Democratic presidential candidates spent Tuesday night’s debate fielding an assortment of questions from CNN’s moderators, but discussed some critical issues only briefly or not at all.
Health care was among the topics largely ignored during the CNN-hosted debate, with the exception of questions about providing health services to undocumented immigrants. The candidates, however, have in recent months explained in detail where they stand on expanding access to health care.
The Affordable Care Act (ACA), President Obama’s signature legislative achievement and a longtime source of Republican scorn, went almost entirely unmentioned. The refrain of repealing and replacing the ACA can still be heard among the Republican candidates, but the lack of focus on the issue during the first Democratic debate may have been driven by the undeniable success of the ACA in expanding health-care coverage across the country.
Since the implementation of the ACA, the national uninsured rate has plummeted from 17.1 percent to 11.6 percent, according to a recent Gallup poll. States that have expanded Medicaid under the ACA have seen dramatic effects. The number of uninsured people dropped by half in Ohio, and two-thirds of previously uninsured people gained coverage in California.
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Each of the five Democratic presidential candidates has supported the ACA, but one candidate, Sen. Bernie Sanders (I-VT), said during the debate he would go a step beyond Obamacare if he won the presidency.
Sanders during his closing remarks reiterated his long held support of universal health care. “We should not be the only major country on Earth that does not guarantee health care to all of our people as a right of citizenship,” Sanders said.
Sanders has advocated the creation of universal health care by providing Medicare to all Americans. His campaign, however, has yet to release the specifics of his health-care plan.
The type of plan Sanders advocates, a single-payer system, enjoys significant public support. A little more than half of those surveyed this year said they support the idea of single payer, including one in four Republicans, according to a GBA Strategies poll.
CNN debate moderator Dana Bash asked candidate and former Secretary of State Hillary Clinton to address some of Sanders’ proposals, including making “Medicare available to all Americans.” Clinton never addressed whether she would support that proposal, even when pressed by Bash.
Clinton has a plan to expand affordable coverage and slow the growth of overall health care costs, according to her campaign site.
She has said that she would be open to considering the idea of allowing insurance companies to compete for customers across state lines. “If we’re going to have a free market system, we need a free market where we’ve got people competing on cost and quality, and that may be one thing we need to look at,” Clinton said, reported MSNBC.
Clinton in September released a multi-point plan that focused on reducing health-care costs and building on the successes of the ACA. The plan would more aggressively confront the insurance and pharmaceutical industries than the ACA does, and includes proposals such as capping a patient’s share of the bill for doctor visits and prescription drugs.
“It has gotten to the point where people are being asked to pay, not just hundreds, but thousands of dollars for a single pill,” Clinton said during a campaign speech in Iowa announcing the plan, reported the Associated Press. “And I can tell you, that is not the way a market is supposed to work. That is bad actors making a fortune off of people’s misfortune.”
Health care has for many years been a critical issue for many American voters, and while the ACA has continued to be a controversial political issue, the public’s view on the government’s role in health care has become less divided. Large bipartisan majorities support government intervention in health care, including reducing the cost of prescription drugs, according to a Kaiser Family Foundation survey.
“Health is really a pocketbook issue more than a political issue now,” Kaiser Family Foundation president Drew Altman told the Los Angeles Times.
During Sanders’ defense of democratic socialism as an alternative to a “rigged economy,” he said it could be a solution to addressing massive income inequality and expanding health-care access, including paid family leave, to every American.
“When you look around the world you see every other major country providing health care to all people as a right—except the United States,” Sanders said. “You see every other major country saying to moms that when you have a baby we’re not going to separate you from your newborn baby because we are going to have medical and family paid leave.”
The benefits of paid family leave include higher productivity, stronger workplace morale, and greater employee retention, as well as significant health benefits, according to a study by Oxford Economics conducted for the U.S. Travel Association.
Paid sick days are also important to public health, advocates say, given that three-quarters of food service industry and hotel workers don’t have paid sick days.
Sanders announced a legislative package in June to provide paid family and medical leave, paid sick leave, and paid vacation. The Guaranteed Paid Vacation Act, which would provide ten days of paid vacation for employees who have worked for an employer for at least one year, was presented as the centerpiece.
The legislation has been referred to the Senate Committee on Health, Education, Labor, and Pensions.
Sanders co-sponsored Sen. Kirsten Gillibrand’s (D-NY) FAMILY Act, which would guarantee every employee 12 weeks of paid family and medical leave. He also was a co-sponsor of Sen. Patty Murray’s (D-WA) Healthy Families Act, which would guarantee seven days of paid sick leave per year.
Former Maryland Gov. Martin O’Malley threw his support behind paid family leave, and noted that his state expanded family leave during his time as governor. “We would be a stronger nation economically if we had paid family leave,” O’Malley said.
O’Malley signed the Maryland Parental Leave Act (MPLA) in May 2014. The law requires employers in the state to provide six workweeks of unpaid leave during any 12-month period after the birth of an employee’s child or the placement of a child with an employee for adoption or foster care.
Bash asked Clinton to respond directly to Republican president candidate Carly Fiorina, who is opposed to federal paid family leave, which she claims would be a disincentive for businesses to hire women. Clinton also endorsed paid family leave, and offered a rebuttal to Fiorina’s opposition.
“I’m surprised she says that because California has had a paid leave program for a number of years, and it has not had the ill effects that the Republicans are always saying it will have,” Clinton said. “We can design a system and pay for it that does not put the burden on small business.”
California’s paid family leave law went into effect in July 2004. Under it, new mothers and fathers can take up to six weeks of paid leave to spend with their child. Leave can also be used by employees with a sick child, spouse, domestic partner, or parent.
In the ten years since its implementation, the program has positively affected children and families and has not caused problems for California employers, according to a report released by the U.S. Department of Labor.
Clinton pivoted from paid family leave and specifically addressed reproductive rights.
“It’s always the Republicans or their sympathizers who say you can’t have paid leave, you can’t provide health care,” Clinton said. “They don’t mind having big government interfere with a woman’s right to choose and taking down Planned Parenthood. They’re fine with big government when it comes to that. I’m sick of that. We can do these things.”
Sen. Marco Rubio (R-FL) is the only Republican candidate who has offered anything other than opposition to paid family leave. The key policy difference between Rubio’s proposal and what the other Democratic candidates have endorsed is the way in which it would be implemented. Rubio has proposed creating tax incentives for businesses to provide family leave instead of requiring it from all employers. Those incentives have proven largely ineffective in changing the ways in which companies operate.
While improving the economy, pushing policies that support the economic standing of the middle class, and addressing income inequality were all subjects of discussion among the candidates, raising the minimum wage received only a few brief mentions.
Since Congress has been mired in gridlock, largely due to a relatively small group of far-right conservatives in the House, lawmakers have been unable to increase the federal minimum wage of $7.25 per hour. Several states and municipalities have acted independently to raise the minimum wage—a move supported by voters across the political spectrum. During the 2014 midterm, elections voters in four states approved ballot measures to increase the minimum wage.
Sanders said in order to raise the federal minimum wage to $15 an hour, people who work would have to unite and confront Republicans who are opposed to a living wage. “Workers are going to have to come together and look the Republicans in the eye, and say, ‘We know what’s going on. You vote against us, you are out of your job,’” Sanders said.
Clinton said she supported raising the minimum wage.
“At the center of my campaign is how we’re going to raise wages,” Clinton said. “Yes, of course, raise the minimum wage, but we have to do so much more, including finding ways so that companies share profits with the workers who helped to make them.”
O’Malley said that the difference between himself and his fellow candidates was that he was able to increase his state’s minimum wage.
During his time as governor, lawmakers in the Democratic-majority Maryland legislature passed measures that O’Malley took credit for during the debate. However, those legislative accomplishments, including the increase in the minimum wage, were modest. O’Malley in 2014 approved an increase to the state’s minimum wage to $10.10 per hour by 2018. That’s a far cry from the $15 per hour that activists are calling for in 2015.