ACHIEVING UNIVERSAL, AFFORDABLE, QUALITY HEALTH CARE
Democrats have fought to achieve universal health care for a century. We are proud to be the party of Medicare, Medicaid, and the Affordable Care Act. Because of the Obama-Biden Administration and the Affordable Care Act, more than 100 million Americans with pre-existing conditions, from heart disease to asthma, are secure in the knowledge that insurance companies can no longer discriminate against them. Women can no longer be charged more than men just because of their gender. And more Americans are able to get health coverage than ever before.
Democrats will keep up the fight until all Americans can access secure, affordable, high-quality health insurance—because as Democrats, we fundamentally believe health care is a right for all, not a privilege for the few.
Unfortunately, at every turn, Democrats’ efforts to guarantee health coverage have been met by obstruction and opposition from the Republican Party. It has been Republicans who have embraced junk plans that undermine protections for pre-existing conditions. It was Republican state attorneys general who sued to block Medicaid expansion and Republican governors who refused to extend Medicaid coverage to their citizens, leaving millions of low-income Americans, disproportionately people of color, unable to access health coverage. And in the midst of the worst global pandemic in generations—one that has left more than 150,000 Americans dead and counting—the Trump Administration is fighting in court to invalidate the entirety of the Affordable Care Act and eliminate insurance for tens of millions of people. Overturning the Affordable Care Act remains a central plank of the Republican Party platform. The difference in values between the two parties on this life-or-death issue could not be more stark.
The COVID-19 pandemic has made this difference in values painfully, brutally clear. President Trump has repeatedly downplayed the threat of the coronavirus, bullied governors for enacting life-saving public health measures, and left our frontline health care heroes without the equipment they need to protect themselves and the American people. The burdens of this pandemic have not been borne equally, as communities of color have suffered higher rates of infection and death, and struggled to access life-saving care when they need it most. Our essential workers have been deemed expendable by the President and his Administration.
As Democrats, we say with one voice: no more.
We are going to at last build the health care system the American people have always deserved: one that finally provides universal health care coverage; reduces prescription drug prices, premiums, and out-of-pocket costs; reins in overall health care expenses; and tackles the deep-seated inequities in our health care system. We will build a health care system that is driven by the needs of patients and the people who care for them, instead of the profit motives of corporations. We will tackle entrenched racial disparities in health care, reduce prescription drug prices by standing up to big pharmaceutical companies, and make it easier to access mental health and substance use disorder treatment and long-term services and supports in metropolitan and rural areas alike.
Democrats will always fight to save Americans’ lives by making it easier and more affordable to go to the doctor, get prescription medicines, and access preventive testing and treatments.
Generations of Democrats have been united in the fight for universal health care. We are proud our party welcomes advocates who want to build on and strengthen the Affordable Care Act and those who support a Medicare for All approach; all are critical to ensuring that health care is a human right.
Securing Universal Health Care Through a Public Option
Democrats believe we need to protect, strengthen, and build upon our bedrock health care programs, including the Affordable Care Act, Medicare, Medicaid, and the Veterans Affairs (VA) system. Private insurers need real competition to ensure they have incentive to provide affordable, quality coverage to every American.
To achieve that objective, we will give all Americans the choice to select a high-quality, affordable public option through the Affordable Care Act marketplace. The public option will provide at least one plan choice without deductibles; will be administered by CMS, not private companies; and will cover all primary care without any co-payments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people.
Everyone will be eligible to choose the public option or another Affordable Care Act marketplace plan. To help close the persistent racial gap in insurance rates, Democrats will expand funding for Affordable Care Act outreach and enrollment programs, so every American knows their options for securing quality, affordable coverage.
The lowest-income Americans, including more than four million adults who should be eligible for Medicaid but who live in states where Republican governors have refused to expand the program, will be automatically enrolled in the public option without premiums; they may opt out at any time. And we will enable millions of older workers to choose between their employer-provided plans, the public option, or enrolling in Medicare when they turn 60, instead of having to wait until they are 65. Democrats are categorically opposed to raising the Medicare retirement age.
Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches.
We also know that finally covering every American through the public and private insurance system alone is not enough to guarantee universal access. That is why Democrats support doubling investments in community health centers and rural health clinics in underserved urban and rural areas, including increased support for dental care, mental health care, and substance use services like medication-assisted treatment, and why we will increase support for mobile health clinics. We will enact longer, multi-year funding cycles for these critical health services so they can operate with greater certainty, as community health centers are the nation’s only providers that are required by law to be both located in medically underserved areas and required to serve all who seek care, regardless of their ability to pay. And we will leverage innovative payment options through Medicare and Medicaid to help community health centers and rural health clinics keep their doors open. We will expand the National Health Service Corps and Teaching Health Center Graduate Medical Education Program to grow a diverse primary care workforce and to address critical shortages of health care providers in medically underserved rural and urban areas, including primary care nurses, dental professionals, and mental health and substance use counselors. Democrats will also increase monitoring and enforcement to ensure that health care facilities are accessible to people with disabilities.
Bringing Down Drug Prices and Taking on the Pharmaceutical Industry
Too many Americans struggle to afford the prescription drugs they need to get or stay healthy. No American should find themselves foregoing or rationing medications because they can’t afford to pay—especially when taxpayer money underwrites research leading to the development of many prescription drugs in the first place.
Democrats will take aggressive action to ensure that Americans do not pay more for prescription drugs than people in other advanced economies, and ensure that all necessary medications are covered. We will empower Medicare to at last be able to negotiate prescription drug prices for all public and private purchasers—for families and businesses, as well as older Americans—no matter where they get their coverage. We will also prevent the price of brand-name and outlier generic drugs from rising faster than the inflation rate. We will cap out-of-pocket drug costs for seniors, and ensure that effective treatments for chronic health conditions are available at little or no cost.
For too long, prescription drug companies have gamed the system to justify their price increases by any means available. Democrats will crack down on anti-competitive efforts to manipulate the patent system or collude on prices. And we will eliminate tax breaks for prescription drug advertisements.
Reducing Health Care Costs and Improving Health Care Quality
The United States spends more per capita on health care than any other advanced economy, and has less to show for it. Health care costs have been increasing for decades, with average premiums for an employer-provided family plan topping $20,000 in 2019. Democrats know we can reduce out-of-pocket costs for families while improving the quality of health care for all. We will make it easier for working families to afford high-quality insurance in the Affordable Care Act marketplaces by ensuring that no one pays more than 8.5 percent of their income in premiums and eliminating the cap on subsidies.
Democrats believe that when Americans are in the hospital or an emergency room, they shouldn’t have to worry about whether their health care providers are in-network or not, which is why we will outlaw the predatory practice of surprise medical billing. We will work to increase price transparency in the health care system across all payers, and reduce paperwork through uniform medical billing. And we will vigorously use antitrust laws to fight against mega-mergers in the hospital, insurance, and pharmaceutical industries that would raise prices for patients by undermining market competition.
Excessive prescription drug cost-sharing and voids in coverage such as dental, vision, and hearing services can lead to severe health consequences for Medicare patients. Democrats will fight any efforts to cut Medicare benefits, and support finding financially sustainable policies to expand Medicare to cover dental, vision, and hearing.
Democrats will support policies that increase the number of primary care practitioners, registered nurses, dentists, and dental therapists, especially in rural and low-income metropolitan areas, so it’s easier for every American to access preventive and primary health care. Democrats value all people and will actively promote wellness programs for all ages in our diverse communities for better overall health.
Expanding Access to Mental Health and Substance Use Treatment
Every American who needs it should be able to access mental health care or substance use disorder treatment, no matter where they live. Democrats will aggressively enforce the federal mental health and substance use disorder parity law and ensure that health insurers adequately cover mental health and substance use treatment. We will also invest in training and hiring more mental health providers, substance use disorder counselors, and peer support counselors, including by expanding funding for health clinics, especially in rural areas, and increasing access to these services through Medicaid. Trauma has a profound effect on both mental and physical health, and Democrats will support increased training for health care professionals, educators, social workers, and other care workers in trauma-informed care and practices. We will oppose efforts to weaken HIPAA and FERPA privacy rights of people with mental illness.
The opioid epidemic has devastated American communities, and the Trump Administration has completely failed in its response, leaving millions of families desperate for help. Democrats will make medication-assisted treatment available to all who need it, and will require publicly supported health clinics to offer medication-assisted treatment for opioid addiction and approved treatments for other substance use disorders. We believe we must stop over-prescribing while improving access to effective and needed pain management. Democrats recognize that incarcerated people suffer from serious mental health and substance use disorders at higher rates than the general population, which is why we will support expanded access to mental health and substance use disorder care in prisons and for returning citizens. We will ensure no one is incarcerated solely for drug use, and support increased use of drug courts, harm reduction interventions, and treatment diversion programs for those struggling with substance use disorders.
Expanding Long-Term Care Services and Supports
The COVID-19 pandemic exposed the vulnerabilities of people who reside in institutional settings, such as nursing homes and independent living facilities, and made clear that biases within Medicaid create undue barriers to home- and community-based long-term services and supports. Democrats will work to eliminate waiting lists for home and community-based care and the institutional bias within Medicaid, making investments in building the capacity of the Medicaid system to provide home and community-based services. We will modernize Medicaid eligibility so people with disabilities do not have to work low-wage jobs to access needed services, and to ensure the spouses of people with disabilities can maintain a certain level of income and assets. We will also help Americans pay for long-term care by creating a tax credit for informal and family caregivers and increasing the Child and Dependent Care Tax Credit. Democrats will also pursue policies to improve nursing home staffing and quality standards, strengthen accreditation processes, and combat corporate abuses in nursing homes and independent living facilities. And Democrats are strongly committed to protecting and enforcing the Americans with Disabilities Act and fulfilling the promise of the Olmstead v. L.C. decision, which found institutional segregation of people with disabilities to be unlawful.
Eliminate Racial, Gender, and Geographic Health Inequities
The national statistics on American health care mask profound disparities in insurance rates, access to primary and specialized care, and disparate health outcomes, which are a symptom of those disparities in access. Even before the COVID-19 pandemic, the uninsured rate was nearly three times higher for Latinos and nearly twice as high for Black Americans as it was for whites. Some segments of the Asian American and Pacific Islander population faced uninsured rates rivaling those of Black Americans and Latinos, and more than one in five Native Americans and Alaska Natives was uninsured. Black children are far more likely than white children to suffer from asthma. Latinos, Native Americans, Asian Americans and Pacific Islanders, and Black Americans are diagnosed with diabetes at higher rates than whites. And average life expectancy is more than two years lower for rural Americans compared to those who live in metropolitan areas.
We recognize it is not enough to have a commitment to eliminating health disparities: we must have a plan. That is why Democrats will launch a sustained, government-wide effort, with leadership at the highest levels, to eliminate racial, ethnic, gender, and geographic gaps in insurance rates, access to quality care, and health outcomes. That includes tackling the social, economic, and environmental inequities—the social determinants of health like poor housing, hunger, inadequate transportation, mass incarceration, air and water pollution, and gun violence—that contribute to worse health outcomes for low-income Americans and people of color.
We can and must fix these inequities by expanding coverage, making health care more affordable, and tackling implicit bias in our health care system. Democrats will ensure that people with disabilities are never denied coverage based on the use of quality-adjusted life year (QALY) indexes. Democrats will ensure federal data collection and analysis is adequately funded and designed to allow for disaggregation by race, gender, sexual orientation, gender identity, geography, disability status, national origin, and other important variables, so that disparities in health coverage, access, and outcomes can be better understood and addressed.
We will expand access to health care for people living and working across the United States by extending Affordable Care Act coverage to Dreamers, and working with Congress to lift the five-year waiting period for Medicaid and Children’s Health Insurance Program eligibility for low-income, lawfully present immigrants.
Democrats remain committed to ending the HIV/AIDS epidemic, which disproportionately affects communities of color and the LGBTQ+ community, and will support critical investments under the Ryan White HIV/AIDS Program and the Minority HIV/AIDS Fund.
Protecting Native American Health
Native American tribes have for too long been forced to cope with insufficient access to health care and mental health services, nutrition services, and modern infrastructure. Democrats are committed to pursuing environmental justice and climate justice, including for Indigenous peoples and communities, and will invest significant new resources in clean water and wastewater infrastructure, clean energy generation and distribution, and sustainable and regenerative agriculture. And we will make mandatory and work toward full funding for the Indian Health Service as part of our commitment to pursuing strong nation-to-nation relationships and honoring the United States’ trust obligations to Native American communities.
Securing Reproductive Health, Rights, and Justice
Democrats are committed to protecting and advancing reproductive health, rights, and justice. We believe unequivocally, like the majority of Americans, that every woman should be able to access high-quality reproductive health care services, including safe and legal abortion. We will repeal the Title X domestic gag rule and restore federal funding for Planned Parenthood, which provides vital preventive and reproductive health care for millions of people, especially low-income people, and people of color, and LGBTQ+ people, including in underserved areas.
Democrats oppose and will fight to overturn federal and state laws that create barriers to reproductive health and rights. We will repeal the Hyde Amendment, and protect and codify the right to reproductive freedom. We condemn acts of violence, harassment, and intimidation of reproductive health providers, patients, and staff. We will address the discrimination and barriers that inhibit meaningful access to reproductive health care services, including those based on gender, sexual orientation, gender identity, race, income, disability, geography, and other factors. Democrats oppose restrictions on medication abortion care that are inconsistent with the most recent medical and scientific evidence and that do not protect public health.
We recognize that quality, affordable comprehensive health care; medically accurate, LGBTQ+ inclusive, age-appropriate sex education; and the full range of family planning services are all essential to ensuring that people can decide if, when, and how to start a family. We are proud to be the party of the Affordable Care Act, which prohibits discrimination in health care on the basis of sex and requires insurers to cover prescription contraceptives at no cost. These efforts have significantly reduced teen and unintended pregnancies by making it easier to decide whether, when, and how to have a child.
We believe that a person’s health should always come first. Democrats will protect the rights of all people to make personal health care decisions, and will reject the Trump Administration’s use of broad exemptions to allow medical providers, employers, and others to discriminate.
Protecting and Promoting Maternal Health
Black women are more than three times as likely to die from complications of pregnancy and childbirth compared to white women. To save mothers’ lives, Democrats will expand postpartum Medicaid coverage to a full year after giving birth, invest in rural maternal health, promote a diverse perinatal workforce, and implement implicit bias training for health professionals. We will support comprehensive solutions to address every dimension of the Black maternal health crisis in America and eliminate all racial and ethnic disparities in maternal health outcomes, and support policies and approaches that will at least halve our nation’s unacceptably high maternal mortality rate. We strongly and unequivocally support the decision to have a child, including by ensuring a safe and healthy pregnancy and childbirth, and by providing services during pregnancy and after the birth of a child, including adoption and social support services, as well as protections against pregnancy discrimination. We are committed to creating a society where children are safe and can thrive physically, emotionally, educationally, and spiritually.
Protecting LGBTQ+ Health
We condemn the Trump Administration’s discriminatory actions against the LGBTQ+ community, including the dangerous and unethical regulations allowing doctors, hospitals, and insurance companies to discriminate against patients based on their sexual orientation or gender identity. Democrats will reverse this rulemaking and restore nondiscrimination protections for LGBTQ+ people and people living with HIV/AIDS in health insurance, including coverage of all medically necessary care for gender transition. We will also take action to guarantee that LGBTQ+ people and those living with HIV/AIDS have full access to needed health care and resources, including by requiring that federal health plans provide coverage for HIV/AIDS testing and treatment and HIV prevention medications like PrEP and PEP, gender confirmation surgery, and hormone therapy.
Democrats support increased community HIV prevention and testing programs which target Latino, Black, Asian American and Pacific Islander, Native American, and other at-risk communities to address the increases of HIV. Democrats will recommit the federal government to ending the HIV/AIDS epidemic by 2025.
Democrats are proud that the Obama-Biden Administration lifted the discriminatory lifetime ban on blood donation by healthy gay and bisexual Americans. We will work to ensure blood donation regulations are based on science, not fiction or stigma and that no American, when seeking to donate blood, will face more stringent limitations than any other simply because of who they are.
Strengthening and Supporting the Health Care Workforce
The COVID-19 pandemic has made plain to people across the country that our health care workers are heroes. Our doctors and nurses, our home health aides and physician’s assistants, our public health professionals, our home care workers and nursing home workers, and our cleaners and service workers have shown up to work every day despite dire shortages of personal protective equipment. Far too many of them have lost their lives to this terrible disease, and untold thousands are suffering the mental and emotional strain of losing far too many patients. And yet, despite the critical role they play in our society and our economy, these frontline workers—a majority of whom are women of color—are often underpaid and lack access to paid sick days, paid family and medical leave, health insurance, and other benefits critical for their own health and the health of patients.
Democrats believe that all jobs in the caring economy must come with family-sustaining wages, good benefits, access to paid leave, fair and predictable schedules, access to training and professional development, and the ability to join a union and collectively bargain. We believe all employers funded by taxpayer dollars must pay their workers at least $15 an hour and protect workers’ rights to organize.
Although health care jobs are among the fastest growing in the economy, demand for services still far outstrips supply, especially in primary care. We will invest in community health worker care-forces around the nation proven to prevent, manage, and better treat chronic illnesses, and empower first-time mothers with home visiting. We will close provider gaps and increase diversity in the health care profession by creating a robust pipeline of talent with career ladders for advancement. And we will also increase opportunities for community health workers to come from the communities they serve.
Investing in Health Science and Research
Scientific research is at the heart of medicine—and of health care. Democrats want the United States to be at the forefront of scientific research and discovery for the benefit of our people, our economy, and our global competitiveness. We will support increased and sustainable funding for health and medical research and federal grants across agencies, including at the National Cancer Institute and other components of the National Institutes of Health (NIH), the CDC, and the Agency for Health Care Research and Quality. We will increase the federal investment in research and development for new medications through the NIH, and make sure that there is a return on that investment for taxpayers. We will also build on the foundation of the Obama-Biden Administration’s Cancer Moonshot to break down silos and accelerate research into cancer and cancer treatments by creating an agency with the sole mission of finding new cures and treatments for cancer and other diseases.
Democrats also support increasing funding for research into health disparities by race, ethnicity, gender, gender identity, sexual orientation, age, geographic area, and socioeconomic status, with a particular focus on how the social determinants of health contribute to differences in health outcomes. We support fully integrating people with disabilities in all stages of health and medical research to ensure outcomes reflect the true needs of Americans with disabilities. Democrats will take steps to increase the diversity of principal investigators receiving federal grants, as well as of participants in federally supported clinical trials, to improve the quality and applicability of our medical research for women and people of color, who are too often left out of research on disease and medical responses to treatment options.
The Trump Administration’s systematic efforts to undermine, discredit, dismiss, fire, disempower, and diminish the contributions of scientists, in health science and other disciplines, have weakened our public institutions, slowed the pace of scientific inquiry, and profoundly damaged America’s standing in the world. Democrats will protect the independence and intellectual freedom of scientists, whether they are employed by the federal government or receiving federal grants in support of their research, and take steps to shield our scientific research agencies from future political interference.