Proposals range from single-payer, Medicare-for-all ideas to a restoration of the ACA provisions that have been chipped away under the Trump Administration.
Self-insured employers are watching the nomination race with interest because of the potential impacts to employer-sponsored health plans. Let’s take a closer look at what the top candidates are planning for healthcare.
The former vice president is polling consistently 1st among the candidates, and voters are energized by his wide name recognition and fiery persona. He falls firmly into the “moderate Democrat” camp, and isn’t pushing for a “Medicare-for-all” style healthcare plan like his more progressive challengers.
However, Biden’s plan does indeed include a public option. His goal is to build on the Affordable Care Act that he helped push through the legislative branch. Here’s how his website explains the plan:
“We should give every American the right to choose a public option like Medicare. We should also offer premium-free access to this public option for people who would otherwise qualify for Medicaid, but for the fact they have been denied access to it by governors and state legislatures who have refused the Affordable Care Act’s Medicaid expansion. We must ensure that they are receiving coverage that matches what they would have access to through Medicaid.”
Essentially, Biden would like all Americans to have the option of sticking with private insurance or buying into a government plan that has the buying and negotiating power of Medicare. This is an appealing middle ground for many. Of all the payers in the healthcare system, Medicare pays the lowest prices. Hospital groups and pharmaceutical companies aren’t thrilled with the idea of the government holding negotiating power for prices, but healthcare consumers would be the ones to benefit from lower out-of-pocket costs.
Coupled with Biden’s plan to make subsidies for lower- and middle-class families more generous than they were under the ACA, this plan could influence the state of employer-paid benefits. A public option might convince some employers to eliminate or reduce coverage in favor of a stipend that allows employees to buy their own plans.
If you don’t know about Bernie Sanders’ healthcare opinions by now, you haven’t been paying attention. Senator Sanders is one of the most vocal advocates for a “Medicare-for-all” style reform. He comes out swinging in a statement on his 2020 campaign website:
“We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right. All Americans are entitled to go to the doctor when they’re sick and not go bankrupt after staying in the hospital.”
This is a much more dramatic proposal than Biden’s, and it focuses not on the system as a whole, but on the patients who access healthcare. When it comes to pharmacy spending, Bernie offers three specific ideas that would affect employers:
While a Medicare-for-all plan would clearly change the way employers provide benefits, even these three smaller proposals would “disrupt” the status quo. We’ve written before about the ways Pharmacy Benefit Managers affect employee benefits, and these proposals would effectively cut them out of the system. Patients would have access to healthcare without the middleman under Sanders’ plan, and the benefits industry would be completely redefined.
Like her progressive compatriot Bernie Sanders, Senator Warren is also a proponent of a Medicare-for-all style plan. She advocates for an end to private insurance and a government-sponsored plan for all Americans.
In a debate back in June, Warren laid out her case:
“Look at the business model of an insurance company. It’s to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your healthcare. That leaves families with rising premiums, rising co-pays, and fighting with insurance companies to try to get the healthcare that their doctors say that they and their children need. Medicare for All solves that problem.”
Again, this plan would mean fundamental shifts in the way benefits professionals engage with employees.
Finally, let’s look at Senator Kamala Harris’ ideas for healthcare reform. While her proposal initially seems like a “Medicare-for-all” plan similar to those of Sanders and Warren, she suggests a middle ground that would allow for some version of employer-sponsored health insurance. Here’s how her website puts it:
“Third, in setting up this plan, we will allow private insurers to offer Medicare plans as a part of this system that adhere to strict Medicare requirements on costs and benefits. This would function similar to how private Medicare plans work today, which cover about a third of Medicare seniors, and operate within the Medicare system. Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around. This preserves the options that seniors have today and expands options to all Americans, while also telling insurance companies they don’t run the show.”
Some voluntary benefits will still be available through private insurance as well, which gives benefits teams an interesting option for attracting and retaining talented employees.
With a whopping 23 candidates still in the race for the Democratic nomination, we could continue with deeper dives into each candidate’s healthcare proposals. As the 2020 election approaches and a nominee is chosen, we’ll revisit and explain further how the candidate will tackle healthcare and how it affects self-insured employers and employee benefits. In the meantime, this Washington Post infographic does an exceptional job of breaking down the positions. The main takeaway? 14 of the 23 candidates support some version of Medicare-for-all.