Category Archives: Health

House Calls Provide Better Care and Save Money. Why Don’t More Use Them?

October 8, 2019

Only a fraction of older adults eligible for home-based primary care are being served
By  Beth Baker  September 13, 2019

Margaret Birt, then 62, had routine surgery in 2006. But in the recovery room, she had complete cardiac arrest. Initially in a vegetative state, Birt regained much of her cognition. Her life, however, was never the same. She was left with no physical capabilities, needing constant care.

Rather than ending up in a nursing home, though, Birt lives at home in Wheaton, Ill. with her husband, Maurice. She receives primary medical care there, covered by Medicare, from Dr. Thomas Cornwell and his team at Northwestern HomeCare Physicians. They perform exams, chest x-rays and blood draws — all in the comfort of Birt’s home. “We’re very fortunate,” says her husband. Cornwell is also CEO of the Home Centered Care Institute, dedicated to mentoring and training home-based providers.

In addition to her Medicare-covered primary care, Margaret Birt requires 24-hour help from caregivers that the couple must pay for out-of-pocket. Without the generous long-term care policy purchased years ago, Maurice Birt says, he would be bankrupt.

House Calls: A Cost-Saving Measure

“Home-based primary care focuses first on a vulnerable and disenfranchised population, often older adults with multiple chronic conditions who also experience problems with basic activities of daily living [such as walking or dressing],” says Dr. Bruce Leff, director of The Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine. “They are what payers refer to as ‘high need, high cost.’”

Prior to January 1, 2019, health providers had to document the medical necessity for why a house call was needed instead of an office visit. Medicare has since eliminated this requirement. Now it is at the provider’s discretion where a patient is seen, explains Cornwell.

“The main difference is house calls could not be done prior to this year for the convenience of patients who could easily get to the office. Now they can. Having said this, most house call programs have as their mission to serve patients who otherwise cannot get to a provider’s office,” notes Cornwell.

It may seem counter-intuitive, but giving these vulnerable patients individualized primary care at home saves money for the nation’s health care system, according to studies by Department of Veterans Affairs and the Centers for Medicare and Medicaid Services (CMS), among others.

“Now there is strong evidence that home-based care results in better care outcomes and better experience of care by patients and by caregivers, who often have a lot put upon them,” says Leff, who is working with colleagues to develop quality standards for home-based primary care. “It also has a pretty robust effect on reducing health care costs.”

The John A. Hartford Foundation (a Next Avenue funder) awarded Leff and colleague Dr. Christine Ritchie, in partnership with the Home Centered Care Institute and the American Academy of Home Care Medicine, a $1.5 million grant to foster and expand home-based primary care.

“What we’re focusing on is a population who is really in need,” says Brent Feorene, executive director of the American Academy of Home Care Medicine. “Even if the adult son could get mom to the doctor’s office, the average primary care practice is not equipped to handle the patients. The doctors don’t have time, and often [the patients] have psychosocial issues.”

Patients with dementia may experience fear and anxiety at a doctor’s office, for example, and be disruptive to others in the waiting room.

At least 2 million older adults would benefit from home-based primary care, according to Health Affairs. Because these patients have difficulty getting to an office visit, they frequently end up in emergency rooms or hospitals. Per-patient savings range from $1,000 to $4,000 annually through reduced hospital and nursing home stays, emergency room trips and specialist visits, according to research cited by the American Academy of Home Care Medicine.

According to the American Academy of Home Care Medicine, the CMS Independence at Home Demonstration, part of the Affordable Care Act, estimated that Medicare would save $10 to $15 billion total over a 10-year period if home-based primary care were extended nationally to those on Medicare who are homebound.

Benefits to Patients and Families

For patients with chronic conditions, in addition to the convenience of home-based primary care, “The biggest benefit is that the care is very well coordinated,” says Dr. Zia Agha, chief medical officer of West Health, a research and policy center focused on improving care delivery to older adults.

“You have a team of providers who are working together to provide services to you. There is a tremendous emphasis on delivering palliative care. We see a lot of these patients where mom used to be in the ER or hospital ten times a year, and now she has not had a single hospital admission,” says Agha. “That is the biggest advantage, to be helped at home and have the right care to allow them to have quality of life, and not be on aggressive medical services.”

Geriatrician Dr. Carla Perissinotto, medical director of UCSF Care at Home at the University of California, San Francisco, stresses that home-based primary care is person-centered by definition. “When you are in someone’s home, you [as the doctor] are not the center, it is the person,” she says. “It is on their territory. You have to be comfortable with a change in the dynamic.”

For example, she says, “In the clinician’s office, you very clearly know as a patient where you’re supposed to sit. When I go into someone’s home, I wait for them to tell me where to sit.”

She recently had a medical resident ask her what to do about a patient who was stuck in the hospital and becoming increasingly delirious, begging to go home. The hospital did not want to keep him and no nursing home would take him.

“I said, ‘Has anyone thought of taking him home?’” says Perissonotto. “’I can see him at home, we can get home physical therapy. Has anyone applied for in-home support services?’” Two days later, he was back at home where he and his wife have lived happily for 18 months.

“We’re spending billions and no one has asked, what are the barriers to being at home? That’s not rocket science,” Perissinotto says.

“I see this is mostly a high-touch field. But in order to provide quality care, you have to have high-tech capability,” Cornwell adds. “With my smartphone, I can do an EKG within a minute. We have x-ray services, lab services, ultrasound in the home to check things like blood clots in the legs or abdominal pain. I can have more done in the home with smart technology than most can do in the office. It’s having the technology that enables truly quality care.”

Obstacles to Expanding At-Home Care

Despite the growing evidence that home-based primary care is superior in terms of cost and quality for those with complex needs, only a fraction of eligible older adults are being served.

Huge swaths of the country have no home-based primary care, especially in rural areas in Idaho, Montana, the Dakotas and other states.

Most people who are homebound live at least 30 miles from a home-based practitioner. Experts point to two major obstacles: reimbursement and lack of physicians.

Providers of primary care at home, including physicians, nurse practitioners and physician assistants, see roughly six to 10 patients a day, compared to office-based physicians who see up to 25. Providers receive a modest amount more per house call (Medicare pays $10 to $30 extra), which usually does not cover the time spent driving or coordinating the care of these complex patients. In the traditional payment model, this has meant much lower salaries for home-based practitioners (unless they are subsidized by a health system), making it hard to attract doctors to the field.

But that is changing. The fee-for-service model is giving way to value-based payments, a flat-fee per patient for primary care, including home-based. Here, high-quality care is incentivized and more complex cases receive higher reimbursement. In January 2020, providers in 26 regions may voluntarily opt for this method of payment. Medicare also recently eased some of the record-keeping burdens on physicians making house calls by not requiring them to justify every home visit.

Beyond the reimbursement challenges, many doctors barely know of the field’s existence. Residency programs often do not require rotations in home-based medicine or even in geriatrics.

“When I say I’m a geriatrician, I don’t get ‘Wow, you must be brilliant’ like I would if I said ‘I’m a neurosurgeon,’” says Perissinotto. “A lot of it is how we as a society value older adults. And it’s exposure. We have to explain it’s very challenging work and it’s amazing.”

“If you’re going into medicine not with a procedural focus [such as surgery], but to have a relationship with the patient for many years, you find a home in home-care medicine,” says Feorene. “You’re seeing the patient’s surroundings, you get to know the elder’s story. We’re often there in the last three years of life, and we’re making a difference in that final chapter. For those providers looking for a Marcus Welby relationship with the patients, this delivers in spades.”

The field is growing. Feorene’s organization, the American Academy of Home Care Medicine, has 900 members, half of them physicians, one-quarter nurse practitioners and physician assistants and the rest being social workers and nurses.

Nurse practitioners are “flocking to the field,” he says.

To spread the word and develop best practices, the Home Centered Care Institute in 2017 created a national network of Centers of Excellence that includes the Cleveland Clinic, University of California, San Francisco and four others.

Cornwell urges consumers to ask their physicians and health systems to support home-based primary care and the new value-based payment programs.

“It would be wonderful to have a groundswell,” he says.

Beneficiary Advocates Raise Alarms Concerning Roll-Out of New Medicare Plan Finder and Revision of Medicare Marketing Rules

October 8, 2019

Washington, DC ─ Justice in Aging, Medicare Rights Center, Center for Medicare Advocacy and the National Council on Aging sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), on August 27, 2019, urging the agency to address concerns regarding changes to the Medicare Plan Finder (MPF) tool and the 2020 Medicare Communications and Marketing Guidance (MCMG).

The four organizations expressed appreciation for CMS’s efforts to update these resources to better support beneficiary decision-making, while raising concerns that the revisions may instead have the opposite effect. The groups urged CMS to mitigate adverse consequences by closely monitoring the roll out and functionality of the new MPF tool, providing enrollment relief as needed, and by rescinding the updated MCMG in its entirety.

Earlier today, CMS unveiled long-awaited updates to MPF—the federal government’s primary enrollment assistance tool for Medicare Advantage and Part D plans. While the new site includes a number of improvements, the groups are concerned that its late-August launch date may not give third-party assisters, like State Health Insurance Assistance Programs (SHIPs), adequate time to learn the new tool before Fall Open Enrollment begins. And that coupled with recent legislative and regulatory changes set to take effect this year, the truncated MPF launch timeline may generate demand for enrollment assistance that these chronically underfunded programs are unable to meet.  Further, CMS has stated that there will be no back-up system in place or ability to revert to the current “legacy” system during the upcoming Fall Open Enrollment period.

The Medicare Communications and Marketing Guidelines (MCMG) is a set of rules that govern the selling and promotion of Medicare Advantage and Medicare Prescription Drug plans. Revised each year, these guidelines help ensure that people with Medicare have accurate information about a plan’s costs and benefits as well as adequate protections against inappropriate marketing practices. The 2020 revisions, however, effectively disregarded the regular process for stakeholder input and introduce changes that primarily ease the burden on plans and downstream entities while at best doing little to benefit or protect consumers and at worst increasing the likelihood consumers will experience harm.

Apparently in direct conflict with current law, the revised MCMG weaken the distinction between “marketing” events, which are designed to steer or attempt to steer beneficiaries toward a plan or limited set of plans; and “educational” events, which are designed to inform beneficiaries about Medicare Advantage, Prescription Drug, or other Medicare programs. In addition, the revisions removed several disclaimers required of plans, including a short one alerting Spanish speakers of the availability of translations of certain important plan communications. The burden on plans of including the two-line notice was miniscule, but the need to alert limited-English proficient beneficiaries that they can receive help is great.  Further, the revision failed to include provisions outlined in the draft version that would have limited the aggressive marketing of plans referred to as D-SNP look-alikes. These Medicare Advantage plans, which are not subject to the oversight that CMS and states impose on plans designed to serve the complex needs of dual eligibles (people with both Medicare and Medicaid), are being marketed almost exclusively to this population. CMS has itself identified this marketing as a significant problem but abandoned its proposal to address its concerns in the guidelines.

Kevin Prindiville, Executive Director of Justice in Aging stated: “CMS’s harmful updates to the Marketing Guidelines are a step backward, leaving consumers more vulnerable to aggressive marketing tactics and making it more difficult for them to request important health information in their language. The hasty roll out of plan finder changes will only add to the challenges of this year’s Open Enrollment season.

Judith Stein, Executive Director of the Center for Medicare Advocacy, noted, “The revisions to the Marketing Guidelines cater to Medicare private plans and those who sell them, rather than being in the best interest of Medicare beneficiaries, those who assist them, or in furtherance of an equitable Medicare program. CMS should rescind these changes, and should ensure that beneficiaries are not hindered by a delayed roll out of a completely new Plan Finder format, with no back-up system in place.”

Frederic Riccardi, President of the Medicare Rights Center, stated: “Based on our experience assisting people with Medicare and their families, we know how challenging it can be for beneficiaries to make the best coverage decision for their unique circumstances. CMS must ensure that its tools and resources are developed, distributed and updated in ways that maximally support this decision-making process.”

Read the letter here.

New Rule May Make It Harder for Medicare Beneficiaries to Receive Home Care

October 8, 2019

It may become harder for Medicare beneficiaries to find home health care due to a new rule from the Centers for Medicare and Medicaid Services (CMS). Although the rule changes the way home health care providers are reimbursed, it could affect patient care as well.

Starting in January 2020, Medicare will reimburse home health agencies at a lower rate when they care for patients who have not been admitted to a hospital first. CMS estimates that it will pay home health agencies approximately 19 percent more for a patient who hires the home health agency directly after leaving a hospital than a patient who was never in the hospital or was only an outpatient.  (The Center for Medicare Advocacy calculates that the disparity could be as high as 25 percent.)

In part due to pressure from Medicare to reduce costly inpatient stays, hospitals often do not admit patients, but rather place them on observation status to determine whether they should be admitted. These patients, if not admitted to the hospital for at least three nights, are not eligible for Medicare reimbursement of a limited amount of skilled nursing care and typically head home instead to continue care with Medicare’s home health care benefit.

But a home health agency that cares for a patient who was in the hospital under observation will be reimbursed as if the patient had been an outpatient. This lower reimbursement rate means that home health agencies may be reluctant to provide care for patients who were under observation status or who haven’t been in a hospital at all.

If you are hospitalized, it is important to learn whether you are admitted or under observation. Hospitals are required to provide notice to patients if they are under observation for more than 24 hours.

For more information about the new rule from the Center for Medicare Advocacy, click here.

Medicare Prescription Drug Premium to Drop Slightly in 2020

October 8, 2019

courtesy of NAELA eBulletin:

Monthly charge for Part D enrollees will decline for third year in a row

En español | The average monthly premium for Medicare Part D prescription drug plans will decrease from $31.83 this year to $30 in 2020, the Centers for Medicare and Medicaid Services (CMS) announced late Tuesday. This is the third straight year that premiums will decline.

The actual amount beneficiaries will pay in 2020 will vary depending on which prescription drugs they take, what plan they select and where they live. How much participants will pay out of pocket for their drugs also depends on the deductibles and copays that different plans charge.

CMS officials say that the three years of declining monthly charges will add up to $1.9 billion saved in premium costs for beneficiaries. In addition, enrollment in Part D plans has grown by 12.2 percent since 2017, in keeping with increases in Medicare enrollment as the number of older adults has risen. Federal officials say they have made changes to the program that have increased competition among Part D plans, including requiring plans to provide more information about drug price increases, allowing generic drugs to be substituted for brand names more quickly, and changing certain rules that have expanded the number of plan options available to Part D enrollees.

Medicare open enrollment begins Oct. 15 and lasts through Dec. 7. During that period, beneficiaries can evaluate their current coverage and decide whether to keep their plans or enroll in different ones. Final Part D premiums as well as premiums and deductibles for the other parts of Medicare are typically released in the fall.

Medicare’s New Plan Finder Could Boost Insurers’ Advantage Enrollment

October 8, 2019

courtesy of NAELA eBulletin:
Bruce Japsen Senior Contributor

Myriad upgrades to the way seniors choose Medicare health plans and drug coverage online could boost already fast-growing private Medicare Advantage enrollment.

Calling the upgrades  the first in a decade, the Centers for Medicare & Medicaid Services (CMS)  Tuesday announced a new “Medicare Plan Finder” on the government’s Medicare.gov web site that allows 60 million seniors and others with Medicare coverage to shop and compare Medicare Advantage and Medicare Part D drug plans.

“The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer,” CMS said in a  statement Tuesday morning.

CMS said seniors can compare pricing and plan options between original Medicare, supplemental policies and Medicare Advantage plans. And they can also “compare up to three drug plans or three Medicare Advantage plans side-by-side,” CMS said.

The upgrades will be welcome to seniors, but also to health insurance companies as they invest billions of dollars in their own upgrades and medical care provider networks to offer seniors private Medicare Advantage coverage.

“CMS’ Medicare Plan Finder redesign could boost Medicare Advantage enrollment by reducing the complexity of the purchase process,” says Andrew Kadar with L.E.K. Consulting, which has projected enrollment of seniors in private Medicare Advantage plans could reach 70% of those eligible for federal health benefits for the elderly between 2030 and 2040, a new report shows.

Enrollment in Medicare Advantage plans surpassed 22 million in 2018, which is 35% of total Medicare beneficiaries.

The new plan finder and related technology upgrades come ahead of annual open enrollment when seniors begin in October to choose their plans for 2020. The new plan finder also comes as health insurers including Anthem, CVS Health’s Aetna health insurance unit, Cigna, Humana and UnitedHealth Group are expanding sales of Medicare Advantage plans into new states, counties and regions. Meanwhile, several startups and new entrants including Bright Health and medical care provider plans are also expanding while some companies like Oscar Health, best known for sales of individual Obamacare coverage, are going to be selling Medicare Advantage for the first time.

Medicare Advantage plans provide extra benefits and services to seniors, such as disease management and nurse help hotlines, as well as some plans providing vision and dental care. But the Trump administration via CMS has changed the rules for Medicare Advantage plans to allow them to cover more supplemental health benefits beyond what Medicare Advantage typically covers.

Though open enrollment is more than a month away, CMS wants seniors and others to try out the plan finder and offer feedback in the meantime.

“We want consumers to have the best tool possible when open enrollment begins on October 15,” CMS Administrator Seema Verma said. “Try it out and let us know what you think.”

Medicare Will Cover Pioneering Cancer Treatment Nationwide

August 30, 2019

NAELA eBulletin:

August 7

Medicare will cover an innovative but high-priced cancer treatment nationwide, a step Trump administration officials said Wednesday would ensure patients have “consistent and predictable access” to a potentially lifesaving therapy.

In announcing the decision, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said that until now, Medicare’s regional administrators had decided whether to cover the treatment, which led to confusion.

Verma said the agency, which had scheduled this coverage decision originally for late May, has been struggling to figure out how to cover and pay for the treatment, called CAR T-cell therapy. The treatment costs $375,000 or $475,000, depending on whether it is used for advanced lymphoma or pediatric leukemia. Hospital stays can add hundreds of thousands of dollars to the cost of care.

Drugmakers note CAR T-cell therapy is designed to be given just once and to be a potential cure for patients who have run out of other options. But not all patients benefit from it and because it is so new, it’s too soon to know whether it will deliver long-term cures.

Such expensive treatments are “begging the question of how the system is going to pay for this over the long term,” Verma said, especially given Medicare’s considerable financial strains. “This is something we are extremely concerned about,” she added.

The coverage decision announced Wednesday is different in some important aspects from an agency proposal from February. That proposal called for “coverage with evidence development” — which would have required hospitals to collect and report data on patient outcomes over a long period. Hospitals said the data collection would be overly burdensome.

CMS’ final decision dropped that requirement. Instead, the agency said it will rely on patient information collected by the Food and Drug Administration and the National Cancer Institute. The FDA is requiring the two manufacturers of the therapy — Novartis and Gilead Sciences — to follow patients for years and report on outcomes. Such data will be put in a registry supported by NCI.

The Medicare decision also said it will cover the therapy when it is administered at health care facilities enrolled in an FDA-mandated safety program requiring special training on handling side effects. That means the treatment could be given on an outpatient basis, which would be much less costly.

The American Society of Hematology praised the decision, especially the elimination of the “coverage with evidence development” requirement. It said the proposed mandate would have prompted some hospitals not to provide CAR T-cell therapy.

The group also praised the decision for saying Medicare would cover all FDA-approved uses for CAR T-cell therapy and off-label uses recommended in CMS-approved compendiums, which are used to determine medically accepted uses of drugs and biologics.

The Medicare decision was the second step in a week taken by CMS to bolster CAR T-cell therapy. Last Friday, the agency said it would increase the reimbursement for CAR T-cell therapy, but didn’t go as far as many hospitals had wanted. Medical centers have complained they are losing money on Medicare patients because reimbursements have been too low.

The FDA approved two versions of CAR T-cell therapy, which stands for chimeric antigen receptor T-cell, in 2017. Kymriah is made by Novartis for certain types of lymphoma and childhood leukemia, and Yescarta is manufactured by Gilead Sciences for lymphoma. Other CAR T-cell therapy products are in development.

The complicated treatment involves extracting and genetically altering the patient’s T cells to attack a protein on the surface of cancer cells. The cells are then infused back into the patient.

Living with Dementia – 51 Tips to Help You With Daily Living

July 30, 2019

In this in-depth infographic and article we share with you a whole range of tips of advice to help those living with dementia, whether that be you or a loved one.

We’d like to start this article by dispelling a few key myths about Dementia.

1. Dementia is not a disease

Contrary to popular belief, Dementia is not a singular illness. It’s a condition, caused by lots of different diseases. ‘Dementia’ is the collective term for the symptoms of these illnesses.  The most common forms of dementia are Vascular DementiaLewy Body Dementia and Frontotemporal Dementia.

2. Dementia is not ‘part of getting older’

Dementia isn’t a normal part of the ageing process. Although the likelihood of developing Dementia rises with age, it also affects many people under the age of 65.

Dementia is about more than just memory loss

Dementia affects people in a variety of ways – which all differ of course from person to person. Everybody experiences Dementia differently, and may have one symptom or many in varying degrees.

It’s still possible to live a healthy, happy, independent life with Dementia.

Dementia doesn’t stop you enjoying life

The fourth and final fact is what this infographic and article is all about. People with Dementia can – and do – continue to live their lives to the full, even as the condition progresses. But living well is only possible with the right tools, support and advice.

Below this infographic you will find a lot more written information regarding the tips.  We hope you find this useful. Please click on https://ukcareguide.co.uk/living-with-dementia/ for the infographic and for the remainder of the article.

How the Democratic Candidates Responded to a Health Care Policy Survey

July 2, 2019

When the 2020 Democrats were asked the best way to improve the health care system, a split in the field was revealed. Here are full responses from 19 candidates.  The New York Times asked all 23 Democratic presidential candidates for their views on the best ways to improve the health care system. We received responses from 19 of them.

[Read our analysis of the responses here.]

The first three questions asked whether the candidates supported three possible routes for
changing how Americans receive health insurance: by creating a “Medicare for all” system
that would eliminate private insurance; by providing a choice between a “public option”
health care plan run by the government and private insurance; or by making more modest
changes to the Affordable Care Act.
Candidates could indicate support for more than one option. But in the fourth question, we
asked which of the three options would be the best way to improve the health care system,
and that is where a split in the field was revealed.
The survey also included several other questions about health insurance and coverage, how
the candidates would finance their plans, and other matters like prescription drug prices.
Below are the responses from each of the 19 candidates. Many of the questions were posed
in a yes-or-no format but also allowed the candidates to add additional comments. Some of
the responses we received were written in the first person, while others were supplied by
campaign staff members. Aside from a few corrected typos and minor punctuation changes
for clarity, these are the full, unedited answers we received.

No.

We need to have universal coverage, lower costs, and improve quality — those are the three objectives we should be working toward. The best path to achieve those objectives is with Medicare-X, my plan to create a strong public option that provides people with the choice of buying into that option or keeping the insurance they receive through their employer or union.

In just four years, Medicare for All would take health insurance away from about 180 million Americans who receive their insurance through their employer or their union, the vast majority of whom like it. And it would take insurance away from another 20 million people who receive insurance through Medicare Advantage.

Yes.

All Americans.

The best path to covering all Americans with high-quality, affordable health insurance is with Medicare-X, my plan to create a strong public option that provides people with the choice of buying into that option or keeping their private insurance.

Medicare-X would start in rural areas where there is one or no insurer to increase competition and lower costs. It would then expand to every ZIP code, and become available as an option on the small business exchange. Medicare-X would also, for the first time, allow the federal government to negotiate lower drug prices on behalf of the American people. By using the existing Medicare framework, it does all of this without adding any bureaucracy.

No.

We should build upon the Affordable Care Act, including by extending premium assistance to more middle-class Americans who are above the A.C.A. cliff of 400 percent of the Federal Poverty Level. My Medicare-X plan would do that, in addition to increasing support to families under the 400 percent threshold who are currently receiving tax credits to help pay for insurance.

But we shouldn’t stop there. Medicare-X would also provide everyone with the choice of purchasing a public option, and it would allow the federal government to negotiate lower drug prices. We also need to reduce the cost of health care by increasing transparency and modernizing how we care for people.

Public option.

If you went into a living room anywhere in the country and told everyone about Medicare-X, my plan to create a true public option, I believe it’s a plan they could get behind. We don’t need to blow up our current health care system to provide everyone with high-quality, affordable care. And we don’t need to take insurance away from people who receive it through their employer and like it. Medicare-X starts in rural areas where the market is failing too many people. It covers essential health benefits and uses Medicare’s network of doctors and providers. It allows the federal government to negotiate lower drug prices. And it does all of this without creating any new bureaucracy.

Yes.

All Americans should be covered by high-quality, affordable health insurance. For people who are already eligible for Medicaid and other programs, our default should be for those programs to cover them. States that have yet to take advantage of the Medicaid expansion in Obamacare should do so in the best interests of their residents. Ultimately, by offering a strong public option through Medicare-X, we can accomplish universal coverage.

My Medicare-X plan would save taxpayer dollars relative to the current health care system, even as it covers millions more people. For example, a more modest public option has previously been projected by the nonpartisan, independent Congressional Budget Office to save $158 billion for taxpayers over a decade (source: bit.ly/2MH8b1V). That’s because a public option like Medicare-X requires premiums, but also cuts health care costs relative to private health insurance. We would then take those savings and reinvest them in improving upon Obamacare, so that more middle-class Americans are able to afford health insurance.

Notably, this differs dramatically from Medicare for All, which the nonpartisan Urban Institute has suggested would cost more than $32 trillion over the next 10 years (source: urbn.is/2WEIH9H). Regardless of whether people think this is the right approach, we have to acknowledge that nobody has shown how they would specifically pay for even a significant fraction of this total cost. According to Vox, when single-payer failed in Senator Sanders’s home state of Vermont, it failed when taxpayers were confronted with the fact that it would necessitate an increase in payroll taxes of 11.5 percent and income taxes by 9 percent (source: bit.ly/2VCeMOW).

My Medicare-X plan does not require a tax increase at all, because it saves taxpayer dollars relative to private health insurance. It allows the American people to choose this high-quality, affordable option instead of taking away their current health insurance.

Yes.

Undocumented immigrants should have the option of purchasing health insurance on the exchange.

Yes.

Americans are growing older, and we need to figure out how to provide them with long-term care.

Health coverage in long-term care is fragmented, insufficient, and inefficient. Americans shouldn’t be forced to spend down their life savings in order to be covered by Medicaid for long-term care. There are a number of ways to ensure that coverage is lifelong, and we should have that discussion.

No.

The United States government should negotiate drug prices through Medicare Part D and other federal programs on behalf of the American people. Medicare-X does that.

Importation from Canada is not a sustainable solution, because the reason drugs cost less in Canada is that the Canadian government uses its leverage to negotiate prices downward. Even if Canada allowed us to import all of its drugs (which it will not), we would still not be able to supply the demand in the United States, and it would have a limited effect on overall prices. We are nine times the size of Canada, and Canada would be left with drug shortages, which it would never allow.

After writing and passing legislation to secure our supply chain, I’m also concerned about counterfeit medications sold through supposedly Canadian online pharmacies, which are often not even based in Canada.

Yes.

I support allowing the United States government to negotiate drug prices through Medicare Part D and other federal programs. That’s the only way to get drug prices under control for the American people. Medicare-X does that.

Public option.

[The Biden campaign did not complete the survey, but indicated that Mr. Biden preferred a public option and referred to his statements on the campaign trail.]

Yes.

I support Medicare for All. There are different ways we can get there. Right now, there are several bills in the United States Senate that move our country closer to Medicare for All, and I’m a sponsor of them. The most important thing is to keep the ultimate goal in mind: affordable health care for every American, because health care is a human right.

Yes.

All Americans.

I am a co-sponsor of several bills in the Senate to create a public option, a powerful tool to introduce real competition into the market and drive down costs for consumers.

Yes.

I support strengthening the A.C.A., including by extending premium assistance to more middle-class Americans and undoing the Trump administration’s sabotage around enrollment, as one part of a broader effort to improve care and lower costs.

“Medicare for all.”

I believe our country needs to work towards Medicare for All and have co-sponsored several bills to help do just that, including through a public option and lowering the Medicare eligibility age.

Yes.

It is important that every American has health insurance not only to keep individuals and families healthy, but also to help keep health costs stable.

High out-of-pocket costs for people with insurance is one of the most concerning problems in our current system. On the path to Medicare for all, I support concrete steps to increase access and lower costs — including lowering the Medicare eligibility age and introducing a public option — all of which would be financed differently. Whatever the plan, we must do more to help low- and middle-income Americans, many of whom can’t afford to go to the doctor or get even basic preventative care due to prohibitive cost-sharing.

Our country already spends trillions of dollars on health care every year. By directing existing spending into a more efficient system, reducing the outrageous cost of many prescription drugs, and leveraging Medicare’s lower cost structure system, we can achieve savings that offset many of the costs of improving affordability and access. We can also raise taxes on the wealthiest Americans, while ensuring that most families are paying less for better care.

Yes.

Access to quality, affordable health care is a human right. We need to make our health care system more effective and efficient, and we must pass comprehensive immigration reform that creates a pathway to citizenship for those already living in the United States.

Yes.

Long-term care is an integral part of health care, especially for people with disabilities.

Yes.

I wrote and introduced the Affordable and Safe Prescription Drug Importation Act along with Senators Bernie Sanders and Bob Casey to allow for the safe importation of prescription drugs.

Yes.

I am an original co-sponsor of the Affordable Medications Act, which includes a number of provisions to bring transparency and competition to pharmaceutical companies responsible for outrageous drug prices. By allowing Medicare to directly negotiate with manufacturers, we can leverage the federal government’s buying power and cut costs for taxpayers and beneficiaries.

No.

Everyone should have access to health care — and it should be affordable to the individual and to the taxpayers. Access to health care shouldn’t depend on the size of your paycheck. It should be a right for all.

Through the A.C.A., we have been able to make great strides in ensuring coverage for more Americans, beginning to reduce the growth in health care costs, and providing better care inclusive of prevention, drug and alcohol treatment, screenings, and mental health care.

Yet even after the A.C.A., many people still can’t access care. And most of us are paying too much. More can be done.

About 156 million Americans are enrolled in employer-sponsored health insurance plans. Moving immediately to a Medicare for All system would both undermine existing employer sponsored health care, upset a significant portion of the economy, and result in significant payroll tax increases for working Americans to cover Medicare for All.

At the same time, 25 million Americans still lack coverage, and the Trump administration is only making things worse.

I believe that we can increase access and affordability by providing a public option for Americans who want to buy into government insurance which will also ensure competition in the private market; allowing the federal government to negotiate drug prices and bring down the costs of prescription drugs; automatically enrolling Medicaid eligible people in Medicaid; and ending surprise billing and out of network charges.

Yes.

All Americans.

Yes.

The Affordable Care Act began to put America on a path toward significantly improved health care coverage, better health prevention and results, and reduced expenses. The Trump administration has worked aggressively to block the important changes brought about by the Affordable Care Act resulting in reduced coverage, lower quality coverage options, and increased costs to consumers.

I believe by fully implementing the Affordable Care Act, providing a public option, allowing the federal government to negotiate drug prices, automatically enrolling people eligible for Medicaid, and ending surprise billing and out of network charges, we can significantly improve health care for all Americans.

Public option.

As a Governor, I am on the front lines of implementing health care solutions. I will never forget testifying in front of the U.S. Senate about implementation of the Affordable Care Act and Medicaid Expansion, and how they had meaningfully impacted health care in our states. At the same time, as we were testifying, Republicans were trying to repeal the A.C.A. and take our country backward. While some have the luxury of debating the ideal health care system, governors must implement effective systems that work for our constituents — and that’s what I have been doing in Montana.

Estimates indicate that a Medicare for All system would require between $2.5 and $3 trillion in new revenue each year. When you consider that the U.S. government is expected to bring in $3.6 trillion in 2020, an additional $2.5 to $3 trillion is a 69 percent to 83 percent tax increase.

The Affordable Care Act increased access to health care, behavioral health care, stabilized rural hospitals, improved health care in Indian country, provided preventative care, increased access to substance abuse treatment, and provided incredible improvements throughout Montana. Continuing to strengthen the Affordable Care Act while adding a public option and automatic enrollment for people eligible for Medicaid will go a long way toward full coverage, reduced costs, and improved health outcomes throughout the country.

No.

The vast majority of health insurance is provided by employers. We must make it both more affordable to employees, and for employers to offer health care. Those who are not covered by employer-based health care must be incentivized to have coverage through a public option — and we should help with the incentives. A mandate, however, is not an incentive.

The first thing we have to address is health care costs — for employers and families. Improving affordability will make it easier for everyone to access health care whether it is employer-based or publicly available.

Businesses that choose not to provide their employees with benefits, or businesses avoiding employee benefits through excessive use of contract employees, need to be examined.

No.

Comprehensive immigration reform that protects our border, helps the Dreamers who have known no other home than ours, and provides a path to citizenship for immigrants who have been part of the fabric of our country for many years is the best way to address health coverage for people who want to become American citizens.

No.

Long-term care is an increasingly important challenge for many families, and we should explore ways to make long-term care more affordable and accessible for all Americans without adding crushing costs to working families.

No.

Americans pay more for prescription drugs than nearly anyone else, yet we have nothing to show for it. Rather than focusing on importing drugs from other countries, we need to get our pharmaceutical companies to charge Americans less for vital medicines. If these efforts are unsuccessful, moving toward a safe drug reimportation program would remain an option.

Yes.

As Governor of Montana, I negotiated health care costs between our hospitals and the state employee insurance plan resulting in significant cost savings. It is long past time that the federal government did the same to lower pharmaceutical costs. With the purchasing power of the federal government and its many health care systems — Department of Veterans Affairs, Indian Health Service, Medicare, Medicaid, Federal Employee Health Benefits Program — we have significant leverage in these negotiations.

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I support universal health care and believe that a Medicare-type buy in provides the best glide path to a Medicare for All environment. Even then, private insurance can play a role, but only on a supplemental basis. Medicare for All is our goal because it represents a fairer, more efficient health care system that will spend less money on profits and bureaucracy and more on patient care.

Yes.

All Americans.

The path to Medicare for All that I believe makes Americans better off along the way is one that starts with a Medicare-like plan as a public option for people who want it. It will challenge private options to become more affordable and efficient; I am skeptical that they will be able to do so, and expect that this will lead to a Medicare for All environment in the future as more Americans opt in to the Medicare-like plan.

No.

I am in favor of strengthening the Affordable Care Act while we work to implement full reform.

Public option.

Yes.

New health spending should be financed by a combination of premiums and tax-based funding to ensure it is affordable.

Federal spending that makes health insurance affordable could be offset by taxes on the wealthy and on corporate profits.

Yes.

Undocumented immigrants should be able to buy coverage through the public option.

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America needs a comprehensive, universal insurance program for long-term care. This can either be done within a universal Medicare plan, or in parallel to it, but the United States must establish such a program so that families can count on long-term care.

Yes.

Such importation must be done in a way that ensures safety and quality.

Yes.

No.

I support Medicare for all with a role for private insurance for individuals that choose it.

Yes.

All Americans.

I support universal health care with Medicare as the foundation. Americans should have options to choose either a complementary or supplementary private insurance.

No.

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The best way to improve the health care system is to provide Medicare for all, with an option to choose either a complimentary or supplementary private insurance.

Yes.

An expanded Medicare program should be financed mostly through a restructured tax code. Premiums and co-payments may still exist, but my proposal will prioritize keeping these payments low.

I would support repealing the Trump tax plan and replace it with one that asks corporations and the wealthiest elite to contribute their fair share.

Yes.

Undocumented immigrants pay taxes and are contributing members of our communities. I believe they should be eligible for government health care support and put on a pathway to citizenship. I look forward to putting forward a health care plan that addresses the health care gap for undocumented families.

Yes.

Yes.

Yes.

No.

I support the Universal Healthcare plan that I have crafted, which provides health care to every American as a right. It will allow Americans to have the option of having private insurance.

link: https://www.johndelaney.com/issues/health-care/

Yes.

All Americans.

No.

The first thing that the next President should do is fix the A.C.A. The A.C.A. was a good law and has been under attack from Republicans since the day it was signed. Our primary obligation should be to first stabilize our health care system before we begin overhauling it.

A.C.A. fixes.

Your question does not fully capture my views — I would first fix the A.C.A. and then work to create universal health care. The A.C.A. has been under attack from Republicans since the day it was signed. The best way to improve the A.C.A. is to stabilize premiums and bring down costs.

No.

Every American should have health care as a right via a federal program but have the option of purchasing health insurance.

A combination of revenues is the best path forward. Americans who are struggling financially should not have to pay co-payments that will restrict their ability to receive proper care whereas Americans with more resources would contribute. I also believe a government-only (single-payer) system would result in lower quality and more limited access.

My universal health care plan is fully paid for by eliminating the deductibility of employer-provided health care. https://www.johndelaney.com/issues/health-care/

No.

I support comprehensive immigration reform which provides a pathway to citizenship.

Yes.

Yes.

We should also tax big pharma when they charge other countries less than they charge Americans, thereby inflating the price of prescriptions drugs for Americans. https://www.johndelaney.com/issues/prescription-drugs/

Yes.

“Medicare for all.”

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I support Medicare-for-All. It is unacceptable that in our country we pay far more for health care than any other country in the world, yet we have far worse outcomes. No one in this country should be sick and in need of care and not able to get that care simply because they don’t have enough money.

We have to address the high cost of prescription drugs and hold pharmaceutical companies like Purdue accountable for deceptive sales practices. Right now, Medicare today still can’t negotiate with prescription drug companies to bring down the cost of health care. That has to change.

Like many other countries in the world that have universal health care, I believe there is a role for private insurance but we have to re-evaluate what that looks like — we need to create transparency in the system, break up what is essentially an oligarchy in the pharmaceutical and health care industries and ensure Americans aren’t being gouged for services they need to live.

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Senator Gillibrand is a co-sponsor of the Senate Medicare for All bill and wrote the transition piece in the legislation. She supports the goals of that legislation and believes a single-payer system is the best way to achieve universal health care coverage, and to guarantee high quality and low-cost health care to all Americans.

Senator Gillibrand believes that a Medicare for All system will eventually displace the private insurance industry from providing health care. She believes that private insurers are welcome to compete with Medicare, but because Medicare is a nonprofit program, without shareholders or high C.E.O. pay, their prices will consistently be lower than private insurers, who will no longer have a role in health care.

Private insurers could still have a role in providing consumers additional elective medical services that they want to pay for individually, such as cosmetic plastic surgery.

Yes.

All Americans.

Senator Gillibrand’s overarching goal is to get Americans to universal coverage, and supports several pieces of legislation to that end. While she believes that Medicare for All is the ideal and best way to accomplish universal coverage, she also co-sponsors both Senator Stabenow’s Medicare at 50 Act, and Senator Schatz’s State Public Option Act.

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Senator Gillibrand would of course support modifications to improve the cost and access to health care provided through the Affordable Care Act. But her main focus is achieving universal coverage and she believes the best way to do that is through a single-payer system like Medicare for All, with a critical public option as a transition.

“Medicare for all.”

Senator Gillibrand believes that a single-payer system like Medicare for All will get America to universal coverage quickest, while also providing the most affordable and highest quality health care. She believes that a nonprofit health care system that focuses solely on its patients’ health and well-being, and that does not have to worry about shareholder value or C.E.O. pay, will deliver the best care to the American people.

Yes.

Senator Gillibrand believes that extending health care coverage to all Americans is the most efficient way to ensure low prices. Moving to a single-payer system, where everyone is covered, will provide all Americans with health insurance they can afford.

Under Senator Gillibrand’s ideal system, health care would be financed through a combination of employer-matched co-payments and taxes.

Senator Gillibrand supports a financial transaction tax, repealing the corporate tax cuts, eliminating subsidies for excessive C.E.O. pay and for companies that ship jobs overseas, and restoring the estate tax.

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As is outlined in the Senate Medicare for All bill, Senator Gillibrand supports extending health care coverage to all U.S. residents as defined by H.H.S. Residents will receive coverage provided that they are paying into the health care system, and are on a pathway to citizenship.

Yes.

Yes.

Senator Gillibrand supports the importation of generic drugs and is a co-sponsor of the Affordable and Safe Prescription Drug Importation Act.

Yes.

Senator Gillibrand supports giving the federal government the ability to negotiate drug prices for Medicare. Medicare for All would empower the government to negotiate all prescription drug prices. She also co-sponsors the Medicare Drug Price Negotiation Act, which would allow the Secretary of Health and Human Services to negotiate drug prices in Medicare, and the Empowering Medicare Seniors to Negotiate Drug Prices Act, which would allow Medicare to negotiate for prescription drugs.

Yes.

Medicare for All will guarantee access to health care, with no premiums or co-pays, for every single American. Private supplemental insurance for procedures not covered under the Medicare for All plan would still be allowed, but it is time to stop letting big insurance companies put profit over people’s health care.

Yes.

All Americans.

Medicare for All is my preferred plan. I am also supportive of other measures to expand insurance to more Americans, which is why I am a co-sponsor of the State Public Option Act, the Choose Medicare Act, and the Medicare-X Choice Act.

No.

Protecting the A.C.A. from repeal is one of the proudest moments I’ve had in the Senate, and I am for strengthening it and building on its success. That’s why I support Medicare for All, so that we can ensure every American has access to health care.

“Medicare for all.”

Medicare for All will extend health insurance to every single American, with no co-pays or premiums. It will cover most procedures, as well as dental, vision and hearing aids, and will allow you to choose your doctor, without worrying about who’s in-network or not. We have to change a system that allows big insurance companies to put profit over people’s health.

Yes.

Republicans’ decision to repeal the Affordable Care Act’s individual mandate has destabilized our health care system, made costs go up for families, and increased the number of uninsured Americans.

I support the system set up under the Medicare for All bill I sponsor, where every American can have access to health care with no co-pays or premiums.

The U.S. spends more on health care than any country. In the next decade, we’ll spend $50 trillion on our current health care system. We simply can’t afford to do nothing. Budget estimates of Medicare for All show the system would save the system money.

Yes.

I support the process outlined in the Medicare for All bill, which ensures universal coverage.

Yes.

Too often, elderly Americans and people with disabilities are forced to leave their homes, live in poverty, or go without critical long-term care. It’s unacceptable. That’s why I’m proud to support Medicare for All, which would provide much-needed support for millions of Americans.

Yes.

I co-sponsor legislation to allow importation of prescription drugs from countries with safety standards as strong as the U.S., such as Canada. It will help lower costs for Americans who need access to medicine.

Yes.

I co-sponsor legislation to allow Medicare to negotiate drug prices, which would significantly reduce costs for our seniors.

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I believe that health care is a right for all Americans. As president, I am committed to achieving the goal of universal coverage. This week, I signed into law the nation’s first public health care option to create another pathway for delivering affordable coverage. I believe the public option should be a key first step toward delivering universal health care in our country. We must also lower the age of enrollment for Medicare, allow Americans to buy into or automatically enroll in Medicare, allow Medicare to import and negotiate the price of drugs, and end the Trump administration’s outrageous effort to strip millions of Americans of their health care. I am proud of my record as governor in expanding health care to 800,000 Washingtonians, passing the first public option in the country and passing the first long-term care insurance program in the country. As president I will build on this record of success to achieve universal health coverage for all Americans.

Yes.

All Americans.

Yes, and I believe the unprecedented accomplishments we have made in Washington State show that we are able to get this done. I believe that we must lower the age of enrollment for Medicare, including allowing all Americans to buy into Medicare or automatically enrolling in Medicare at birth. The Cascade Care public option plan that I have signed into law makes public health plans available to all Washingtonians, regardless of income, by 2021. It also requires establishing cost-sharing agreements that will reduce, by up to 10 percent, the cost of plans on the health care insurance exchange, which currently serves 266,000 Washingtonians.

No.

I am the only candidate in this race who has both voted for and implemented Obamacare, which now provides health insurance to over 800,000 Washingtonians. Because of Obamacare, we slashed our uninsured rate from 14 percent to 5.5 percent. I support efforts to shore up the Affordable Care Act, and when I am president, I will end the Trump administration’s persistent undermining of Obamacare that threatens the health care of millions of Americans. But we must also do more to build upon the progress we’ve made thanks to Obamacare with policies such as lowering the Medicare enrollment age, allowing Americans to buy into or automatically enroll in Medicare, and allowing Medicare to import and negotiate the price of drugs.

Public option.

Yes.

Health insurance should be financed through a combination of public subsidization for those who need assistance to obtain health insurance and premiums that are affordable. Our fundamental goal must be providing health insurance and health care to everyone in America.

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Our goal must be to ensure that everyone in America has health insurance and enjoys a right to health care. To help accomplish this, we must also quickly create a path to citizenship for undocumented immigrants, and I will do so as president.

Yes.

I signed into law the nation’s first publicly funded long-term care benefit, and I believe this is a model for national policy. Washington State’s Long-Term Care Trust Act leads the nation by providing support to care for an aging loved one, or for people of any age to receive long-term care for unexpected injuries or illnesses. It will provide dignity and peace of mind for people everywhere in our state, and it’s the right thing to do.

Yes, and I voted to do so repeatedly in Congress.

Yes, and I voted to do so in Congress.

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The Senator wants to see universal health care and there are many ways to get there. She believes the smartest transition right now would be to do a public option — which could be done by expanding Medicaid or Medicare — and that this will get us there more quickly.

Yes.

All Americans.

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The Senator supports a public option and she favors modifications to the Affordable Care Act, including extending premium assistance to more Americans.

Public option.

Yes.

Combination.

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The Senator believes that all seniors should have access to high-quality long-term care.

Yes.

The Senator leads the bipartisan bill that allows for the importation of safe, less-expensive drugs from countries like Canada.

Yes.

The Senator leads the bill on lifting the ban on Medicare negotiating prices directly with drug companies on behalf of the 43 million seniors in the Part D program.

No.

Every American deserves excellent, affordable care. But as the only candidate in the race who receives single-payer health care today (through the V.A.), I’ve experienced such a system firsthand — and there are serious problems with it.

There are 150 million Americans who currently receive private health care, and they should be able to choose public health care if they want it — but they shouldn’t be forced onto a plan if they don’t. That’s why the right answer is a public option, exactly what President Obama had in the original plans for the Affordable Care Act, not Medicare-for-All.

Yes.

All Americans.

A public option would force public and private insurers to compete against each other for our business, which would give Americans the benefits they deserve: better coverage, cheaper prescriptions, lower costs, and health care that isn’t tied to a job.

Imagine having Congress and the next President force UPS and FedEx out of business, making everyone use the U.S. Postal Service whether they wanted to or not. Does anyone honestly believe that lack of competition would improve the U.S.P.S.? Just as we have choices for delivering packages, we should have choices for delivering health care. It’s a better, healthier, more efficient, and fundamentally more American system.

Yes.

I would be happy to sign premium assistance into law. It would extend benefits to the middle class, making health care more affordable for millions of Americans.

But we also need to go further; premium assistance is a great step forward, but it won’t drive costs down far enough, or for enough Americans. We need a public option to truly fix our system.

Public option.

I had private insurance growing up but now get my health care from the V.A. — one of the closest things we have to Medicare-for-All today — so I’ve seen the ups and downs of both systems firsthand. Neither one is good enough on its own.

The right answer is an aggressive public option, where all Americans can buy into a Medicare-like program if they want and keep their current insurance if they don’t. Competition between the private sector and a public option will drive improvements to both.

Yes.

For health care to be affordable, both healthy and sick folks need to be covered on our plans. Everyone does. That’s because if only sick or injured people received health care, the cost of health care would spiral out of control. And any of us can get sick or injured at any moment, so everyone needs coverage to drive down costs and keep everyone healthy. Having everyone enrolled in health care is also critical for preventative care, which saves lives and keeps down costs.

A combination of taxes, co-payments and premiums.

Our system is currently funded through a combination of taxes, co-payments, and premiums, all of which totaled 18 percent of G.D.P. in 2017. That’s twice as much as nearly every other wealthy country in the world. A well-designed system, including an aggressive public option, will address that problem and reduce the overall taxes needed to fund the system. For plans to compete, they will need to bring down the astronomically high bureaucratic costs in our current health care system.

Yes.

They would be allowed to buy into my public option. Under current law, hospitals in the U.S. cannot refuse to treat patients who need care. Therefore, our system already pays for health care for undocumented immigrants — usually through emergency rooms, which are the most expensive form of care.

By allowing everyone to buy into a public option, more folks will be covered, the risk pool will be younger and healthier, and fewer hospital bills will go unpaid. Everyone deserves good health care, and it makes the system stronger and more efficient overall.

No.

We should fund long-term care through government programs, as most other nations do. We should also invest more in home care and senior-adapted home technology to increase the quality and quantity of housing for seniors.

No.

Importing cheaper prescriptions from other countries is not the solution to our high drug costs. Prescriptions are cheaper in other nations because they negotiate drug prices. We should import their system, not their drugs. Importing their drugs has the potential to undermine safety, and more than that, it would risk exporting our drug prices to other nations — thus spreading the problem instead of solving it.

Yes.

Negotiating drug prices will make prescriptions more affordable for all Americans.

I made a commitment to continue receiving my health care through the V.A. even as a Member of Congress. Because the V.A. negotiates drug prices, any prescription I get is 40 percent less expensive than the same medications on private insurance. We should be doing that in all of our health systems to keep costs down for all Americans.

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Beto supports universal, guaranteed, high-quality health care. He believes the surest, quickest way to get there is a proposal like the Medicare for America bill, which says that everyone who does not have insurance today is enrolled in Medicare and that everyone who has insurance they cannot afford, premiums they cannot pay, a deductible they cannot bridge, is free to choose Medicare while letting Americans have the choice of keeping the employer-sponsored and private insurance plans that work for their family’s needs.

Yes.

All Americans.

No.

The Affordable Care Act allowed millions of people to get insurance, see a doctor, afford their medications, receive lifesaving procedures that allow them to live up to their full potential. Beto believes that we need to build on that success by getting to a place where there is guaranteed, universal, high-quality health care. He believes the surest and quickest way of getting there is through a plan like Medicare for America.

Public option.

Beto supports universal, guaranteed, high-quality health care. He believes the surest, quickest way to get there is a proposal like the Medicare for America bill.

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Beto supports a system like the one proposed under Medicare for America which would automatically enroll every uninsured individual and provide universal coverage. Those insured through their employer could choose to stay on that plan or enroll in the Medicare for America system.

Under the current system, the costs of health care are increasingly being shifted onto consumers. Beto is committed to reducing out of pocket costs. Beto supports a plan like Medicare for America which eliminates out of pocket costs for lower-income families, eliminates deductibles for all families, and limits out of pocket costs for middle income and upper income families to levels far below costs under the ACA or the current Medicare program. Such a plan would also set premiums based on a sliding scale as a percentage of income — with free care or subsidies for low- and middle-income Americans. Overall, we will reduce what America will pay on health care costs.

At a time when corporations and the wealthiest among us received a $2 trillion tax cut, we know we have the means to achieve universal, guaranteed, high-quality health care. By using existing allocations more wisely, controlling costs, and letting working families take the money they pay to private insurers and instead let them pay into a public option at a lower cost, we can ensure that every person can see a doctor, afford a prescription, and be well enough to live up to their full potential.

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This issue is one of many reasons Beto believes that comprehensive immigration reform must be a top priority. Because our laws rightly require hospitals to provide care to everyone, the cost of care for uninsured individuals is currently shifted onto other consumers. Therefore, it is in everyone’s interest to provide a pathway for obtaining insurance.

Yes.

Beto supports a plan like Medicare for America, which covers long-term care, including nursing homes as well as home and community-based services. By providing an option to every business and individual to buy into this system at an affordable cost, we ensure people can get the coverage they need.

Yes.

Beto has supported legislation that facilitates the import of safe, low-cost medicine from Canada and Europe where the same medications are available for cheaper.

Yes.

Yes.

Yes.

All Americans.

Yes.

“Medicare for all.”

We need to think big when it comes to making health care more accessible and affordable, which is why I am a long time supporter of Medicare for All. But as we move towards that ultimate goal, we need to be realistic on how we get there. That is why I also support making modifications to the Affordable Care Act and adding public option that would allow Americans to buy into Medicare without eliminating private health insurance options until we as a country can implement Medicare for All in a way that will move our country forward.

Yes.

A combination of taxes, co-payments and premiums.

A surcharge on very wealthy people. But we also need to reform these broken system so we are not throwing money at things that aren’t working. We need more revenue, but we also need to maximize what we have through deep reforms to how our government works.

No.

Yes.

Yes.

Yes.

Yes.

Bernie is running for president because the time is long overdue for the United States to join every other major country on Earth and guarantee health care to all people as a right, not a privilege, through a Medicare-for-all program. Health care is not a commodity. It is a human right. The goal of a sane health care system should be to keep people well, not to make stockholders rich. That is why we need Medicare for All. Bernie’s Medicare for All program would provide comprehensive health coverage to all with no premiums, deductibles, co-payments, or surprise bills.

No.

The question we face is whether we will guarantee health care as a human right. The only way to do that is to pass Bernie’s Medicare for All plan. The current system is completely dysfunctional, and in the current profit-driven health care system, we are at the mercy of the private insurance and pharmaceutical companies, whose greed dictates the cost of health care. The U.S. federal government has failed to rein in health care costs, which many of our peer nations have successfully done.

A public option or other buy-in plans fail to address the underlying problem in the U.S. health care system: corporate greed and profiteering off of the sick. The other proposals do not address skyrocketing prescription drug prices. They fail to simplify the current confusing and dysfunctional administrative system that makes up 17 percent of health care expenditures. Under Bernie’s Medicare for All plan, we slash administrative costs by relying on one payment and billing entity — the federal government — instead of hundreds.

Buy-in and other option plans still leave millions of Americans at the whim of their employers. 30% of employers change plans every year. On top of that, 66 million people separated from their job sometime last year, and by age 50, the average worker has held 12 different jobs. Medicare for All provides stability. After a four-year transition period, every man, woman, and child in the United States will have health care coverage from birth, with no changes or confusing “open enrollment,” no networks, and no surprise bills.

Medicare for All completely eliminates premiums, deductibles and co-payments for services. Under Medicare for All, health care is free at the point of service for all people in the U.S. regardless of income.

No.

Making only minor tweaks to the status quo is not enough. More than 30 million people do not have insurance. 41 million people are underinsured, meaning they have insurance but cannot afford to use it because the deductibles and other cost-sharing is too high. Keep in mind that 40 percent of Americans cannot afford a $400 emergency, yet deductibles routinely run into the thousands of dollars. Making small tweaks to the system may help a few of those tens of millions Americans, but small tweaks are not enough to solve the fundamental problems underlying our health care system.

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Yes.

Bernie will guarantee health care as a human right, not a privilege or commodity. The United States must join the rest of the major countries in the world to guarantee health care to every person regardless of income. The only way to do that is to pass Bernie’s Medicare for All plan. Under Medicare for All, every American would be guaranteed care as a right and automatically enrolled in this new system.

Completely by taxes.

Let’s be clear, study after study shows that Medicare for All will save workers and average families thousands of dollars every year on health care, all while making sure corporations like Amazon and the ultra-wealthy pay their fair share.

Health care costs are a crushing tax for middle class families right now. If you count health care premiums as taxes, the United States is the second-highest taxed nation in the world. We can guarantee health coverage to all Americans while bringing down costs, just like every other developed country.

For decades, the American people have been told a lie: that we cannot afford to do what every other major country already does, and guarantee health care to all our people as a right, not a privilege. What the insurance industry’s lies fail to mention is that we already spend more per capita on health care than any other major country, with worse health outcomes, and that moving to a Medicare-for-all, single-payer system would actually end up saving the American people trillions of dollars.

By cutting unnecessary administrative costs, bringing down the outrageous prices of prescription medication, and ensuring large corporations and the wealthy pay their fair share in taxes, we can afford to bring the United States, the richest country in the world, in line with every single other industrialized nation and guarantee quality health care coverage to all Americans.

Yes.

Medicare for All means just that: all. Bernie’s plan would provide coverage to all U.S. residents, regardless of immigration status.

Yes.

Bernie believes that as a nation, we have a moral responsibility to ensure that all Americans have the supports and services they need. Under Medicare for All, health care will be guaranteed as a right and home and community based services and supports will be fully covered.

Yes.

We pay the highest prices in the world for prescription drugs. It does not have to be that way. Bernie introduced the Affordable and Safe Prescription Drug Importation Act, which would allow the importation from Canada and other major countries.

Yes.

If the pharmaceutical industry will not end its greed, which is literally killing Americans, then we will end it for them. Bernie’s Medicare for All plan will allow drug prices to be negotiated by the Secretary of Health and Human Services under Medicare Part D. Bernie also introduced the Prescription Drug Price Relief Act, which will index the price of prescription drugs in the U.S. to the median price of the same drug in five other major countries.

No.

I support coverage for all, i.e., Medicare for all who want it. This would serve as a public option for any American, operating alongside and competing with private insurance plans, in order to drive prices down for everyone. If you’re sick you should be seen, and if you’re seen you shouldn’t go broke.

But we also should do what we do best as Americans: Find the unfindable, solve the unsolvable, and cure the incurable. We must invest in and commit to finding cures and more effective treatments in our lifetime, an initiative to publicly invest in genomics, targeted therapies, and data sharing. We’ll drive down the cost of care, increase our quality of life, and put a new generation of scientists to work while we’re at it.

Yes.

All Americans.

Americans should have a choice between coverage provided by private companies and that provided by the government. While I do not want to bring an end to private insurance, I support coverage for all, which would be a public option that would drive down the pressure on the private insurers and ultimately lead to more affordable plans for all Americans.

No.

It’s not the only solution, but we can and must protect, restore, and improve the protections that the Affordable Care Act gives all Americans regarding coverage for pre-existing conditions, coverage for maternity care, allowing people to remain on their parents’ plans through age 26, and so on.

Public option.

Public option, while restoring/protecting A.C.A. rules for private insurers.

Yes.

Requiring all Americans to have insurance, either public or private, means our health care system no longer has to bear the cost of treating uninsured patients.

A combination.

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Yes.

It is in society’s interest to have everyone be as healthy as possible, and that’s achieved through access to affordable health care for everyone.

Yes.

We have the opportunity to expand a care economy in which we invest in retraining mid- and end-of-career workers, including those displaced by technology, to work in providing long-term care — jobs for those who need them, care for those who need it.

Yes.

I support importing drugs if they meet safety standards and the manufacturers can be held liable.

Yes.

I will do anything that is safe for patients — from negotiating prices to better enforcement of antitrust laws — to make prescription drugs more affordable, because prices are simply too high now for too many Americans. When my son, Nelson, got sick recently, we took him to the doctor and then I went to a chain-store pharmacy to have a prescription filled. The pharmacist told me I was lucky to have insurance because what cost me $5 would cost an uninsured person $250. Later, I talked with one of my district’s few remaining independent pharmacists; he said the prescription’s actual wholesale cost is about $80, so he would have charged an uninsured person about $100. This is a broken system.

There are a variety of additional steps the government could take, such as increasing access to generic drugs and improving access and opportunity for clinical trials, to help lower costs. Whatever is done should reduce prices, maintain incentives for innovation, and ensure drugs continue to be safe and effective.

And our public investment in finding cures, and making those available and affordable, would bring costs down too.

Yes.

I support Medicare-for-All so that everyone is covered, no one goes broke because of a medical bill, and we start treating health care like the basic human right that it is.

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Every proposal on the table right now would layer coverage expansions that add up over time, but there’s no excuse for stopping at half-measures. The aim has to be very clear: make sure every single person in this country has guaranteed health care coverage.

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I have a bill to crack down on shady behavior by insurance companies and improve the quality and affordability of health insurance purchased on the A.C.A. exchanges or provided through employer coverage. We have to protect the A.C.A., but we can’t stop there.

“Medicare for all.”

Our aim should be to cover the most people at the lowest cost, and for me that means Medicare for All. Health care is a basic human right and no one should go broke to pay a medical bill.

Yes.

Massachusetts was a leader in health care reform, including by adopting a requirement that everyone have coverage. This requirement is one of several features that has made health care coverage in Massachusetts some of the very best in the nation.

Studies show that health care costs will decrease under Medicare for All. Families are going broke today from medical bills, and Medicare for All will ensure that co-pays, deductibles, emergency room visits, and prescription drugs don’t drown families with sky-high medical expenses.

Yes.

Health care is a basic human right.

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Medicare for All would guarantee long-term care coverage for everyone in this country. I also believe we must fight against Republican attacks on Medicaid, which is the backbone of our long-term care system for millions of Americans.

Yes.

Yes.

No.

I want to make Medicare available to everyone as an option, but not eliminate private insurance.

Yes.

All Americans.

Yes.

We should keep and strengthen the A.C.A.

Public option.

Medicare provides good quality care at affordable rates, and should be available to those who want it. But millions of people like their private insurance and should be able to keep it. So the best is including Medicare as an option on the health exchanges, a public choice along with the private choices.

Yes.

Through a combination of taxes, co-payments and premiums.

Repeal the 2017 tax breaks for big corporations and very wealthy, retain for middle class.

Yes.

No.

Yes.

Often the same drug is less expensive in other countries. However we need strict monitoring to ensure good quality.

Yes.

Medicare could negotiate lower drug prices for consumers.

Yes.

We pay more than any other major industrialized country for our health care to worse results. When Americans get sick, they’re focused more on how to pay for their care than how to get well. Our current system is dysfunctional and we need to move towards a Medicare for All system that provides coverage for all Americans from birth. I wouldn’t eliminate private health insurance, but I don’t imagine it being an economically viable business outside of supplemental plans since it’s competing against a no-cost alternative.

Yes.

All Americans.

A public option for all would be a major step in the right direction and can serve as a good option for people during the transition from our current system to Medicare For All.

No.

Our health care system today is fundamentally broken and we need to make bigger moves to fix it — not just incremental modifications.

“Medicare for all.”

While all these policies would move us in a better direction than our current system, I believe the best path forward is Medicare for All. This system will ensure coverage for all Americans while allowing us to keep costs under control.

Yes.

By ensuring everyone has coverage, we can promote preventative care and keep costs under control, while also making administrative costs lower for both the federal government and individual providers. And, most importantly, we can make sure that all Americans are taken care of when they’re ill or injured.

A combination of taxes and co-payments, not premiums.

Employer-sponsored health care already represents a huge percent of our spending in this area, and that money can be used to largely fund Medicare for All through a payroll tax. The Medicare for All system will be cheaper because of lowered administrative and other costs, a lack of profit motive, and a focus on preventative care.

Yes.

I believe in a pathway to citizenship for all undocumented immigrants. Anyone who applied for that pathway would be eligible to buy into the Medicare for All system.

Yes.

Long-term care, especially end-of-life care, is an important part of anyone’s lifetime health care needs, and as such should be a part of a Medicare for All plan.

Yes.

Many Americans are paying as much as 8-10 times the prices as Canadians for the very same prescription drugs. While we should start by trying to control prices in the domestic market through mechanisms such as international reference pricing, forced licensing, and public manufacturing of generics, if these efforts don’t work, then we should allow for the importation of prescription drugs.

Yes.

It’s ridiculous that this isn’t allowed already.

 

 

Researchers test vaccine they hope could stem Alzheimer’s

July 1, 2019

courtesy of NAELA eBulletin:

See video at Researchers work on anti-Alzheimer’s vaccine

Albuquerque, N.M. — Researchers at University of New Mexico researchers are working on a vaccine they hope could prevent Alzheimer’s disease, reports CBS Albuquerque affiliate KRQE-TV. UNM’s Health and Sciences Department Associate Professor Kiran Bhaskar, who’s been passionate about studying the disease for the last decade, says the work started with an idea in 2013.

“I would say it took about five years or so to get from where the idea generated and get the fully functioning working vaccine,” he said.

Bhaskar and his team started to test the vaccine on mice. It has not yet been shown if it works in people.

“We used a group of mice that have Alzheimer’s disease, and we injected them over a series of injections,” said PhD student Nicole Maphis. She said the vaccine targets a specific protein known as tau that’s commonly found in the brains of Alzheimer’s patients.

“These antibodies seem to have cleared (out) pathological tau. Pathological tau is one of the components of these tangles that we find in the brains of patients with Alzheimers disease,” she explained. The response lasted for months, according to UNM.

Those long tangles “disrupt the ability of neurons to communicate with one another,” the school points out, adding that tau is “normally a stabilizing structure inside of neurons.”

The mice were then given a series of maze-like tests. The mice that received the vaccine performed a lot better than those that hadn’t.

However, drugs that seem to work in mice do not always have the same effect in humans. A clinical trial involving people will be required to see if the drug helps in real life, and that’s a difficult and expensive undertaking — with no guarantee of success.

“We have to make sure that we have a clinical version of the vaccine so that we can test in people,” Bhaskar said.

Testing just a small group would cost the UNM Health Sciences Department $2 million. Right now, Maphis and Bhaskar are looking for partnerships to help them toward a clinical-grade vaccine.

Alzheimer’s affects almost a third of senior citizens and “is on the rise, currently affecting 43 million people worldwide,” UNM notes.

Editor’s note: This story has been updated to clarify that the vaccine has not yet been shown to work in humans.

 

Cannabis use among older adults rising rapidly

July 1, 2019

courtesy of NAELA eBulletin:

Study is first state-wide investigation of cannabis use among older Americans and the outcomes they experience

UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS

AURORA, Colo. (May 30, 2019) – Cannabis use among older adults is growing faster than any other age group but many report barriers to getting medical marijuana, a lack of communication with their doctors and a lingering stigma attached to the drug, according to researchers.

The study, the first to look at how older Americans use cannabis and the outcomes they experience, was published this month in the journal Drugs & Aging.

“Older Americans are using cannabis for a lot of different reasons,” said study co-author Hillary Lum, MD, PhD, assistant professor of medicine at the University of Colorado School of Medicine. “Some use it to manage pain while others use it for depression or anxiety.”

The 2016 National Survey of Drug Use and Health showed a ten-fold increase in cannabis use among adults over age 65.

The researchers set out to understand how older people perceived cannabis, how they used it and the positive and negative outcomes associated with it.

They conducted 17 focus groups in in senior centers, health clinics and cannabis dispensaries in 13 Colorado counties that included more than 136 people over the age of 60. Some were cannabis users, others were not.

“We identified five major themes,” Lum said.

These included: A lack of research and education about cannabis; A lack of provider communication about cannabis; A lack of access to medical cannabis; A lack of outcome information about cannabis use; A reluctance to discuss cannabis use.

Researchers found a general reluctance among some to ask their doctors for a red card to obtain medical marijuana. Instead, they chose to pay more for recreational cannabis.

Lum said this could be driven by feeling self-conscious about asking a doctor for cannabis. That, she said, points to a failure of communication between health care providers and their patients.

“I think [doctors can] be a lot more open to learning about it and discussing it with their patients,” said one focus group respondent. “Because at this point I have told my primary care I was using it on my shoulder. And that was the end of the conversation. He didn’t want to know why, he didn’t want to know about effects, didn’t want to know about side effects, didn’t want to know anything.”

Some said their doctors were unable or unwilling to provide a certificate, the document needed to obtain medical marijuana. They also said physicians need to educate themselves on the latest cannabis research.

Some older users reported positive outcomes when using cannabis for pain as opposed to taking highly addictive prescription opioids. They often differentiated between using cannabis for medical reasons and using it recreationally.

“Although study participants discussed recreational cannabis more negatively than medical cannabis, they felt it was more comparable to drinking alcohol, often asserting a preference for recreational cannabis over the negative effects of alcohol,” the study said.

The researchers also found that despite the legalization of cannabis in Colorado and other states, some older people still felt a stigma attached to it.

“Some participants, for example, referred to the movie `Reefer Madness’ (1936) and other anti-marijuana propaganda adverts that negatively framed cannabis as immoral and illegal,” the researchers said.

The study adds to the growing literature on the diversity of marijuana use patterns in older adults, said co-author Sara Honn Qualls, PhD, ABPP, professor of psychology and director of the Gerontology Center at the University of Colorado Colorado Springs.

“Older adults who use marijuana are ingesting it in a variety of ways for multiple purposes,” she said. “This and other papers from the same project show growing acceptance of marijuana use for medical purposes by older adults, and a clear desire to have their primary health providers involved in educating them about options and risks.

Lum agreed.

She said Colorado, the first state to legalize recreational marijuana, provides a unique laboratory to gauge public attitudes toward cannabis.

“From a physician’s standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis,” she said. “Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients.”

The study co-authors include: Julie Bobitt; Melissa Schuchman; Robert Wickersham; Kanika Arora; Gary Milavetz and Brian Kaskie.