Plan for High-Quality, Affordable Health Care


It is a disgrace that we remain the only industrialized country in the world that doesn’t provide universal coverage. As a nation, we spend almost double what other advanced economies spend on health care. Yet nearly 27 million Americans still lack health insurance. It is a moral imperative that we fix this.

The growing costs of coverage, care, and prescription drugs burden or bankrupt families and small businesses every day. Every American must have access to affordable, high-quality health care.

The Bennet Administration will achieve these goals with Medicare-X, a public option plan that builds on the Affordable Care Act instead of ripping out the progress we’ve made over the last 10 years.

Medicare-X will:

  • Establish a public insurance option — an insurance plan that would be available on the exchange for people to buy if they had no insurance or didn’t like their current private insurance.
  • Start on the individual exchange in rural areas with one or no insurers. Over the course of two years, Medicare-X expands to every county in the country and becomes available on the small business exchange.
  • Require the federal government, for the first time in history, to negotiate lower drug prices for Medicare and Medicare-X.
  • Include all of the essential health benefits required under the ACA, including maternity care and mental health services.
  • Provide an affordable option without adding government bureaucracy by using the Medicare framework.
  • Save taxpayer dollars and reduce the deficit because Medicare-X’s payment rates to medical providers are lower than those for private insurance.
  • Ensure that individuals will not pay any more than 13% of their income on insurance premiums. For millions of Americans, it would be even less. A family of four making $101,000 would have a maximum of 9% of their income that would be spent on premiums, and they would see their current premiums cut in half.
  • Increase the tax credit for individuals earning less than 400% of the federal poverty line and eliminate the arbitrary subsidy cliff and provide premium tax credits for those earning more than 400% of the federal poverty level, who currently do not qualify for any assistance.
  • Authorize $30 billion over three years for a national reinsurance program to stabilize the marketplace.
  • Direct additional reforms to coordinate health care with employment, education, food, housing, and transportation, all of which affect health and often result in delays to accessing health care.

Unlike Medicare for All, Medicare-X does not ban employer- or union-provided insurance for the 180 million Americans who have it now, nor does it kick 22 million seniors off of Medicare Advantage.

We cannot afford to wait another day, another month, or another election to provide the high-quality, affordable care Americans need. We need a proposal that has broad support from the American people. That plan is Medicare-X.


Plan for High-Quality, Affordable Health Care for Rural America

America has nearly 20,000 cities, towns, and villages. 97% of them have fewer than 50,000 residents. 72% of land in the United States is outside of metropolitan areas, far away from a major or mid-sized city. When we talk about small towns and rural America, we are talking about most of America.

Rural Americans currently face unique challenges to accessing high-quality, affordable health care. In 2019, 37% of counties—almost all of them in rural and small-town America, and home to nearly one in five Americans—had only one insurer on the Affordable Care Act exchanges. Chronic diseases, such as heart disease and diabetes, are more prevalent in rural communities. And the lack of providers and insurers has resulted in higher costs and lower quality of care.

Unlike the current administration, which has tried to rip health care away from millions of Americans, cut funding to Medicare and Medicaid, and block a public option, the Bennet Administration will make it a top priority to expand health coverage to every community in America. This includes a comprehensive approach to closing the rural-urban health care divide.

To achieve universal health care, lower costs, and improve the quality of care in rural America, the Bennet Administration will:

  • Establish the Medicare-X public option.
  • Lower the cost of health care.
  • Close existing coverage gaps.
  • Harness technology and innovation.
  • Increase access to rural health providers, including mental health and primary care providers.
  • Improve maternal and infant health outcomes.
  • Combat substance abuse.
  • Support seniors and caregivers.

Establish the Medicare-X Public Option

It is a disgrace that we remain the only industrialized country in the world that does not provide universal coverage. As a nation, we spend almost double what other advanced economies spend on health care. Yet nearly 27 million Americans still lack health insurance, many of whom live in rural communities.

Michael has led the fight for a public option since 2009, when he traveled to some of the most rural, conservative areas in Colorado defending the Affordable Care Act and advocating for a public insurance plan that would increase competition and lower costs.

The Bennet Administration will establish Medicare-X, a true public option that starts in rural areas where the market is failing too many people with only one or no insurers. Over the course of two years, Medicare-X expands to every county in the country and becomes available on the small business exchange. Medicare-X gives people the ability to make a choice about what kind of insurance that have for their families, whether that is keeping their private insurance or purchasing the public option.

Medicare-X will:

  • Provide a high-quality, affordable insurance choice for every individual and small business in America.
  • Increase competition and lower costs, especially in rural areas.
  • Require the federal government, for the first time in history, to negotiate lower drug prices for Medicare and Medicare-X.
  • Provide tax credits to help middle-class Americans in rural areas afford health insurance by extending support to people who earn too much to be eligible currently.
  • Expand tax credits to Americans who earn below 400% of the federal poverty threshold to further decrease their monthly insurance premiums.
  • Provide reinsurance to help spread the costs of sicker and more costly patients and stabilize health insurance markets in rural areas.
  • Ensure that individuals do not pay more than 13% of their income in insurance premiums, and for millions of low- to middle-income Americans, it will be even less.
  • Pay up to 25% more for services in rural and underserved areas, helping sustain rural hospitals and other health providers.
  • Include all of the essential health benefits required under the ACA, including maternity care and mental health services.
  • Use the Medicare framework to reach universal coverage without creating any more government bureaucracy.
  • Save taxpayer dollars and reduce the deficit by having payment rates to medical providers that are lower than those for private insurance.
  • Protect the Medicare trust fund for seniors who have paid into it their entire lives.
  • Direct additional reforms to coordinate health care with employment, education, food, housing, and transportation, all of which affect health and often result in delays to accessing health care.

Lower the Cost of Health Care

Make Prescription Drugs More Affordable

The most effective way to lower the cost of prescription drugs is for the federal government to negotiate prices. With high rates of chronic conditions, affordable prescription drugs will make it easier for Americans in rural areas to consistently take their medications, improve their health, and require fewer hospitalizations and emergency room visits. No one should have to split tablets or go without insulin.

The Bennet Administration will:

  • Require the federal government, for the first time in history, to negotiate lower drug prices for Medicare and Medicare-X.
  • End “pay for delay” and monopolistic tactics that keep affordable generic drugs off the market.
    Implement value-based reimbursement for prescription drugs where pharmaceutical manufacturers are paid based on health outcomes.
  • Require manufacturers to justify price increases and pay penalties when prices increase faster than inflation.

Enhance Price Transparency and End Surprise Medical Bills

Our current health care system is completely opaque. Families should not have to pay tens of thousands of dollars because an out-of-network doctor treats them at an in-network facility, or because an emergency leaves them with no control over the hospital in which they receive care. This is particularly critical for rural areas where there are fewer choices in health care providers. Michael has led a bipartisan effort in Congress to put an end to surprise medical bills and will make it a priority as president.

The Bennet Administration will:

  • Establish transparency and real-time benefit tools so Americans can compare services and choose the highest-quality, lowest-cost care.
  • Require providers and insurers to provide real-time cost-sharing information for health care services and prescription drugs.
  • Close the loophole that allows providers to charge exorbitant prices by ending out-of-network surprise medical bills for emergency room visits or hospital charges that were incurred when a patient selected an in-network physician or hospital.

Implement Additional Reforms in Our Health Care System

The Bennet Administration will:

  • Reimburse health care services based on health outcomes and value so that we pay hospitals and doctors to keep people healthy. Chronic diseases such as heart disease and diabetes are more prevalent in rural communities and can be prevented or managed by restructuring incentives in the health care system.
  • Direct the Federal Trade Commission to investigate the effect of consolidation in the provider and insurance industries. Consolidation in rural areas is especially detrimental where there are already fewer choices.

Close Existing Coverage Gaps

About 25% of Americans who are currently uninsured—approximately 7.5 million people—already qualify for Medicaid or CHIP. Another 25%—approximately 7.5 million additional people—are eligible for tax credits in the health insurance marketplace, with 3 million eligible for the most generous levels of those credits. Yet, instead of attempting to provide all Americans with high-quality, affordable health insurance, the Trump Administration has repeatedly tried to take health insurance away from tens of millions of Americans, while undermining and defunding efforts to sign up Americans for affordable coverage.

The Bennet Administration will:

  • Automatically enroll the 7.5 million Americans who currently qualify for Medicaid or CHIP.
  • Expand outreach efforts to families and individuals to ensure that those who are eligible for tax credits to make health care affordable are attaining coverage.
  • Fix the so-called “Family Glitch” to clarify that individuals can access tax credits for premium support on the exchange if their employer coverage is not affordable for their family, including their spouse and children.
  • Cover Medicaid expansion at 100% for states that have not yet expanded and phase to a 90% match over five years.
  • Support and prioritize innovative state plans, through Section 1332 of the Affordable Care Act, that address underserved rural areas, including state-level efforts to add a public option or to encourage greater private competition on the exchanges.

Harness Technology and Innovation

The United States leads the world in innovation in health care, with a commitment to research, technology, and medical innovation that is unparalleled. We must ensure the benefits of this innovation are reaching rural communities and harness 21st century technology to close the urban-rural divide in access to health care.

The Bennet Administration will:

  • Invest in innovative care solutions, such as telemedicine and remote patient monitoring. Telemedicine—when doctors see patients via video-chat—can play an important role in delivering services to people in remote communities who cannot easily drive to often far-away medical facilities. Remote patient monitoring provides patients and their providers the ability to track their health metrics, which can prevent hospitalizations and emergency room visits.
  • Invest in and promote research to find cures and promote personalized medicine with better efficacy and fewer side effects. This builds on the breakthrough therapies designation, which Michael created in 2012 and has resulted in the FDA approving more than 140 breakthrough-designated treatments for cancer and other life-threatening diseases.
  • Increase funding for the National Institutes of Health (NIH) by 40% by 2025 to support path-breaking research into cures and treatments for cancer, Alzheimer’s, diabetes, heart disease, ALS, and other chronic or life-threatening illnesses that affect tens of millions of Americans.
  • Make a $40 billion capital investment to connect the entire country to high-speed, reliable, affordable broadband, so that rural health providers can communicate with their patients and monitor health conditions remotely through telemedicine.

Increase Access to Rural Health Providers, Including Mental Health and Primary Care Providers

America will face a shortage of as many as 100,000 doctors by 2030, and the shortages are particularly acute in rural areas. Nearly half of rural hospitals lost money last year. Shortages in mental health and primary care providers also have a devastating effect on rural communities, including higher suicide rates.

The Bennet Administration will:

  • Provide loan forgiveness and repayment support of up to $10,000 per year for doctors, nurses, and other health care professionals who provide care in rural areas that are underserved.
  • Increase funding and support for community health centers and disproportionate share hospitals that treat a high percentage of uncompensated care as we transition to universal coverage.
  • Integrate primary care with behavioral health so that mental health conditions can be screened and treated the same way we manage physical health conditions.

Improve Maternal and Infant Health Outcomes

Women and infants in rural areas have much higher mortality rates in childbirth than those in large urban areas. Fewer than half of rural women live within a 30-minute drive to a hospital with services for expecting and new mothers, and more than 10% have to drive 100 miles or more—making them much less likely to receive prenatal care.

The Bennet Administration will:

  • Address the rural maternal and infant health divide by expanding coverage through Medicare-X.
  • Increase the number of OB-GYNs and other rural providers.
  • Expand Medicaid coverage for pregnant women to six months postpartum to support new mothers.
  • Invest in telemedicine, which can reduce the risks to expectant mothers and newborns by providing care via video-chat.
  • Support midwives and home visitation as a key component for maternal care in rural communities.
  • Increase research funding on maternal and infant health to enhance our understanding of best practices for pre-natal and neonatal care. This includes research on the health effects of breastfeeding, early access to technology and its effects on cognitive development, and other areas of underexplored research.
  • Address racial disparities in maternal mortality by ensuring people of color are covered with quality care throughout pregnancy and childbirth. This includes ending maternity care deserts, requiring culturally competent screening and treatment, and strengthening state and federal programs that cover family planning and maternity care.

Combat Substance Abuse

Between 1999 and 2015, overdose deaths increased 325 percent in rural counties. And while opioid-related overdoses decreased slightly between 2017 and 2018, deaths related to cocaine and methamphetamine overdoses increased. Additionally, the decrease in life expectancy in the United States has been linked to overdoses and suicides.

Our work as a country to address the opioid and substance abuse epidemic should reflect the magnitude of the problem. Not only do we need to invest in more treatments facilities in rural communities, but we also need to ensure they are equipped with the resources to combat opioid addiction and drugs of abuse that are on the rise.

The Bennet Administration will:

  • Make a $60 billion investment to combat substance use disorders, including funding to build and sustain treatment centers that are accessible to people in every county in America.
  • Hold manufacturers and distributors accountable for the problem they created by requiring them to pay in to a $20 billion fund for the treatment and prevention of opioid use disorders.
  • Hold manufacturers and distributors criminally liable and increase fines for illegal marketing of addictive opioids.
  • Increase access to both inpatient and outpatient addiction treatment centers where patients can receive behavioral therapy and medication for withdrawal.
  • Provide individuals at risk with naloxone to reverse overdoses and save more lives.
  • Supply law enforcement with naloxone.
  • Remove burdensome restrictions on providers to prescribe addiction treatment and expand evidence-based medication addiction treatment.
  • Require insurers to cover addiction treatment without prior authorization.
  • Require insurers to cover alternatives for pain management.

Support Seniors and Caregivers

Americans should have the freedom to age with dignity, which means making every effort to help older Americans stay in their homes and receive quality, long-term health care services. With fewer health care and social services and a lack of access to transportation, older Americans in rural communities face unique challenges. The median age of adults in rural areas is 51, compared to 45 in urban areas. In the last decade, more than 440 nursing homes in rural communities have closed or merged.

According to AARP, 40 million family caregivers provide an estimated $470 billion annually in unpaid care. Family caregivers spent nearly 20% of their income in 2016 providing care for an adult relative or friend for expenses such as adult day care, transportation, modifications to their loved ones’ homes, and home care aides.

The Bennet Administration will:

  • Increase resources for home health and tele-health so people can stay in their communities and still benefit from modern medicine. This builds on the “Independence at Home” effort that Michael has championed in the Medicare program.
  • Increase the flexibility Medicaid and Medicare allow for these and other federal programs to support keeping seniors in their homes when that is a more beneficial option for them and less costly to taxpayers, for example by financing minor home renovations that can help keep seniors in their homes.
  • Support caregivers with a tax credit of up to $3,000 to acknowledge that caregiving is important work and to offset some of the costs of that work.
  • Implement a long-term care strategy so that Americans don’t have to spend down their life savings just to qualify for Medicaid so they can afford a nursing home when it’s no longer possible for them to remain at home.
  • Provide funding for innovative transit alternatives targeted to small metropolitan areas, rural communities, and non-metropolitan towns with populations below 200,000. The funds would be designed to either augment existing transit options or to serve places where no public transit options currently exist, with a focus on helping seniors and other vulnerable populations.

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