When Diana Moats from Salida looks at the American health care system, she sees an overwhelming problem.
“Health care is just such a complicated issue that is just out of the scope of the average person to even comprehend, to make appropriate choices of what the best way to go about it is,” Moats said. “It's pretty daunting.”
Daunting also describes her health care situation. Moats is a massage therapist and works several other jobs to make ends meet. She’s also a single mom of a 15-year-old who has had some expensive health struggles. Moats signed her daughter up with Medicaid and hopes the program will help cover those bills.
“That’s just been a saving grace for me because I had a $12,000 hospital bill for a week,” she said. “And that really would've just really ruined me financially if I had to pay all that myself.”
Moats, who is 51, hasn’t been able to afford to buy health insurance for herself. She looked into it but found it’d cost $500 a month, roughly a quarter of her income. “That's totally unaffordable for me. So no, I'm not gonna pay for that. And what am I going to do if something happens? I don't know.”
Moats is an independent, to the right of center. In the past, she backed libertarian Ron Paul. This year, she is trying to decide how and whether to vote in the Democratic primary. But she’s concerned candidates’ plans for health care put too much power in the hands of the federal government.
“I just think enacting a policy like that on a national level — it's just too daunting,” she said. “I would bring it back to the state. I think every state should come up with their own plan.”
As for who she’d vote for in the Democratic primary, Moats says she’s still not sure.
Across the political spectrum, voters told us the high and rising price of health care plays a significant vote in how they’ll vote.
Hundreds of them told CPR, as part of our Voter Voices project, health care is a key, perhaps the key, issue of the 2020 presidential election. Ballots have already gone out to Coloradans and votes will be counted on Super Tuesday, March 3.
Health care costs are “the primary reason why I didn't take the opportunity to retire,” said Ken Devilbiss, a moderate from Brighton who does computer analysis. Instead, the 65-year-old is continuing to do contract work to cover the expenses.
Devilbiss has diabetes and got a rude awakening when he recently retired and transitioned from insurance through his employer to Medicare. Devilbiss says costs for his medications rose from $150 a month to $2000 a month.
“It's just absolutely horrendous," he said.
George McHenry, 78, lives in Federal Heights and is also worried about prescription drug costs. A few years back, he was diagnosed with prostate cancer. He takes hormone treatments, which would cost more than $10,000 a month if he weren’t on Medicare. But McHenry, a reliably Democratic voter, considers himself lucky.
“I'm aware that a lot of seniors cannot afford the cost of either drugs or care,” McHenry said. “And I think that's really terrible.”
Maureen O’Mara-Sanzo, a 73-year-old from Highlands Ranch, describes herself as a conservative-liberal, or a liberal-conservative. She’s retired from the roofing industry and says her health and health care coverage — Medicare, plus supplemental coverage — are pretty good. But she worries about all the people who don’t have health coverage they can afford and thinks people need more affordable insurance options.
“It's a very crucial issue for people in terms of living and dying,” she said.
Candidates have made health care central to their campaigns.
President Donald Trump has promised to essentially defend the private insurance system. He’s staked out a position in opposition to Democrats, promoting an expansion of private Medicare advantage plans.
Last fall in Florida, Trump signed an executive order before a sign reading “Great Health Care for You,” to expand what medical savings accounts or MSAs, which some Medicare recipients make use of. In announcing the plan, he described Democrat’s “Medicare for All” as a disaster for seniors on the program.
"They want to raid Medicare to fund a thing called socialism,” he said.
The Trump administration and its Republican allies in Congress have taken a number of steps to circumvent the Affordable Care Act. As NPR described last year, Republicans ditched the individual mandate, the requirement people get health coverage pay a penalty. The provision aimed to keep more healthy people insured in order to keep premiums low.
"We eliminated Obamacare's horrible, horrible, very expensive and very unfair, unpopular individual mandate. A total disaster. That was a big penalty,” Trump said last fall.
The administration has taken other steps: allowing states to implement “work requirements” to Medicaid, ending cost-sharing subsidies to insurers, and slashing federal funding to programs aimed at helping people sign up for insurance on state exchanges.
One of the biggest moves came last spring when the Justice Department threw its weight behind a lawsuit aimed at invalidating the law.
Still, the ACA has proved resilient, with signups remaining fairly steady.
Bernie Sanders backs Medicare for All. The Vermont senator’s plan would expand the popular federal health program and essentially get rid of private insurance. It’d provide comprehensive care for everyone, with no out-of-pocket expenses. He says the average worker pays 20 percent of their income for health costs and his proposal would cut that sharply “because we're eliminating the profiteering of the drug companies. And the insurance companies and ending this Byzantine and complex administration of thousands of separate health care plans.”
Sanders has been criticized for not providing more specifics of how he’d pay for his plans. He estimated on 60 Minutes last weekend that the cost of his plan would be $30 trillion over a decade. But questions remain about whether projected revenues would meet projected costs.
Sanders visited Colorado earlier this month, welcomed by a boisterous crowd of 11,000. In response to the rally, Colorado Republicans jumped on Sanders’ signature issue. Spokesman Kyle Kohli said the party is confident Sanders would find tough footing in the general election, due his support for the universal health care measure that Colorado voters rejected soundly in 2016.
“Coloradans already made it loud and clear they have zero interest in Bernie Sanders’ government takeover of their health care,” Kohli said.
In 2016, Sanders easily won the Colorado Democratic caucuses, capturing 59 percent of the vote, prior to a major overhaul of Colorado’s nomination process.
Elizabeth Warren also supports Medicare for All, although she proposes a more gradual transition.
“Costs are gonna go up for billionaires,” the Massachusetts senator said. “They're going to go out for giant corporations, and out of pocket costs for middle class families are going to go down. It's costs that matter.”
When she unveiled her plan in November, Warren said it would raise $20.5 trillion, but that middle class tax increases wouldn’t pay for it. Instead, the funds would come from a variety of sources, including tax increases on the rich, cuts in spending on the military and payments to doctors. She said there would be considerable savings from a more efficient national system, in which administrative costs are expected to fall significantly.
Warren said by her third year in office, she aimed to pass legislation through Congress to complete “the transition to full Medicare for All.”
A number of big players in the health care world, including insurers, hospitals, drug companies and doctors groups oppose the sweeping changes in the plans of both Warren and Sanders as too far-reaching and too expensive.
Both Warren and Sanders say though their plans are expensive, they’ll result in significant savings for consumers overall.
Joe Biden is among the many candidates in the Democratic field who balk at the ten-of-trillions price tag of a Medicare-for-All system. One recent poll showed a majority of Americans like both ideas, but more favor the public option.
“It covers everybody. It's realistic and most importantly, it lets you choose what you want,” the former vice president has said about his plan. On his website he describes it as protecting and building on Obamacare. Then-President Barack Obama signed the law into effect nearly a decade ago, on March 23, 2010.
His plan includes a public option proposal, which Biden argues would help bring costs down, without the disruption to the health system and patient care of Medicare for All. And it would give consumers a choice.
Biden’s proposals echo those of some of the other candidates in the middle with goals like giving every American access to affordable health insurance, by expanding Medicare, promising a less complex system, and standing up to what his website describes as “abuse of power” by prescription drug corporations. He’d do that by letting Medicare directly negotiate drug prices and allowing for generally cheaper prescription drugs to be imported from Canada.
His approach has critics as well, as Politico reported when his plan was unveiled. Some progressives view the improvements he’s aiming for as too cautious and incremental. Republicans blasted his plan as “Obamacare 2.0,” and a group of major health associations fretted that Medicare expansion would hurt hospital bottom lines.
Michael Bloomberg, the billionaire former New York mayor, has also come out as sharply critical of the more ambitious progressive push to expand health coverage. “Medicare for All doesn't work because about 155 million people in America get their insurance from their employer. They want to keep it,” Bloomberg told CPR’s Colorado Matters earlier in February.
“The hospitals and the doctors want to make sure that's still there as well because that's what subsidizes the people who are getting paid for by Medicaid and Medicare.” He noted unions have often fought very hard and negotiated for medical benefits “so they want to make sure that they continue to do that as well.”
He’s also described Medicare for All as “unfeasible” and likely to win over key voters Democrats would need to prevail in the fall.
His plan, like Biden and others, would create a public alternative to private insurance. His website describes it as being “administered by the federal government but paid for by customer premiums” It aims to expand and improve on the ACA, by reversing what his campaign calls “the Trump administration’s attempts at sabotage.” It would do that by boosting enrollment efforts, restricting the sale of skimpy health plans that don’t meet ACA requirements and defending the ACA against “politically motivated lawsuits.”
Like Biden’s proposal, Bloomberg too has drawn criticism for being too gradual. And Democrats in Congress have already been unable to get through some of his ideas, like ending “surprise” medical bills and lowering drug costs.
But Bloomberg touts his skills as a businessman to explain why he could succeed.
“Look, in New York, I had a Republican Senate and a Democratic House and I got gay marriage through the Republican Senate. If I can do that, I can get a health care plan through a Republican Senate at a national level,” he told Colorado Matters.
Pete Buttigieg also favors a more centrist approach. He backs a public option that he says would result in coverage for everyone, but that cuts cost.
“The idea of my proposal, Medicare for all who want it, is that we take a version of Medicare and make it available to anybody who wants in on it without commanding people to adopt it if they'd prefer their private plan,” the former South Bend, Indiana, mayor said.
Buttigieg maintains his plan would “incentivize private insurers to compete on price” and bring down costs. If private insurers can’t offer “something dramatically better,” the plan would create a natural “glide-path” to Medicare for All, according to his website.
To make health care more accessible, the Buttigieg plan would expand subsidies for low-income people to make insurance coverage “dramatically” more affordable for individuals and families.
Buttigieg’s proposal has drawn fire for what critics have likened to a “supercharged” version of the mandate to buy insurance contained in the Affordable Care Act, aka Obamacare. Under his plan, those who don’t have coverage would be automatically signed up in the government program, which could cost them thousands. His campaign told the Washington Post the payments are justified because it allows a consumer to be insured throughout the year.
Amy Klobuchar favors building on the ACA. According to her website, she thinks the “quickest way” to achieve universal health care is via a public option that expands the government programs Medicare and Medicaid.
“What I favor is something that Barack Obama wanted to do from the very beginning,” Sen. Amy Klobuchar (D-MN) said about her proposal.
“And that is a public option, a nonprofit choice that will bring down the cost of insurance.”
The senator backs changes to the ACA to reduce consumer costs like making it easier for states to implement reinsurance, something Colorado launched last year with approval from the federal government.
Klobuchar stresses the importance of making prescription drugs affordable. According to her campaign site, Klobuchar has authored proposals to lift the ban on Medicare negotiations for prescription drugs. She’d also allow “personal importation of safe drugs” from countries like Canada, and stop pharmaceutical companies from blocking less-expensive generic products.
Some of the toughest criticism for some of the candidates comes from their rivals. For example, Warren blasted Klobuchar’s plan in a recent debate as being too thin, calling it “a Post-it note, ‘insert plan here.’” Of Buttigieg’s health proposal, Warren said, “It’s not a plan, it’s a PowerPoint.”