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June 26, 2019

Where do the 2020 Democratic hopefuls stand on health care?

Daily Briefing

    Millions of Americans will turn on their TVs Wednesday and Thursday evening to watch the Democratic presidential hopefuls cross swords—and health care is sure to emerge as a major issue.

    The state of policy reform—and 14 other things CEOs need to know in 2019

    There are currently 25 candidates vying for the Democratic nomination, and 20 of them met the Democratic National Committee's criteria to participate in the first presidential debate. They will be split in half, ten candidates per night, for the debates, which will air at 9 pm ET.

    How the candidates differ on health insurance reform

    For most candidates, health care is a major part of their platform. Many of the candidates support substantial changes to the health care system, but the scope and proposed avenues for their changes vary widely. Perhaps the greatest divergence involves how to reform the health insurance system—and how much the government should be involved in those changes.

    Sen. Bernie Sanders' (I-Vt.) "Medicare-for-all" plan, for instance, would create a single-payer health care plan financed by taxpayers. Four other candidates have signed on as co-sponsors of Sanders' proposal in the Senate, and three have co-sponsored a similar bill in the House. Yet, even those who have signed on as co-sponsors don't necessarily view single-payer as the right—or only—answer. Co-sponsor Sen. Kamala Harris (D-Calif.), for instance, has vacillated on whether she supports eliminating private insurance.

    According to the New York Times, eight candidates—Sens. Cory Booker, Kristen Gillibrand, Harris, Sanders, Elizabeth Warren, Rep. Tim Ryan, and entrepreneur Andrew Yang—broadly support a single-payer system. The remaining candidates mostly support creating a public insurance option to compete with private insurance, although some, like South Bend, Indiana Mayor Pete Buttegeig and Washington Gov. Jay Inslee, say they see a public option as a stepping-stone toward either a fully government-administered system or universal health care.

    How the candidates differ on strategies to lower Rx drug prices

    Beyond health coverage, many of the candidates have included substantial health care reforms in their platforms. Of the 19 candidates who filled out the New York Times' survey on their health care views, all 19 said they supported having Medicare directly negotiate drug prices with manufacturers. Others have submitted more ambitious proposals. Warren, for instance, has called for the government to manufacture prescription drugs when prices get too high (a tactic that several major hospitals have recently been pursuing). Several candidates support the importation of prescription drugs from other countries as a strategy to lower prices. Booker, Sen. Amy Klobuchar (D-Minn.), Gillibrand, Warren, and Harris have all signed on to co-sponsor Sanders' Affordable and Safe Prescription Drug Importation Act which would instruct FDA to allow prescription drug imports from Canada and then, within two years, from other countries which meet US regulatory standards.

    How the candidates differ on other major health care issues

    Another major health care talking point is long-term care. Most candidates support either requiring health insurers to cover long-term care, such as care in skilled nursing facilities, or publically funding this care. Inslee, for instance, signed the country's first publically funded long-term care benefit into law in Washington, and believes it should be a model for a national system. Other candidates have taken strong positions on mental health care and the opioid crisis. Warren proposed a highly ambitious proposal to tackle the opioid epidemic that would allocate $100 billion over 10 years for the crisis. Klobuchar has unveiled a similar plan to spend $100 on addiction and mental health services over the next 10 years.

    But beyond these major headlines, many of the candidates have largely similar views, especially on topics like vaccines, marijuana legalization, and abortion care. To learn more about each candidate's view, click on their names below:

    First night lineup:

    Second night lineup:

    Sen. Michael Bennet

    Sen. Michael Bennet (D-Colo.) on May 2 announced he is seeking the 2020 Democratic nomination for president. Bennet was appointed to the Senate in 2009 to replace then-Sen. Ken Salazar (D-Colo.), who had been appointed as secretary of the Department of Interior. Bennet has held the Senate seat since his appointment. Bennet has said his campaign will focus on health care and the economy, and his time in the Senate has given insight into his health care positions.

    • Abortion rights: According to the Associated Press, Bennet during his 2010 Senate race criticized his Republican opponent for opposing abortion rights.

    • Health care reformBennet has said he thinks Sen. Bernie Sanders' (I-Vt.) so-called "Medicare-for-All" proposal—which largely would eliminate private health insurance and, over a four-year period, would expand Medicare to cover all U.S. residents—is "a bad opening offer" for health reform, Vox reports. Instead, Bennet and Sen. Tim Kaine (D-Va.) last month introduced the Medicare-X Choice Act of 2019, which would create a public option health plan that would use Medicare payment rates and networks.

    • Prescription drug prices: Bennet has called for increased transparency in the prescription drug market as a way to lower U.S. drug prices. Bennet last month was among a bipartisan group of senators who introduced legislation aimed at lowering prescription drug prices by bolstering oversight of FDA's citizen petition process, which the senators said could help increase competition in the prescription drug market. Bennet does not support the importation of prescription drugs from Canada as he believes it would leave Canada with drug shortages and therefore they would not support it. He supports letting Medicare negotiate drug prices with manufacturers through Medicare Part D. 

    • Marijuana legalization: Bennet in February co-sponsored a bill to legalize marijuana at the federal level, Axios reports.

    • Substance misuse: According to Axios, Bennet co-sponsored the First Step Act bill (S 3629) in 2016, which "reduced minimum sentences for some repeat non-violent drug crimes." Bennet also has co-sponsored legislation intended to expedite approval of non-opioid pain treatments, as well as treatments for substance use disorders.

    Former Vice President Joe Biden

    Former Vice President Joe Biden on April 25 announced that he is seeking the Democratic nomination for president in 2020. Biden served in the U.S. Senate for about 40 years, and served as vice president under former President Barack Obama. His time in both positions offers insight into where he stands on various health care issues.

    • Abortion rights: Biden generally supports abortion rights and has said he backs the Supreme Court's Roe v. Wade  decision, which guaranteed U.S. women's right to abortion care. However, Biden "has gone back and forth on abortion in the past and has publicly struggled to reconcile his political positions with his Catholic faith," the New York Times reports. According to the Times "As recently as 2008, [Biden] said he believed life began at conception, though he emphasized that this was a personal view and that he did not think it was appropriate to impose it on others through abortion restrictions." Still, Biden has voted against federal funding for abortion and supported the so-called "Mexico City Policy" when former President Ronald Reagan enacted it, the Times reports. In addition, Biden in 1981 authored an amendment to prohibit federal "foreign aid for abortion-related biomedical research," according to the Times. The Times reports that aides for Biden earlier this year "would not say whether he still supported those policies."

    • Health care funding: Biden has criticized proposals included in Trump's budget proposal that would cut funding for Medicare and Medicaid. Biden also has also advocated for increased federal funding for medical research, and led the Obama administration's cancer "moonshot" initiative.

    • Health care reformDuring a short-lived presidential run in 2007, Biden proposed a health reform plan that would have expanded public health programs that cover low-income children, allowed U.S. residents older than 55 to buy into Medicare, and created a new government health plan that younger U.S. residents could have purchased. Biden went on to support the Affordable Care Act (ACA) while serving as vice president, and has since publicly defended the ACA against attempts to repeal the law. Biden during a campaign event on April 29 said he thinks policymakers should work to protect the ACA, and announced that he supports building on the ACA’s progress by launching a public option health plan on the ACA’s exchanges. The public option plan would allow U.S. residents to buy into Medicare. Biden has not endorsed implementing a Medicare-for-All proposal.

    • Marijuana legalization: Biden has long opposed legalizing marijuana, and has called the substance a "gateway drug," Axios reports. While serving as vice president, Biden said he supports decriminalizing marijuana instead of legalizing the drug.

    • Substance misuse: According to the Washington Post's "The Fix," Biden in 1988 supported legislation that lengthened criminal sentences for drug charges. However, Biden earlier this year called the legislation a "mistake." He said, "It was a big mistake when it was made," adding, "It's trapped an entire generation."

    • Vaccines: According to BuzzFeed News, Biden in the past has expressed support for vaccines. In 2016, he said, "I look forward to the day when your grandchildren and my grandchildren and their children show up at the office to get their physical to start school and get a shot for measles and they get a vaccine that affects significant causes of cancer."

    Sen. Cory Booker

    Sen. Cory Booker (D-N.J.) on Feb. 1 announced he is running for the Democratic presidential nomination—and health care is expected to play a role in his campaign.

    Booker in the past has taken a number of actions that shed light on where he stands on various health care issues.

    • Health care reform: Booker in September 2018 voiced his support for Sanders' Medicare-for-All proposal. Booker co-sponsored Sanders' 2017 Medicare-for-All legislation. However, Booker in May said he would take incremental steps to reform the U.S. health system if he is elected president. "I stand by supporting Medicare for All," Booker told CNN, adding, "But I'm also that pragmatist that when I'm chief executive of the country ... I'm going to find the immediate things that we can do." Booker said, "I'm telling you right now, we're not going to pull health insurance from 150 million Americans who have private insurance who like their insurance."

    • Maternal mortality: Booker and Rep. Ayanna Pressley (D-Mass.) in May introduced legislation that would expand Medicaid coverage for comprehensive prenatal, labor and postpartum care in an effort to lower maternal mortality rates, particularly among black women.

    • Marijuana legalization: Booker in February introduced a bill that would remove the federal ban on marijuana. Booker said the bill, called the Marijuana Justice Act, "seeks to reverse decades of ... unfair, unjust, and failed policy by removing marijuana from the list of controlled substances and making it legal at the federal level."

    • Prescription drug prices: Booker, who has agreed to no longer accept campaign donations from pharmaceutical companies, has co-sponsored legislation aimed at lowering prescription drug prices by allowing prescription drug imports from Canada into the United States.

    • Vaccines: Booker in May told BuzzFeed News, "First and foremost, vaccines are proven to reduce the incidence of terrible disease. Vaccines keep people safe and healthy. We need to trust the scientists who work to develop vaccines and the medical professionals who administer them."

    Pete Buttigieg, mayor of South Bend, Indiana

    South Bend, Indiana, Mayor Pete Buttigieg announced his campaign in January. Buttigieg has not talked in great detail about his health care priorities but he has spoken in depth about one policy issue.

    • Health care reform: Buttigieg has said while he feels a transition toward a Medicare-for-All program is "the right place for us to head as a country," he doesn't think such a proposal has to eliminate private health plans. During an interview with ABC's George Stephanopoulos, Buttigieg said, "If the framework we're using is Medicare, a lot of people who have Medicare also have Medicare supplements, Medicare Advantage, something like that." He continued, "So if we want to make Medicare available to everybody, whether it's as a public option to buy in or simply establishing that as how the payer structure works in this country, that's going to be the center of gravity." Buttigieg said, "The bottom line is, we need to make sure that every American is able to get health care."
    • Prescription drugs: According to the New York Times, Buttegeig supports the importation of prescription drugs, but "in a way that supports safety and quality." He also believes Medicare should be able to directly negotiate drug prices.
    • Vaccines: A spokesperson for Buttigieg in May told Buzzfeed News, "The law of the land for more than a century has been that states may enforce mandatory vaccination for public safety to prevent the spread of a dangerous disease. Pete does support some exceptions, except during a public health emergency to prevent an outbreak."

    Former HUD Secretary Julian Castro

    Julian Castro, who served as secretary of the Department of Housing and Urban Development under former President Barack Obama's administration, in Jaunary announced he is running for the Democratic presidential nomination. Since the announcement, Castro has indicated his stance on a number of health care issues, including support for a universal health care system and efforts to lower prescription drug prices.

    • Abortion rights: Castro has said he supports legal access to abortion care, and has opposed a Texas law that bans abortions after 20 weeks of pregnancy and limits abortion access.
    • Health care reform: Castro during a recent event with Iowa Democrats said, "What you're going to hear from me is that … I support universal health care." Castro has expressed his support for Sanders' Medicare-for-All proposal, which largely would eliminate private health insurance and, over a four-year period, would expand Medicare to cover all U.S. residents. He said, "Medicare should be there for everybody in this country. It's time for Medicare for all, universal health care for every single American." Castro has said he would consider funding Medicare's expansion by raising taxes on U.S. corporations and the wealthiest "0.05, 0.5, or 1%" of U.S. residents.
    • Prescription drug prices: Castro also has criticized the effect drugmakers have had on health care costs and called for efforts to lower prescription drug prices. He said he would support the importation of drugs from other countries and allowing Medicare to directly negotiate prices.

    Bill de Blasio, mayor of New York City

    New York City Mayor Bill de Blasio (D) in May announced he is seeking the 2020 Democratic nomination for president. According to Axios, de Blasio "has gained some national recognition over the years for his progressive policies," and his time serving as New York City's mayor offers insight on where he stands on health care issues.

    • Abortion rights and reproductive health care: de Blasio supports abortion rights and women's access to reproductive health care, and has lambasted proposals to restrict women's access to this care.
    • Health care reform: de Blasio earlier this year announced a plan to create a new public coverage option to provide comprehensive health coverage for undocumented immigrants and other New York City residents who do not qualify for health insurance. The plan, called NYC Care, seeks to expand the city's existing public coverage option, MetroPlus, which is a safety-net public health insurance plan run by city hospitals, to more residents. According to Politico, de Blasio has said health care, including mental health care, should be "available to all."
    • Marijuana legalization: de Blasio in December 2018 said he supports legalizing marijuana in New York City and outlined a plan to do so. As part of that plan, de Blasio said the city will work to regulate the substance to ensure it "is clean and safe," and educate the community "about the real public health risks that legalization may pose, including dependence, traffic collisions, and impaired cognitive capacity," NBC New York reports.
    • Maternal mortality: de Blasio's administration last year launched a five-year plan intended to reduce maternal mortality and life-threatening childbirth complications among women of color, noting a disparity in maternal mortality between white and black women.
    • Opioid misuse epidemic: de Blasio in January announced that New York City had filed a lawsuit against opioid drug distributors and manufacturers that claims the companies contributed to the U.S. opioid epidemic, and seeks damages for the money the city has spent to combat the epidemic.
    • Paid sick leave: de Blasio has signed into law legislation that expanded paid sick leave requirements for workers in New York City.
    • Vaccines: de Blasio in April declared the measles outbreak affecting the city a public health emergency and is requiring all residents of certain ZIP codes to receive the measles, mumps, and rubella vaccine or face a fine. de Blasio at the time said, "Every hour, every day matters here. If people would just go and get vaccinated, there's no cause for a fine." However, de Blasio has been skeptical of measures to end religious and other non-medical exemptions to vaccines, Politico reports.

    Former Rep. John Delaney

    Former Rep. John Delaney (D-Md.) announced his bid for the Democratic presidential nomination in July 2017, and has discussed his proposal for implementing a universal health care system in the United States.

    • Health care reform: Delaney has said he does not support Sanders' Medicare-for-All proposal, calling it a "plan that will be very bad for [health care] quality and cost, and then ultimately be bad for access." Instead, Delaney has proposed a new public health plan that would cover all U.S. residents under age 65, including those currently enrolled in Medicaid. The plan would cover basic medical services comparable to those covered under the Affordable Care Act's essential health benefits. Employers would be allowed to offer and U.S. residents would be allowed to purchase supplemental health insurance that would cover additional services. Delaney said the cost of the new health plan would be covered by a shared federal-and-state payment system and by terminating tax breaks for employer health benefits.

    • Vaccines: Delaney in May told BuzzFeed News he thinks vaccines are "necessary," but that exemptions to vaccines should be considered on the basis of a diseases' particular nature.

    Rep. Tulsi Gabbard

    Rep. Tulsi Gabbard (D-Hawaii) in January announced her candidacy for president, and has said bolstering U.S. residents' access to health care is one of her main priorities.

    • Abortion rights: Gabbard has expressed support for abortion rights and has voted against legislation to ban abortion after 20 weeks of pregnancy.
    • Health care reform: Gabbard co-sponsored legislation in the House that would expand health coverage to all U.S. residents. The expansion would be funded by increasing taxes on the 5% of U.S. residents with the highest incomes, establishing a progressive excise payroll and self-employment tax, creating a tax on income that does not come from employers, and taxing stock and bond transactions.

    Sen. Kirsten Gillibrand

    Sen. Kirsten Gillibrand (D-N.Y.) in January announced she also is running for president. Gillibrand has said her campaign will focus on advocating "for better health care."

    • Abortion rights: Gillibrand has indicated her support for expanding access to abortion and has opposed legislation to ban abortions after 20 weeks of pregnancy. Gillibrand also voted against confirming Supreme Court Justice Brett Kavanaugh because she claimed he could help overturn Roe V. Wade, which guaranteed U.S. women's right to abortion care. Gillibrand in May announced that, if she is elected president, she would only nominate judges who vow to uphold Roe v. Wade.
    • Health care reform: Gillibrand co-sponsored Sanders' Medicare-for-All proposal. Gillibrand also has proposed expanding the Affordable Care Act's Basic Health Program to allow states to offer more U.S. residents lower-cost health coverage options.
    • Marijuana legalization: Gillibrand has said she supports full legalization of marijuana, and is co-sponsoring Booker's Marijuana Justice Act.
    • Maternal mortality: Gillibrand has introduced legislation aimed at reducing the U.S. maternal mortality rate. The legislation would give U.S. hospitals access to additional funds to implement best practices for maternal care.
    • Prescription drugs: According to the New York Times, Gillibrand supports the importation of generic drugs and is a co-sponsor of Sanders' Affordable and Safe Prescription Drug Importation Act. She also co-sponsors the Medicare Drug Price Negotiation Act and the Empowering Medicare Seniors to Negotiate Drug Prices Act, bills which would both allow Medicare to negotiate prices for prescription drugs.
    • Universal paid family leave: Gillibrand in 2013 introduced a bill designed to create a universal family leave program to pay U.S. workers when they need to take time off from work because they get sick, give birth, or have to care for their sick children, a parent, or a spouse.

    • Vaccines: Gillibrand in May told BuzzFeed News, "Vaccines save lives. Not only do they provide individual protection, but they protect vulnerable populations, including young children, pregnant women, and people with underlying health issues." She added, "Simply put, they are essential to protecting public health."

    Sen. Kamala Harris

    Sen. Kamala Harris (D-Calif.) in January announced her candidacy for president, and has voiced her support for universal health care, Planned Parenthood, and access to mental health care.

    • Abortion rights: Harris is one of Planned Parenthood's most vocal supporters, and she has voted against legislation to ban abortions after 20 weeks of pregnancy.
    • Gender reassignment surgery: Harris has indicated she does not support requiring states to cover the cost of gender reassignment surgery for transgender inmates. She once filed a court motion to block California from covering the procedure for a transgender inmate.
    • Health care reform: Harris in August 2018 also announced her support for Sanders' Medicare-for-All proposal, and has indicated she will incorporate the proposal into her campaign. Harris co-sponsored Sanders' 2017 Medicare-for-All legislation.
    • Marijuana legalization: Harris has said she supports full legalization of marijuana, and is co-sponsoring Booker's Marijuana Justice Act.
    • Maternal health care: Harris has introduced legislation intended to reduce the United States' maternal mortality rate, particularly among black women.
    • Mental health care: Harris has introduced legislation that seeks to increase U.S. residents' access to mental health care.
    • Prescription drugs: According to the New York Times, Harris supports the importation of generic drugs and is a co-sponsor of Sanders' Affordable and Safe Prescription Drug Importation Act.
    • Vaccines: A spokesperson for Harris in May told Buzzfeed News that Harris "thinks people should get vaccines."

    John Hickenlooper, former governor of Colorado

    Former Colorado Gov. John Hickenlooper (D)—who gained national attention in 2017 for releasing a bipartisan health reform proposal—in March announced his bid for the 2020 Democratic presidential nomination. Hickenlooper in the past has taken a number of actions that shed light on where he stands on various health care issues.

    • Abortion rights and reproductive health: Hickenlooper supports abortion rights, but it hasn't been a central issue for the former governor. Hickenlooper has touted his work to prevent unintended pregnancies in Colorado, particularly among teens in the state. Hickenlooper in 2014 praised a state initiative that provided more than 30,000 contraceptive devices at no- or low-cost to Colorado residents, which preceded a 40% reduction in teen pregnancy rates over five years. Hickenlooper also has expressed support for Planned Parenthood.
    • Health care reform: While serving as Colorado's governor, Hickenlooper worked to fully implement the Affordable Care Act (ACA) in the state by helping to create Colorado's state-run insurance exchange and expanding the state's Medicaid program. Hickenlooper and former Ohio Gov. John Kasich (R) in 2017 entered the health reform debate that raged in the House and Senate by offering a bipartisan health reform proposal that called for leaving the ACA's individual mandate and cost-sharing reduction payments to insurers in place, among other things. Recently, Hickenlooper said he supports transitioning the United States to a universal health care system, though he stopped short of embracing a specific Medicare-for-All proposal. Hickenlooper has said it is more important for policymakers right now to support implementing some form of universal health care, rather than promoting one specific proposal.
    • Marijuana legalization: Hickenlooper gained national attention for implementing legalized recreational marijuana sales in Colorado, after a majority of state voters in 2012 supported a state ballot initiative to legalize recreational marijuana sales in the state. However, Hickenlooper at the time said he, personally, was against legalizing marijuana. Hickenlooper since has said he believes the system he implemented in Colorado to legalize and regulate recreational marijuana sales worked.

    • Vaccines: According to BuzzFeed News, Hickenlooper in in 2015 said "Kids that can be vaccinated should be vaccinated." He added, "There are these urban myths — and in many cases these are now suburban myths and rural myths — that somehow vaccinations increase the probability of autism or other unnamed maladies. But there is no science to support this. The science clearly states that having more and more people unvaccinated puts other children at risk."

    Washington Gov. Jay Inslee

    Washington Gov. Jay Inslee (D) in March announced he is seeking the Democratic presidential nomination with a campaign focused on climate change, which he said "touches the heart of things so many of us care about: our jobs, our health, our safety and our children's future."

    As Washington's governor, Inslee has advocated for policies to address a number of issues related to health care, including increasing access to mental health care, protecting abortion rights, reducing carbon emissions, and implementing a state-funded public health insurance option, among other things.

    • Abortion rights: Inslee's administration has taken action against Trump administration policies that Inslee has argued could restrict access to abortion care. For example, Inslee's administration in 2017 sued the Trump administration over interim final rules that significantly expanded exemptions available to employers that oppose the Affordable Care Act's (ACA) contraceptive coverage rules. Inslee also recently criticized the Trump administration's decision to finalize a rule that bars abortion providers and clinics that refer patients for abortion care from receiving Title X family planning grants, saying the rule places "tens of thousands of Washingtonians and millions of Americans" in danger. Inslee's administration has filed a lawsuit seeking to block the regulation.
    • Climate change as a health issue: Inslee's campaign will focus on tying climate change to other issues, including health care. Inslee in January told Fox News, "Climate change is a health care issue."
    • Health care reform: Inslee in 2013 signed a state budget that expanded Medicaid in the state, and since then, has called on policymakers to fully implement the ACA, including the law's Medicaid expansion. Inslee this year announced that state Democratic lawmakers in Washington would be introducing legislation to create a state-funded public health insurance option, which residents would be able to select on Washington's health insurance exchange. Inslee in his state budget proposal requested $500,000 to create the plan. He said the state-based public insurance option would represent a "step toward universal health care."
    • Marijuana legalization: Inslee recently issued pardons to more than 3,500 Washington residents who had misdemeanor convictions for marijuana possession. Washington has decriminalized marijuana, allowing it to be sold for recreational use.
    • Mental health: Inslee in a state budget proposal has requested $155 million to increase mental health care support in schools by funding guidance counselors, psychologists, and school nurses in elementary and middle schools. According to the Seattle Times, Inslee also has "overseen a multitude of crises in the state's mental-health system, including the federal decertification of the state's largest psychiatric facility."
    • Prescription drugs: According to the New York Times, Inslee supports importing prescription drugs and has voted to do so several times in Congress.
    • Vaccines: Inslee in May told BuzzFeed News, "I believe in science — and the science on vaccines is crystal clear: vaccinations are safe and protect public health.” He added, "Anti-vax misinformation is a danger to public health, as we've seen with the Southwest Washington measles outbreak this year."

    Sen. Amy Klobuchar

    Sen. Amy Klobuchar (D-Minn.) in February announced she was joining the swath of Democrats seeking the party's nomination for president, and she indicated health care will be one of her major priorities. Klobuchar has spoken about proposals to implement a universal health care system in the United States, among other health care issues.

    • Abortion rights: Klobuchar has said she believes abortion is a decision that should remain between a woman and her physician. Klobuchar co-sponsored the Women’s Health Protection Act, which bars states from establishing restrictions on abortions.
    • Health care reform: Unlike many other Democrats currently running for president, Klobuchar has not indicated her support for Sanders' Medicare-for-All proposal. Klobuchar has said she supports taking a more gradual approach toward implementing universal health coverage in the United States, noting about 50% of U.S. residents have private health insurance.
    • Mental health and substance use disorders: Klobuchar on May 3 introduced a $100 billion plan aimed at improving access to mental health care and services to address substance use disorders.
    • Marijuana legalization: Klobuchar in February said she "support[s] the legalization of marijuana and believe[s] that states should have the right to determine the best approach to marijuana within their borders."
    • Prescription drug prices: Klobuchar and Sen. Chuck Grassley (R-Iowa) in January introduced a bill called the Safe and Affordable Drugs from Canada Act of 2019, which aims to address high prescription drug prices by allowing U.S. residents to import drugs from Canada. Klobuchar also has pushed for federal lawmakers to approve legislation that would allow CMS to negotiate prices for drugs covered under Medicare Part D. In addition, Klobuchar has introduced legislation that would allow the federal government to prevent drugmakers from entering so-called pay-for-delay agreements, under which brand-name drugmakers pay generic drugmakers to delay when generic versions of their products enter the market.
    • Vaccines: According to BuzzFeed News, Klobuchar in April signed a Senate resolution touting the importance of vaccines.

    Rep. Beto O'Rourke

    Former Rep. Beto O'Rourke (D-Texas) in March announced that he is seeking the 2020 Democratic nomination for president, and indicted health care will be a priority in his campaign. O'Rourke served three terms in the House, representing Texas' 16th congressional district. Last year, he unsuccessfully sought to unseat Sen. Ted Cruz (R-Texas). O'Rourke's time in Congress and on the campaign trail has provided insight into his positions on various health care topics.

    • Abortion rights: O'Rourke has long supported abortion-rights. His campaign website during his unsuccessful 2018 Senate bid stated policymakers should "ensur[e] that a woman's right to choose is not compromised by limited access to safe and legal abortion services or family planning help."

    • Health care reform: O'Rourke during his time in Congress helped pass legislation related to temporary health benefits, and has urged Texas lawmakers to expand Medicaid under the ACA. However, O'Rourke has criticized the ACA for not going far enough to ensure all U.S. residents have access to affordable health coverage, and has said policymakers should create incentives to encourage health insurers to participate in the ACA's exchanges. In addition, O'Rourke has said he wants the United States to achieve universal health coverage, "whether it be through a single-payer system, a dual system, or otherwise." When asked directly about his stance on single-payer options during a March campaign stop in Iowa, O'Rourke said, "No, my goal is to get to guaranteed, high-quality universal health care for all, and I think there are many ways to get there." He later added that he's "no longer sure" that Medicare-for-All or a single-payer system would be "the fastest way for us to get there."

    • Marijuana legalization: O'Rourke has called for legalizing marijuana nationwide and expunging the records of individuals who have been jailed for possessing marijuana.

    • Prescription drug prices: O'Rourke during his 2018 Senate campaign called for allowing the federal government to negotiate prescription drug prices. He supports Sanders' Affordable and Safe Prescription Drug Importation Act.
    • Vaccines: A campaign spokesperson in May told Buzzfeed News, "The evidence is clear and there is wide agreement among doctors and scientists that vaccination is the best course for our kids and our communities. Beto and [his wife] have chosen to vaccinate their three children because they believe it is important to ensuring our country’s children are healthy, safe, and secure."


    Rep. Tim Ryan

    Tim Ryan (D-Ohio), a nine-term Democratic congressional member from Ohio, entered the Democratic presidential candidate race in early April. He's said climate change, the economy, education, health care, and gun control will be key issues in his campaign.

    • Abortion rights:  Ryan has supported abortion rights since 2015, when he concluded the "heavy hand of government must not make this decision for women and families." He's been outspoken against actions to restrict a woman's access to abortion care, including Ohio's 20-week abortion ban and the state Legislature's attempts to defund Planned Parenthood. Ryan has co-sponsored the Equal Access to Abortion Coverage in Health Insurance Act.

    • Health care reform:  Ryan in an interview April 7 on CBS News' "Face The Nation"  said he supports the ACA's  health care model, but also favors adding a government-run "public option" for the general public. In 2017, Ryan introduced  a bill that would create a Medicare buy-in for U.S. residents ages 50 to 64. "I want more people to have more affordable coverage," Ryan said. "I want there to be some kind of public option where middle class people who work hard and play by the rules can get some help so they're not getting squeezed by the pharmaceutical companies and the health care companies."
    • Vaccines: Ryan in May told BuzzFeed News, "I believe mandatory immunizations and vaccinations are critical to keeping our families, our kids, and our communities safe." He added that he supports eliminating religious and personal belief exemptions to vaccines.

    Sen. Bernie Sanders 

    Sanders (I-Vt.) in February announced he is seeking the Democratic nomination for president in 2020, and said his campaign will focus on various health-related initiatives.

    Aides to Sanders said his presidential campaign will focus on a number of his health-related proposals, including promoting his Medicare-for-All proposal, lowering U.S. drug prices, legalizing marijuana, and ensuring workers have access to paid medical leave.

    Sanders' recent proposals and past campaigns can offer insight into the proposals he might put forth during his campaign, as well as into where he stands on other major health care issues.

    • Abortion rights: Sanders, during his 2016 presidential primary race against former Secretary of State Hilary Clinton, implied that he would not support any restrictions on abortion care.

    • Health care reform: Sanders in 2017 first introduced legislation that would implement his Medicare-for-All proposal, which would largely eliminate private health insurance and, over a four-year period, would expand Medicare to cover all U.S. residents. Sanders this month unveiled a new version of the legislation that also includes long-term care coverage.
    • Marijuana legalization: Sanders has said he supports full legalization of marijuana, and is co-sponsoring Booker's Marijuana Justice Act.
    • Opioid epidemic: Sanders in 2018 introduced a bill that would impose penalties on drug manufacturers and pharmaceutical executives in cases of deceptive marketing or illegal distribution of prescription opioids. According to a summary of the bill, the measure would prohibit pharmaceutical companies and their employees from disseminating direct-to-consumer advertising that falsely suggests opioids have no addictive qualities or risks. Pharmaceutical companies that violate that policy would be fined 25% of the profits derived from their opioid products. In addition, executives would face criminal liability and could face fines equal to the executive's compensation package or a minimum of 10 years in prison.
    • Prescription drug prices: Sanders has proposed the federal government take aggressive action to address high U.S. drug prices. Sanders in January introduced a legislative package intended to lower prescription drug costs that includes three bills:
      • The Affordable and Safe Prescription Drug Importation Act (HR 2228), which would allow U.S. residents, pharmacists, and wholesalers to import lower-cost drugs from Canada and other developed countries;
      • The Medicare Prescription Drug Price Negotiation Act (S 41), which would allow the HHS Secretary to negotiate prices for drugs covered under Medicare Part D; and
      • The Prescription Drug Relief Act, which would set U.S. drug prices based on the median prices in Canada, France, Germany, Japan, and the United Kingdom, and require FDA to approve generic versions of the drugs—regardless of whether the drugs are protected by patents—if drugmakers refuse to lower prices to meet the new target
    • Vaccines: A spokesperson for Sanders in May told Buzzfeed News that the senator "believes that vaccinations work and are crucial to overall public health. Instances of serious but preventable diseases have been significantly reduced and many have been eliminated altogether as a result of vaccines."

    Rep. Eric Swalwell 

    Eric Swalwell (D-Calif.), a fourth-term congressional member from California, announced  April 8 that he is running for the Democratic nomination for president. Swalwell said his campaign will focus on gun control, health care, and education.

    • Health care reform:  Swalwell in February co-sponsored a so-called "Medicare-for-All"  bill that would eliminate most private health insurance in the United States and replace it with a government-run health plan that would cover all U.S. residents, except for those enrolled in the Veterans Affairs health system and the Indian Health Service. And in a March op-ed,  he wrote, "We need a Medicare for All universal health guarantee." However, in an interview on MSNBC's "Morning Joe" a few weeks later,  he clarified that he does not support completely eliminating private insurers.

    • Vaccines: Swalwell in May told BuzzFeed News that he supports eliminating religious and personal belief exemptions to vaccines. He said, "Nobody's beliefs should put other people's lives at risk."

    Sen. Elizabeth Warren

    Sen. Elizabeth Warren (D-Mass.) in late December announced she had launched an exploratory committee to fill key staff positions for a campaign to run for president in 2020. Media reports have indicated Warren's bid for president would focus on health care issues such as prescription drug prices, health care reform, and the opioid epidemic.

    • Health care reform: In March 2018, Warren backed a bill intended to bolster consumer protections in the private health insurance market. Warren has said she supports Sander's Medicare-for-All proposal and co-sponsored Sanders' 2017 Medicare-for-All bill.

    • Maternal mortality: Warren on April 24 proposed a plan intended to  address maternal mortality rates among black women that would give hospitals that lower their maternal mortality rates bonus payments and levy financial penalties on hospitals that don’t lower their maternal mortality rates.

    • Marijuana legalization: Warren has said she supports full legalization of marijuana, and is co-sponsoring Booker's Marijuana Justice Act.

    • Opioid misuse: Warren in May unveiled a $100 billion proposal to combat the U.S. opioid epidemic that would emphasize employment and evidenced-based treatment for those struggling with substance use disorders, as well as provider training on treatment methods. According to Vox, the $100 billion proposal "matches the level of spending experts have long said is necessary to make a serious dent in the crisis and reverse it."

    • Prescription drug prices: Warren supports the importation of prescription drugs from other countries and letting Medicare negotiate drug prices with manufacturers.

    • Vaccines: Warren in May told Buzzfeed News, "The more we do on the front end to ensure that everyone gets access to vaccines, the less we'll see individuals contracting hepatitis A, measles, whooping cough, and all of the other vaccine-preventable diseases. We must make sure there is robust public health funding so people have access to vaccines."

    Marianne Williamson, an author and lecturer

    • Health care reform: Marianne Williamson in 2017 called Sanders' Medicare-for-All proposal "an idea whose time has come."

    • Prescription drug prices: Williamson supports the importation of prescription drugs from other countries and letting Medicare negotiate drug prices with manufacturers.

    Andrew Yang, an author and entrepreneur

    • Health care reform: Andrew Yang has called for a transition to Medicare-for-All—though it's not clear whether he supports Sanders' proposal.

    • Prescription drug prices: Yang supports the importation of prescription drugs from other countries and letting Medicare negotiate drug prices with manufacturers.

    • Vaccines: Yang in May told BuzzFeed News, "I believe the science. Numerous studies indicate no connection between vaccines and autism." He said he supports California's requirements that children must be vaccinated to attend school or day care unless they have a medical exemption.

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