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Democrats Try To Distinguish Themselves On Health Care


Twenty of 24 presidential candidates got the chance to distinguish themselves this week during the first televised Democratic debates, hosted by NBC News. One subject that led to a spirited discussion - health care.


BERNIE SANDERS: We will have "Medicare for All."

KIRSTEN GILLIBRAND: I believe we need to get to universal health care as a right and not a privilege to single payer.

JOE BIDEN: You cannot let people who are sick, no matter where they come from, no matter what their status, go uncovered. You can't do that.

MCCAMMON: That's former Vice President Joe Biden and Senators Kirsten Gillibrand and Bernie Sanders. Here to help us understand where the Democratic candidates agree and where they don't is Julie Rovner, chief Washington correspondent for Kaiser Health News. Welcome.


MCCAMMON: So there seems to be consensus about some version at least of this idea of Medicare for All, but not everyone's on the same page about what that phrase actually means. Julie, what does Medicare for All mean?

ROVNER: Well, it can mean a lot of things. That's part of what's so confusing about this debate. First of all, what Medicare are they talking about? Are they talking about the current Medicare that most people over age 65 have? That's not really the case in a lot of these plans. They're mostly talking about a new program that would have much broader, more comprehensive benefits. It wouldn't require people to have copays or deductibles. Then the question is, what do they mean by all? Do they mean that everybody would go into this new Medicare program? Would they be required to give up private insurance they might have now, or would that be voluntary?

MCCAMMON: And why is that distinction important, whether it's voluntary or something that people are just automatically in by virtue of being an American?

ROVNER: Well, we certainly learned during the implementation of the Affordable Care Act that the very few people who were basically required to give up their insurance were extremely unhappy about that. People may not like the private insurance that they have, but they're terrified about going to something new that they fear might be worse.

MCCAMMON: And one telling moment in the debate was when candidates were asked to raise their hands if they would support coverage under a government plan for undocumented immigrants. And all of them did raise their hands on the second night of the debate. Here's South Bend, Ind., Mayor Pete Buttigieg explaining his position.


PETE BUTTIGIEG: Our country is healthier when everybody is healthier. And remember; we're talking about something people are given a chance to buy into.

MCCAMMON: Julie, were you surprised to see all the Democrats take that position, that they would cover undocumented immigrants in a government plan?

ROVNER: I was surprised. This was something that was a big issue during the passage of the Affordable Care Act in 2009 and 2010. Undocumented immigrants were not allowed to sign up for expanded Medicaid or get subsidies on the insurance exchanges. It was a very sensitive issue. And I think Democrats were not very happy about that. But they felt that they literally could not get the bill passed if they were to allow undocumented people to take advantage of some of the benefits. And that seems to have really come around just in the last 10 years.

MCCAMMON: And President Trump tweeted during the debate, quote, "all Democrats just raised their hands for giving millions of illegal aliens unlimited health care. How about taking care of American citizens first? That's the end of that race." I mean, how might this issue play with general election voters?

ROVNER: Well, obviously, immigration is going to be almost as big an issue as health care, I suspect, going into 2020. And I think Democrats are sort of staking themselves out on the supportive of immigration side if only to contrast themselves with what's going on at the southern border and President Trump. I have no idea how it's going to play out, but it certainly seems like they're not being shy about which side they're on.

MCCAMMON: Another polarizing issue - we've heard candidates affirm support for abortion rights opposing the Hyde Amendment, for example, which bans federal funding for most abortions. Several Democratic candidates expressed support for covering abortion under Medicare or another government plan. Senator Elizabeth Warren, for example, when asked if she supports any limits on abortion didn't directly answer that but pivoted to expressing support for reproductive rights in general. Julie, what is the rhetoric we're hearing, say, about where the Democratic Party is on this issue right now?

ROVNER: Well, this has been a gradual but noticeable move to the left for the Democrats. There used to be a significant percentage of the party that were Democrats but didn't support abortion. And Democrats had long been sort of careful about that flank of the party. There seemed to be fewer of them. It seems that both parties are moving sort of to the polls on this issue, Democrats being very supportive of abortion rights, Republicans being very unsupportive of abortion rights. And it makes me wonder what's going to happen to those people in the middle because even though they're not very well represented by the parties anymore, if you look at public opinion polls, there are a lot of people in that sort of middle group. And right now, it seems that neither party is really speaking to them.

MCCAMMON: You know, sort of a reality check here, Julie, if one of these Democrats wins in 2020, what can they actually do on this issue?

ROVNER: Well, obviously, it would take Congress to do a lot of things that some of these candidates are talking about, but it's important to remember that the president alone has a lot of power through making federal rules. The Trump administration is very much rolling back access to abortion and birth control through its rulemaking authority. A Democratic president could reverse all of those things.

MCCAMMON: Well, that was Julie Rovner of Kaiser Health News. Thanks, Julie.

ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.