July 24, 2020

For the past decade, political candidates' stances on health care issues have been a major factor in determining how Americans cast their votes—and the stakes are higher than ever this year, as Americans will cast their 2020 general election votes amid an unprecedented public health crisis.

Welcome to the Covid-19 presidential election

For the presidential election in particular, polling finds that voters this year are paying specific attention to candidates' stances on two main health care issues:

1. Protecting their access to health coverage and care (especially given a looming lawsuit that could invalidate the Affordable Care Act); and

2. How candidates are addressing, or proposing to address, the coronavirus epidemic.

Of America's two likely major-party candidates for president, President Trump, the Republican Party's presumptive candidate, has made his opposition to the ACA clear, and his administration is urging the Supreme Court to invalidate portions of the law. However, Trump this week said he plans to "sig[n] … a full and complete health care plan" within the coming weeks—though he hasn't yet provided details on what will be included in the plan.

In addition, Americans have seen and are living with Trump's management of the country's coronavirus response (whether they think he's been successful at mitigating the crisis or not).

But what about former Vice President Joe Biden, who is the Democratic Party's presumptive presidential nominee? Below, we detail his health care record and current health reform proposal—and take a deep dive into his plans to address the coronavirus epidemic.

Biden's health care record

Biden served as a Democratic senator for Delaware from 1973 through 2009, when he left the Senate to become the United States' vice president under former President Barack Obama.

Although Biden during his time in the Senate didn't primarily focus on health care reform, he did vote for various bills intended to expand Americans' access to health coverage and care, and he supported some funding for federal health care programs and public health initiatives. For instance, Biden voted in favor of bills that aimed to lower prescription drug costs, created Medicare Part D, and looked to expand eligibility for CHIP and the types of services covered by Medicare.

Health care reform was a large focus of Biden's vice presidency, however, as the Obama administration championed and then implemented the ACA. Biden also led the Obama administration's cancer "moonshot" initiative, and he privately continued the initiative after he left office, until 2019.

Biden's health reform proposal

Since announcing his candidacy for president, Biden has released several proposals intended to address some key health care issues in America, and most of those proposals are reflected in his broad health care reform plan.

That plan aims to build on and protect the ACA by creating a so-called "public option" health plan that would serve as an alternative to traditional insurance plans, with premium rates for patients and payments for providers all set by the government.

Biden's proposal also would eliminate the current income cap for receiving federal subsidies intended to help offset the cost of ACA exchange plans, and it would increase the amounts of subsidies that enrollees are eligible to receive.

Biden's health reform plan also looks to address several public health issues. For example, his plan calls for the nationwide implementation of a strategy used in California to address maternal mortality rates. It would also expand funding for mental health services and calls for more stringent enforcement of mental health parity laws.

In addition, Biden's health reform plan aims to lower prescription drug costs in America by repealing current federal law that prohibits Medicare from negotiating lower drug prices with drug manufacturers. His plan also would allow patients to purchase drugs from foreign countries, create a system to link prices for new specialty drugs to those in foreign countries, and tie drug price increases the general inflation rate.

While Biden has said he doesn't support shifting the United States to a so-called "Medicare-for-All," or single-payer, health system, he's said his public option plan could help ensure universal access to health coverage in America.

How Biden would address the coronavirus epidemic

Biden in May also released a proposal to combat the United States' coronavirus epidemic. The plan calls for a "decisive public health response" that includes no-cost testing for the new coronavirus; ensuring Americans are able to access treatment for Covid-19, the disease caused by the virus; and support for efforts to develop vaccines and treatments for the disease.

Notably, Biden's proposal would shift the primary responsibility for coordinating America's coronavirus response from states, which have largely been left to take the lead under the Trump administration, to the federal government.

For instance, Biden's plan calls for having the federal government hire 100,000 contact tracers to help curb the virus' spread, coordinate efforts to ramp-up production of and ensure medical workers have access to personal protective equipment, and oversee coronavirus testing efforts. In addition, Biden has said he would implement certain mandatory requirements for Americans regarding wearing face masks or coverings and encourage local officials to implement mask-wearing requirements. Biden also has said he would listen to public health experts about best practices and policies for mitigating the epidemic, and take action to boost the U.S. health system's capacity to test and treat patients.

Biden's plan also calls for a "decisive economic response" focused on ensuring workers affected by the coronavirus have paid sick leave and that employers are taking precautions to protect workers against the novel coronavirus while reopening nonessential businesses and easing coronavirus-related restrictions. Biden said he would tap public experts to advise on how to safely reopen businesses while also protecting public health, and he would implement nationwide standards to guide reopenings.

Further, Biden's plan calls for providing more financial aid to Americans, state and local governments, and small businesses to help mitigate the coronavirus epidemic's economic effects. Biden also said he would provide financial support to schools and child-care centers, to help ensure they have the resources needed reopen safely.

But as America's coronavirus epidemic continues to evolve, both Biden's and Trump's plans for combatting the crisis likely will shift, too. And the effects of the epidemic on Americans' health care priorities could play into the candidates' respective proposals for reforming the country's health care system, as well. One thing that likely won't change, however, is that health care will once again play a large role in how Americans cast their votes this November.

The most important trends poised to shape the national health care landscape

Join us starting in August for an overview of the most important forces and trends poised to shape the national health care landscape in the wake of the Covid-19 pandemic.

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