Healthcare and the upcoming election

Kaiser Health News

Julie Rovner | 1/30/2020, 2:36 p.m.

Drug companies and insurers aren’t the only ones responsible for high prices.

To listen to many of the candidates’ messages, it may seem drug companies and health insurers are together responsible for most — if not all — of the high health spending in the U.S.

“The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people,” says Sen. Bernie Sanders on his presidential campaign website. “We must defeat them, together.”

Most insurance spending, though, actually goes for care delivered by doctors and hospitals. And some of their practices are far more gouging to patients than high prices charged by drugmakers or administrative costs added by insurance companies. Wall Street firms that have bought physician groups are helping block a legislative solution to “surprise bills” — the often huge charges faced by patients who inadvertently get care outside their insurance network. And hospitals around the country are being called out by the news media for suing their patients over bills almost no patient can afford.

Democrats and Republicans have very different views on how to fix health care.

To the extent health has been covered in the presidential race, the story has been about disagreements between Democrats: Some want Medicare for All, while others are pushing for less sweeping change, often described as a “public option” that would allow but not require people to purchase a government health plan.

There are much bigger divides between Democrats and Republicans, however. Democrats nearly all support a larger role for government in health care; they just disagree on how much larger it should be. Meanwhile, Republicans generally want to see less government and more market forces brought to bear. The Trump administration has already either implemented or proposed a variety of ways to decrease regulation of private insurance and is weighing whether to allow states to effectively cap their Medicaid program spending.

And in the biggest difference of all for the coming campaign, the Trump administration and a group of GOP-led states are, again, challenging the entire Affordable Care Act in court, arguing that it is unconstitutional based on the 2017 tax law’s zeroing out of the tax penalty for failing to maintain insurance coverage.

The Supreme Court has opted not to decide the case in time for the 2020 election, but it is likely to continue to be a major issue in the campaign.

There are important health issues beyond insurance coverage and costs.

While Medicare for All and drug prices have dominated the political debate during the past year, other critical health issues have received far less attention.

Some candidates have talked about long-term care, which will become a growing need as baby boomers swell the ranks of the “oldest old.” Several have addressed mental health and addiction issues, a continuing public health crisis. And a few have laid out plans for the special needs of Americans in rural areas and those with disabilities.

HealthBent, a regular feature of Kaiser Health News, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years