An Easy Guide to Healthcare in the 2020 Election

But our healthcare system is so complex. How can I possibly even begin to understand the issues?

  • Healthcare vocabulary you need to know
  • The 3 main healthcare issues to know in the 2020 election
  • What each candidate wants to do about the 3 main issues (costs, drug pricing, and surprise billing)
  • Helpful resources to learn more

Vocabulary Lesson: Healthcare Election Lingo to Know

  • Read more about specific ACA policies and more in-depth analysis here.
  • Read more about it here.
  • Read more about it here.
  • Medicare Advantage is a type of Medicare plan run by private insurers. Individuals can opt into these plans to get expanded benefits not included in just ‘original’ Medicare. Medicare Advantage plans are growing like crazy with the Baby Boomer influx.
  • Medicaid is a social welfare program that was expanded by Obamacare in 2010. It’s a federal and state program that provides health coverage for certain people with limited income and assets.
  • Nowadays, it’s extreme political taboo and very unpopular to discuss taking away the protections given to those with pre-existing conditions.
  • Back in 2017, Trump and Republican Congressional representatives attempted to repeal Obamacare in an effort to replace it with a conservative healthcare plan. It didn’t gain enough traction. However, the ideas within the proposal are still popular with Trump and Republicans to form a new healthcare reform plan.
  • Another proposal where proof of work must be given in order to be covered under Medicaid.
  • The most important thing to remember when it comes to surprise billing is that a hospital can be in-network on a patient’s insurance plan, but the physician might not necessarily be covered.
  • Patients grow confused — “Wait,” they thought. “I thought my insurance covered an emergency room visit?” Well, yes, Karen — your insurance might cover the facility (hospital) portion of the bill, but the emergency physician treating you (who is separately contracted and probably works in an emergency physician practice) might not be covered at all. Which would put YOU on the hook for 100% of that out of network bill. Yikes.
  • Surprise billing is so contentious because patients in a medical emergency can’t exactly choose which hospital they can go to. Obviously, they’re going to go to the closest one. And if the ER physicians at that hospital are out of network with your insurance? Well, you’re SOL.
  • Arbitration would settle payment disputes for out of network emergency bills by asking a third party to decide what payment a provider should receive. Arbitration would allow providers to negotiate for favorable rates and argue their side.
  • Unsurprisingly, in direct contrast to providers, health insurers want Congress to cap surprise billing payments at some agreed-upon rate — this is called “Benchmarking.”
  • Learn more about them here.
  • For instance, if your primary care physician is on one electronic health records system, but your gastroenterologist is on another, the two systems can’t communicate with each other to transfer your data.
  • Many current policy proposals — on both the right and left — want ALL electronic health records systems to be able to send data to each other. It’s a major-minor issue in healthcare right now.

On to the Issues: The 3 Main Healthcare Issues.

#1. Healthcare spending reform.

  • The U.S. spends much more than other developed countries on its healthcare system. In fact, healthcare costs are one of the top reasons for bankruptcy for Americans. Many officials want to change that.
  • Learn more about the healthcare cost issue here.

#2. Prescription drug pricing.

  • Lowering prescription out of pocket costs has been an extremely popular topic lately. In Congress, getting to the finish line on a bill has been…pretty difficult.
  • Learn more about the drug pricing issue here.

#3. Surprise medical billing.

  • As previously mentioned, patients who visit the ER or hospital will sometimes receive high-cost medical bills from providers who were out of their insurance plan’s network. Multiple bill proposals are floating around Congress, and all of the candidates have plans surrounding the issue.
  • Learn more about the surprise billing issue here.

General Healthcare Plans, by Candidate

  • Repeal and replace Obamacare (details currently fuzzy). Provide more oversight for Medicaid state programs. Give states more healthcare spending flexibility in the form of Medicaid block grants. Increase price transparency for patients and what they’re spending for healthcare procedures.
  • Fully-fledged Medicare for All. Completely replace the private health insurance system that predominantly runs through employer-sponsored benefit programs. Increase taxes, but no copays, deductibles, or any other insurance network problems. Expand coverage to include vision, dental, and others.
  • Medicare for All who want it, meaning instituting a Public Option. Expand the ACA. End surprise billing and cap out of network bill totals. Make mental health coverage easier. Reduce healthcare admin costs and create an all-payer claims database to create better data-driven health outcomes. Put more regulatory scrutiny on healthcare mergers.
  • Institute a public option along with expanding the ACA. Only allow one patent per drug to reduce costs. Increase rural healthcare funding and make rural hospitals more financially viable. Cap surprise medical bills and eliminate anything being ‘out of network.’ Use CMS to directly negotiate with drug companies on pricing.
  • Institute a public option along with expanding the ACA. Provide a middle-class premium tax credit. End surprise billing. Keep healthcare providers from consolidating market power. Use CMS to directly negotiate with drug companies on pricing. Implement a wide variety of other drug regulation to combat rising costs.
  • Medicare for All, but a slower transition to it. First, implement a public option. Use the government to manufacture drugs where there are shortages. Use CMS to directly negotiate with drug companies on pricing. Increased funding for rural healthcare providers. Prioritize mental health.

Broad Healthcare Reform Plans

  • Repeal and Replace Obamacare.
  • Medicare for All that fully replaces private insurance.
  • Public Option that competes with private insurance plans.
  • Public Option that competes with private insurance plans.
  • Public Option that competes with private insurance plans.
  • Medicare for All that fully replaces private insurance, but implement a public option first.

Drug Pricing Proposals

  • Have the U.S. pay similarly to what other developed countries pay for drugs (“International Drug Pricing Index”).
  • Import drugs from other countries (hello, Canada). Speed up FDA approval of generic drugs to increase supply. Increase drug pricing transparency.
  • Use Medicare to directly negotiate with drug companies. Allow drug importation from lower-cost countries like Canada.
  • Use an International Drug Pricing index comprised of other developed countries to determine how much Medicare for All should pay for drugs.
  • Cap patient drug spending at $200 per year.
  • Limit drug out of pocket spending to max $250/month.
  • Cap Medicare part D monthly drug costs at $200/month. Make generic drugs free for Medicare, Medicaid, and the Public Option.
  • Allow the federal government to directly negotiate with drug companies on how much they should pay.
  • Cap drug price inflation. Penalize non-compliant drug companies.
  • Allow the federal government to directly negotiate with drug companies on how much they should pay.
  • Cap Medicare part D costs at $2,000/year. Only allow one patent per drug, no exceptions.
  • Eliminate all drug company payments to pharmacy benefit managers.
  • Have the federal government charge royalty payments for drugs developed by public tax dollars.
  • Allow the federal government to directly negotiate with drug companies on how much they should pay.
  • Limit launch prices for drugs that face no competition and peg prices to an international drug pricing model.
  • Cap drug price inflation to the standard U.S. inflation rate.
  • Allow drug importation.
  • Improve the supply of generic drugs.
  • Allow the federal government to directly negotiate with drug companies on how much they should pay.
  • Use HHS to address generic drug shortages and high drug prices by manufacturing drugs.
  • Introduce tighter patent regulation.
  • Allow drug importation from other countries.

Fixing Surprise Medical Billing

  • Whatever gets through Congress, I’ll probably sign.
  • Under Medicare for All, everything is in network. Therefore, no surprise medical bills.
  • To go one step further — eliminate all medical debt, estimated at $81 billion. Remove medical debt from bankruptcy court.
  • If a facility is in network under your healthcare plan, then require all of the services provided in that facility to be served at in-network rates as well.
  • Put a cap on what out of network providers can charge patients.
  • Ban surprise medical bills by capping all out of network services at 200% of Medicare’s typical payment.
  • Require providers and insurance companies to arbitrate out of network payment amounts, leaving the patient out of it.
  • Prevent providers from charging out-of-network rates for true emergencies, when a patient has no choice over which provider cares for them.
  • Under Medicare for All, everything is in-network. Therefore, no surprise medical bills.
  • But before Medicare for All, cap out of network healthcare services received at the lower cost of A) the median in-network payment rate for that procedure in that region, or 2) 125% of Medicare’s payment rate.

More helpful healthcare election resources.

Candidate Healthcare plans:

Other Resources:

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Blake Madden

Blake Madden

I write about healthcare. Policy, business, digital health, & more. Written in plain English. Here to connect, learn, and continue the healthcare convo.