Presidential Candidates All Want to Lower Drug Prices, Expand Health Care Access, But Disagree How to Do It

Politicians on both sides of the aisle have long been debating key issues in modern health care, including rising drug prices, access to care, and national addiction rates. Despite some agreement on which issues are most pressing, arguments persist in how to address them heading into the 2020 presidential election.

President Donald Trump

President Trump’s goals during his tenure have included loosening insurance regulations, lowering drug prices, and expanding tax-free health savings accounts.¹ Although the administration has yet to present an overarching health care plan to compete with the Patient Protection and Affordable Care Act (ACA), experts have pointed to those goals as a hint of what the Trump alternative plan could include.¹

Thus far, the administration has not been forced to present a comprehensive plan while the ACA is still in effect, but if the Supreme Court were to uphold a Texas court’s ruling that found the ACA is unconstitutional, the administration would have to present an alternative.¹ After the Supreme Court’s decision not to fast-track the decision, however, it is unlikely that a ruling will come before the November elections.²

Amid the ACA debate, however, Trump has won bipartisan support for several initiatives, including a proposal that hospitals be required to post their actual, negotiated prices, and declaring the opioid crisis a nationwide public health emergency.¹

The Democratic Challengers

All of the remaining Democratic presidential candidates agree that drug prices and opioid addiction are major issues that should be addressed, but they have myriad proposals of how to handle them. Although candidates are divided on the scope of a potential Medicare-for-all national health plan, there has been strong support among Democrats—and support from 4 in 10 Republicans—for a government-run health plan or public option, according to a Kaiser Family Foundation (KFF) report. A KFF poll from January 2020 showed that approximately half of Americans support both a Medicare-for-all plan and a public option.

Senator Bernie Sanders (D-NH)

Sanders has proposed several solutions to rising drug prices, including allowing Medicare to negotiate with drug companies and passing legislation to allow patients, pharmacists, and wholesalers to purchase low-cost prescription drugs from Canada and other industrialized countries.³

Sanders also wants to pass the Prescription Drug Price Relief Act, which would peg prices to the median drug price in 5 major countries: Canada, the United Kingdom, France, Germany, and Japan.³ Sanders said this would cut prescription drug prices in half.³ In addition to this legislation, Sanders would cap prescription drug spend at $200 per person annually.³

Furthermore, Sanders has been vocal in his support for Medicare for All, a single-payer, national health insurance program. Under his plan, Medicare coverage would be expanded to include dental, hearing, vision, home- and community-based long-term care, in- and out-patient services, mental health, substance abuse treatment, reproductive and maternity care, and prescription drugs.³

Pete Buttigieg

Unlike Sanders, Buttigieg, mayor of South Bend, Indiana, has proposed a Medicare for All Who Want It plan, under which patients could opt into a public alternative. This option would include plans for mental health, addiction services, expanded access to health care in rural areas, women’s health options, and long-term care.⁴

According to his website, Buttigieg’s plan would cost approximately $1.5 trillion over 10 years, which he says would be funded by rolling back Trump’s corporate tax cuts and by using cost savings from allowing the federal government to negotiate prices with pharmaceutical companies.⁴

Under his plan, Buttigieg wants to cap out-of-pocket prescription drug spend at $250 per month for everyone choosing public coverage under the Medicare For All Who Want It plan.⁴ Finally, Buttigieg would make co-payments $0 for generic drugs for low income patients insured by the public plan, Medicare, or Medicaid.⁴

Senator Elizabeth Warren (D-MA)

Warren’s plan is perhaps the most similar to Sanders’s plan, including Medicare for All, expanded services, and reigning in corruption. Warren wants to strengthen the ACA and expand eligibility to include everyone in the country legally.⁵

Warren also has placed a large emphasis on addressing corruption and minimizing the health industry’s influence on politics, including what she calls “closing the revolving door” between health care lobbyists and government, a plan to tax excessive lobbying, and a proposal to limit corporate spending.⁵ Warren also wants to appoint antitrust enforcers to maintain competition and analyze horizontal and vertical mergers.⁵

Like all of the other candidates, Warren has also discussed drug prices. She plans to utilize 2 already-existing government tools to lower prices: bypassing patents using the compulsory licensing authority and requiring re-licensing of certain patents developed with government involvement for which the contractor was not alleviating health or safety needs.⁵

Senator Amy Klobuchar (D-MN)

Klobuchar has proposed expanding Medicare and Medicaid as well as altering the ACA to lower costs, provide cost-sharing reductions, and make it easier for states to put reinsurance in place.⁶ As part of the ACA expansion, Klobuchar would launch new prevention and early intervention initiatives for substance use disorders and mental health, in addition to expanding access to treatment options.⁶

To lower the cost of prescription drugs, Klobuchar wants to lift the ban on Medicare negotiations, allow personal importation of safe drugs from countries such as Canada, and prohibit pharmaceutical companies from blocking less-expensive generics.⁶

Klobuchar has also emphasized care for senior citizens and has proposed enhanced health care and retirement securities, strengthening social security and Medicare, investing in long-term care and caregivers, and combating senior fraud and abuse.⁶

Joe Biden

Similar to the other Democratic candidates, former Vice President Biden aims to lower drug prices by allowing Medicare to negotiate with pharmaceutical corporations.⁷ He would also limit launch prices for drugs that face no competition; limit increases on all brand, biotech, and “abusively” priced generic drugs to inflate prices; allow consumers to buy prescription drugs from other countries; and terminate corporations’ tax break for advertisement spending.⁷

Biden is perhaps the most vocal supporter of the ACA, stating that he plans to build on it by giving Americans more choice, reducing health care costs, and making the overall health care system less complex to navigate.⁷ Like several of the other candidates, Biden has proposed introducing a new public health option such as Medicare.⁷

Biden has also focused on access for lower-income families and individuals. He has proposed lowering the limit on the cost of coverage from 9.86% of income to 8.5%, as well as automatically enrolling individuals making below 138% of the federal poverty level when they interact with institutions such as public schools or other programs for low-income populations.⁷

Michael Bloomberg

Bloomberg, former mayor of New York, New York, has also proposed a Medicare-like public option to be administered by the federal government but funded by customer premiums.⁸ Bloomberg would also strengthen the ACA by restricting the sale of health plans that don’t meet ACA standards and would expand subsidies to cap premiums at 8.5% of a household’s income.⁸

Bloomberg has also discussed access for patients in rural areas and has proposed changing rural hospital payment models so that they receive a fixed, capitated annual budget, as well as increasing federal funding for community health centers and the National Health Service Corps.⁸

To lower drug prices, Bloomberg has proposed giving Medicare the power to negotiate with drug companies, capping Medicare beneficiaries’ out-of-pocket drug spend at $2,000 per year, and limiting each new drug to a single patent lasting 20 years.⁸

REFERENCES

• Appleby J. Trump Promises ‘Phenomenal’ Health Plan. What Might That Mean? Kaiser Health News; September 4, 2019. https://khn.org/news/trump-phenomenal-republican-health-plan-political-strategy/. Accessed February 19, 2020.
• Luthi S. Supreme Court won’t fast-track Obamacare case. Politico; January 21, 2020. https://www.politico.com/news/2020/01/21/supreme-court-wont-review-obamacare-lawsuit-before-the-election-101356. Accessed February 19, 2020.
• Issues: Health Care as a Human Right — Medicare For All. Bernie Sanders election website. https://berniesanders.com/issues/medicare-for-all/. Accessed February 19, 2020.
• A New Era for Health in America. Pete Buttigieg election website. https://peteforamerica.com/a-new-era-for-health/. Accessed February 19, 2020.
• What Will Elizabeth Warren Do? Elizabeth Warren election website. https://elizabethwarren.com/plans#fix-our-broken-health-care-system. Accessed February 19, 2020.
• On the Issues: Health Care. Amy Klobuchar election website. https://amyklobuchar.com/issue/health-care/. Accessed February 19, 2020.
• Health Care. Joe Biden election website. https://joebiden.com/healthcare/. Accessed February 19, 2020.
• Health Coverage. Michael Bloomberg election website. https://www.mikebloomberg.com/policies/health-coverage-plan. Accessed February 19, 2020.