March 2, 2020

*Editor's note: This story was updated Mar. 19, 2020.

A number of candidates have announced they are seeking the Democratic nomination for president in 2020—and most have indicated health care will be one of their major priorities.

The Daily Briefing will update this page throughout the 2020 presidential primary season to show where the prominent Democratic presidential hopefuls stand on health care. Here's where they stand so far:

Former VP Joe Biden | Sen. Bernie Sanders

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 "global gag rule" 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. and also formerly supported the so-called "Hyde Amendment." However, Biden in June said he no longer supports the amendment. Biden has expressed support for requiring private insurers to cover contraceptives and funding Planned Parenthood.

  • 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 reformBiden's health reform plan aims to build and protect the Affordable Care Act. Biden's plan would create a so-called "public option" health plan that would be available to all Americans, including those with employer-sponsored coverage. Biden's proposal also would eliminate the current income cap for receiving federal subsidies to offset the cost of exchange plans and would increase the amount of subsidies enrollees could receive.

  • 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.

  • Maternal mortality: Biden's health plan calls for the nationwide implementation of a strategy used by the state of California to address maternal mortality rates. California's plan established the California Maternal Quality Care Collaborative, a public-private partnership that championed improvement strategies for maternal quality, including the development of a rapid-cycle Maternal Data Center, and the mobilization of a variety of public and private partners.

  • Mental health: Biden's health plan calls for the expansion of funding for mental health services and says it will ensure enforcement of mental health parity laws.

  • Prescription drug prices: Biden in his health reform plan proposed reducing the cost of prescription drugs by repealing current federal law that prohibits Medicare from negotiating lower drug prices with drug manufacturers. In addition, his plan would allow patients to purchase drugs from foreign countries, eliminate tax breaks on pharma's ad spending, create a system to link prices for new specialty drugs to those in foreign countries, and tie price increases the general inflation rate. Biden's plan would also instruct the HHS Secretary to construct an independent review board to assess the value of specialized drugs that have little to no competition. The board would then recommend a launch price for the drug based on the drug's average price in other countries or based on an evaluation by the board members, if the drug is entering the U.S. market first. The recommended price will be the rate Medicare and the established public option will pay for the drug. Biden's plan would also allow consumers to purchase prescription drugs from other countries, provided HHS has certified the drugs as safe.

  • Rural health care: Biden in July released a plan focused on bolstering rural parts of the United States through economic initiatives and investments and by expanding access to health care, CNN reports. Under the plan, Biden calls for building on the Affordable Care Act as a way to ensure rural U.S. residents can access health coverage and care. Biden's plan also calls for increasing funding for community health centers, medical residencies in rural areas, rural hospitals, and telehealth services.

  • Substance misuse: According to the Washington Post's "The Fix," Biden in 1988 supported legislation that lengthened criminal sentences for drug charges. However, Biden last 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."

  • Veterans' health care: Biden in November released a plan that calls for ensuring veterans have access to quality health care that address their specific needs at Veterans Affairs facilities, lowering the suicide rate among veterans, increasing veterans' access to care in rural areas, and improving health care for women veterans, among other things.

Sen. Bernie Sanders 

Sanders (I-Vt.) in February 2019 announced he is seeking the Democratic nomination for president in 2020, and said his campaign will focus on various health-related initiatives.

Sanders' 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. Sanders in May said, if he is elected president, he would only nominate Supreme Court justices who support the Court's Roe v. Wade decision. Sanders also has expressed support for codifying the Supreme Court's Roe v. Wade decision and repealing the Hyde and Helms amendments and the global gag rule. Sanders has expressed support for requiring private insurers to cover abortion care and contraception, requiring federal review of state-approved abortion laws, and funding Planned Parenthood.

  • Care for individuals with disabilities: Sanders in January introduced a plan that calls for treating disability rights as "civil rights." Sanders under the plan would strive to make sure his Medicare-for-All proposal meets the needs of individuals with disabilities. Sanders also would seek to "incorporate disability issues into every other area of public policy" and create a National Office of Disability Coordination that would work to ensure all public resources adhere to the Americans with Disabilities Act.

  • 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 in 2019 unveiled a new version of the legislation that also includes long-term care coverage. In addition, Sanders in July proposed a plan intended as a supplement to his Medicare-for-All proposal that aims to increase the number of black health care providers, The Hill reports. Further, Sanders in August said, if his proposal becomes law, he would require companies with union-negotiated health plans to renegotiate contracts, and any savings the companies generate by moving workers to Medicare for All's new government-run plan must be passed back to workers "in the form of increased wages or other benefits." Sanders in November said, if he is elected president, he will introduce legislation to implement his Medicare-for-All plan within his first week in office.

  • Hospital closures: Sanders in July announced that he plans to "very soon" introduce legislation to "establish a $20 billion emergency trust fund to help states and local communities purchase hospitals that are in financial distress." Sanders said, "In my view, any time a hospital is put up for sale in America, the local community or the state must have the right to buy it first with emergency financial assistance."

  • Marijuana legalization: Sanders has said he supports full legalization of marijuana, and is co-sponsoring Sen. Cory Booker's Marijuana Justice Act. In addition, Sanders in October announced that, if elected president, he would issue an executive order within his first 100 days in office directing that marijuana be removed from the government's list of controlled federal substances. Sanders also released a legislative plan that would legalize marijuana and expunge the records of individuals who've been convicted of marijuana-related crimes, as well as invest tax revenue from the legal sales of marijuana into communities most effected by the enforcement of marijuana laws. The proposed plan also calls for a $10 billion program to invest in rural and urban marijuana growing operations.

  • Medical debt: Sanders' health plan calls for the federal government to negotiate and pay off all medical bills that are past-due in collections and have been reported to credit agencies. The plan also calls for an end of debt collection beyond the statute of limitations, limiting contact attempts by collectors per week, requiring collectors to ensure the accuracy of their information on a debt before attempting to collect it, and limiting the assets that are able to be seized and the wages that are able to be garnished by collectors. Sanders' plan also calls for the removal and exclusion of medical debt from existing credit reports.

  • 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

  • Substance use disorders: 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. Sanders also has endorsed supervised injection sites, also known as "safe injection sites," which allow individuals who misuse drugs to do so under the care of health care professionals and without risk of arrest.

  • 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."

  • Veterans' health care: Sanders in November released a plan calling for fully funding VA so it has the staff and infrastructure need to provide care to veterans, ensuring veterans can access care at VA health centers, guaranteeing veterans have comprehensive dental coverage, and expanding VA's mental health, long-term care, and caregiver services.

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