Healthcare

There is substantial agreement that the US healthcare system has serious problems. A remarkably high 18% of GDP is devoted to healthcare—far higher than other developed countries, but without producing better health outcomes. Before the COVID pandemic, 28 million people did not have health insurance—also a much higher rate than other developed countries. With the massive job losses associated with the pandemic the number of uninsured rose dramatically.  

In 2009, the Affordable Care Act (ACA) was passed to improve access and lower the costs of healthcare. Since its passage there has been much debate over whether it should be modified. In 2017, the American Health Care Act (AHCA) was put forward calling for the repeal of many of the provisions of the ACA, but it failed to pass.  However in 2018 the repeal of the individual mandate provision of the ACA was passed.  

In the 2020 presidential campaign there has been much discussion of new options for US healthcare, especially the possibility of a public option that would provide government healthcare to individuals and small businesses who wish it.

  • National Sample: 2,430 registered voters
  • Margin of Error: +/- 2.0%
  • Fielded: January 14 - 29, 2020
  • Questionnaire with Frequencies (PDF)
  • Full Report (PDF)

Proposals with bipartisan support discussed below:

  • The government creating a health insurance plan open to all people and small businesses

Proposals that did not have bipartisan support:

  • The federal government providing universal health insurance, with no out-pocket expenses, funded by new taxes

  • National Sample: 2,511 registered voters
  • Margin of Error: +/- 2.0%
  • Fielded: December 6 - 13, 2017
  • Questionnaire

Proposals with bipartisan support discussed below:

  • Allowing insurance companies to offer low-premium high-deductible ‘copper plans’ to people over the age of 30

Proposals that did not have bipartisan support:

  • Restoring funding for outreach to familiarize people with the ACA’s insurance exchanges and training “navigators,” to help people seeking a health plan through the ACA
  • Restoring the subsidies that go to insurance companies to reimburse them for covering the out of pocket costs of low income people for at least two years

  • National Sample: 2,430 registered voters
  • Margin of Error: +/- 2.0%
  • Fielded: June 8 - 13, 2017
  • Questionnaire
  • Report

Proposals with bipartisan support discussed below:

  • Repealing the employer mandate
  • Allowing insurance companies to charge older insurees more than three times what they charge younger ones
  • Reducing the subsidies that lower health insurance costs for low income people
  • Repealing the requirement that insurance companies not consider a person’s pre‐existing conditions

Proposals that did not have bipartisan support:

  • Repealing the individual mandate
  • Repealing the employer mandate
  • The American Health Care Act of 2017 plan to lower healthcare spending for low income households

EXPANDING HEALTH INSURANCE COVERAGE

In an in-person deliberation by Stanford University’s Center for Deliberative Democracy in September 2019, respondents were presented with the following proposal and arguments for and against it:

Proposal: Everybody should be able to buy a public plan like Medicare, the current plan for seniors over 65.

Argument in Favor: Medicare’s history shows that the government experiences much lower administrative costs than private insurance companies. This proposal would also allow new participants to obtain the high-quality care now available to Medicare beneficiaries. Allowing people of any age to buy in to Medicare would ensure that all Americans always have access to quality, affordable coverage regardless of employment status or the decisions of private insurance companies. This “Medicare buy-in” or “public option” would force insurance companies to compete with the government plan on price, potentially reducing costs across the board.

Argument Against: With more enrollees and the same number of, or ever fewer, providers, medical care could be delayed or more difficult to access. Because Medicare pays lower rates to clinics, hospitals and doctors, this approach could compromise access to care. This could lead health care providers to demand higher payments from patients who retain private insurance, resulting in them paying significantly higher premiums for the same medical services.

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle," 71% favored (6-10) the proposal, including 59% of Republicans and 84% of Democrats.

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support increased slightly from the pre-deliberation poll to the post-deliberation poll, overall (67% to 71%), and among Republicans (47% to 59%) and Democrats (80% to 84%). 

Related Standard Polls
A growing majority favors the government creating a health insurance plan open to all individuals:

  • Asked whether they favor “the government offering a health insurance plan, similar to Medicare, that Americans could choose to purchase instead of private insurance,” 73% were in favor, including 86% of Democrats and 53% of Republicans. (January 2020, Pew)
  • Asked whether they favor “a government-administered health plan, sometimes called a public option, that would compete with private health insurance and be available to all Americans,” 68% were in favor, including 85% of Democrats and 42% of Republicans (51% opposed). (January 2020, Kaiser Family Foundation)
  • Asked the same question as above several months earlier, 66% were in favor, including 85% of Democrats and 36% of Republicans (62% opposed). (July 2019, Kaiser Family Foundation)
  • Asked whether it is a “good idea” to have “Medicare for all that want it, that is allow all Americans to choose between a national health insurance program or their own private health insurance,” 70% felt that it is a good idea, including 90% of Democrats and 46% of Republicans (48% bad idea). (July 2019, NPR/PBS NewsHour/Marist)
  • Asked about, “keeping the current healthcare system, but allowing all adults the option of buying into Medicare,” 51% felt it is a “good idea” (30% bad idea), including 61% of Democrats and 43% of Republicans (39% bad idea). Nineteen percent did not express any opinion. (March 2019, Quinnipiac University)

In an earlier poll in 2016 support was lower. Respondents were told that “One of the issues being debated in the election this year (2016) is whether or not the federal government should establish a government-sponsored health insurance program that would compete with private-health insurance plans. This is often called a public option and would be available only for those eligible for the Affordable Care Act.” A plurality of 48% favored “the government offering such a program with 42% opposed. Partisan breakouts were not provided. (September 2016, Politico/Harvard Public Health)

Status of Legislation
There were several pieces of legislation to create a government-run health insurance plan open to all individuals and small businesses that have been reintroduced in the 117th Congress: 

  • Medicare-X Choice Act (H.R. 1227, S. 386), sponsored by Rep. Antonio Delgado (D) and Sen. Michael Bennet (D);
  • Choose Medicare Act (S. 1180), sponsored by Sen. Jeff Merkley (D); and
  • CHOICE Act (S. 983), sponsored by Sen. Sheldon Whitehouse (D).

None of these bills have made it out of committee.

In an in-person deliberation by Stanford University’s Center for Deliberative Democracy in September 2019, respondents were presented with the following proposal and arguments for and against it:

Proposal: Americans aged fifty-five and older should have the option of purchasing Medicare, instead of a private insurance plan.

Argument in Favor: Americans closer to retirement age typically have higher health care costs than younger individuals. This makes them more expensive to insure, resulting in higher premiums. Because these older adults have greater health care needs, they are more likely to enroll in health insurance than younger individuals. When older individuals make up a large share of the population enrolled in a plan, premiums increase for everyone. By allowing this group to buy into Medicare, the price of private plans could go down, because the remaining population enrolled in private insurance plans would be younger and healthier. Allowing individuals aged 55 and older to enroll in Medicare ensures they will always have access to quality, affordable health coverage. Americans 55-65 are likely healthier and less expensive for healthcare compared to those 65+. Allowing them to buy into Medicare will likely lead to a decrease in the average per capita healthcare spending in the patient pool, potentially lowering prices for patients in Medicare as well.

Argument Against: By giving many people who are likely to be high consumers of health care — those 55 and older — access to Medicare, coverage and services to current recipients might be at risk. Just like a more general public option, a Medicare buy-in for people aged 55 and older is simply a way for the government to eventually put everyone into Medicare. And if the goal is to expand access to coverage, everyone regardless of age should be able to buy Medicare as an alternative to a private plan.

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle”, 79% favored (6-10) the proposal, including 70% of Republicans and 88% of Democrats.

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support increased from the pre-deliberation poll to the post-deliberation poll, overall (72% to 79%), and among Republicans (55% to 70%) and Democrats (83% to 88%). 

Related Standard Polls
Bipartisan majorities have favored lowering the eligibility age to purchase Medicare coverage.

  • Asked whether they support, “lowering the Medicare eligibility age to 60,” 61% were in support, including 75% of Democrats. Among Republicans, a plurality of 49% were in support, and just 38% opposed with 12% saying they did not know or had no opinion. (June 2021, Morning Consult/Politico)
  • Told that, “Medicare is a government program that provides health insurance to Americans over the age of 65,” and asked if they would support, “lowering the eligibility age to 60,” 60% were in favor (Democrats 72%, Republicans 56%). (June 2021, Data for Progress)
  • Asked whether they favor, “lowering the age when people become eligible for Medicare from 65 to 60,” 65% were in support, including 79% of Democrats and 51% of Republicans. (December 2020, Kaiser Family Foundation)

However when this possibility is set against adults 55 and over buying private insurance plans support is lower, though still a majority:

  • Asked whether it is a good idea to allow “adults age 55 and over to buy into Medicare instead of buying private insurance plans,” 61% said it was a good idea  (22% bad), including 51% of Republicans (29% bad idea) and 73% of Democrats (13% bad idea). Seventeen percent did not provide did not provide any answer (Republicans 20%, Democrats 14%). (September 2017, Quinnipiac University)

Status of Legislation
There is a proposal that has been in Congressional legislation to allow people aged 50 to 64 to purchase Medicare, and develop new premiums for those between the ages of 50 and 64. This proposal was in the larger healthcare reform bill Medicare Buy-In and Health Care Stabilization Act (H.R. 1346), sponsored by Rep. Clay Higgins (D). It has also been in the Medicare at 50 Act, which was reintroduced in the 117th Congress by Sen. Debbie Stabenow (D) (S. 1279), which has not yet made it out of committee.

Members of Congress introduced the Bipartisan Health Care Stabilization Act of 2017, which would remove the ACA restriction on people age 30 and over purchasing low-cost ‘copper’ plans. 

 The argument in favor was found convincing by 77%, including 69% of Democrats as well as 85% of Republicans.  The argument against the proposal did not do as well--it was found convincing by 57%, including 50% of Republicans as well as 64% of Democrats.

Asked for their final recommendation, 60% favored making copper plans available in the ACA exchanges to anyone seeking individual insurance, including people age 30 and older.  This included 54% of Democrats, as well as 68% of Republicans.

Status of Legislation
The proposal to repeal the Affordable Care Act rule prohibiting low-cost, high-deductible insurance plans, known as ‘copper plans’, from being purchased by people age 30 and over, was part of the Bipartisan Health Care Stabilization Act of 2018. The bill was never officially submitted as legislation.

The proposal was in H.R. 6311 by Rep. Peter Roskam (R) in the 115th Congress, which passed the House with 230 Republicans and 12 Democrats voting in favor, and 1 Republican and 176 Democrats voting against. It was not taken up by the Senate.

This proposal is also in the Fair Care Act (H.R. 1332), sponsored by Rep. Bruce Westerman (R) in the 116th Congress. The bill has not made it out of committee.

LOWERING ACA MARKETPLACE INSURANCE COST

Proposal: The federal subsidies in the ACA that help the middle class should be expanded to include more people.

Argument in Favor: Americans who purchase individual health coverage and who have incomes above 400 percent of the federal poverty line (about $50,000 per year for an individual and $85,000 for a family of three), receive no subsidies to help cover health insurance costs. Some of these individuals are spending 15 or even 20 percent of their income on premiums. These middle-class families have to pay the full cost of premiums and suffer the most when premiums increase.

Argument Against: The ACA already costs the federal government too much money. Increasing the scope of subsidies will result in vastly increased federal spending. It will also allow insurance companies to impose price increases that are borne disproportionately by the government rather than consumers.

Expanding subsidies could result in some losing job-based coverage, as employers curtail coverage in anticipation of employees buying their own subsidized coverage.

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle”, 72% favored (6-10) the proposal, including 51% of Republicans and 87% of Democrats.

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support increased slightly from the pre-deliberation poll to the post-deliberation poll, overall (60% to 72%), and among Republicans (29% to 51%) and Democrats (80% to 87%). 

Related Standard Polls
Given the options to increase, decrease or not change spending on healthcare subsidies for people who can not afford health insurance, a majority of Democrats have preferred increasing spending, and a plurality of Republicans have preferred decreasing it.

  • Asked whether they favor, “an increase, decrease, or no change in government spending to help people pay for health insurance when they can’t pay for it all themselves,” a majority of 57% chose to increase, including 82% of Democrats. Among Republicans, just 31% chose to increase, and 42% to decrease. (2016, ANES Pilot)
  • Asked the same question in a different survey, 46% chose to increase, 26% to decrease and 27% to not change spending. Among Democrats, a majority of 65% increased. Among Republicans, just 24% increased, and 46% chose to decrease spending. (2016, ANES Timeseries)

Status of Legislation
The proposal to expand healthcare subsidies to more people is in Patient Protection and Affordable Care Enhancement Act (H.R. 1425) by Rep. Angie Craig, which would cap ACA Marketplace insurance premiums at 8.5% for all buyers. This bill passed the House with 232D and 2R voting in favor, and 1D, 177R and 1I voting against.

The proposal was also in the Fair Care Act (H.R. 1332) by Rep. Bruce Westerman (R) in the 116th Congress, which would expand income eligibility for healthcare subsidies from 400% of the FPL to 600% of the FPL.

The proposal is also in three bills which have been reintroduced in the 117th Congress:

  • Medicare-X Choice Act (H.R. 1227, S. 386), sponsored by Rep. Antonio Delgado (D) and Sen. Michael Bennet (D);
  • Choose Medicare Act (S. 1180), sponsored by Sen. Jeff Merkley (D);
  • Improving Health Insurance Affordability Act of 2021 (S. 499) by Sen. Jeanne Shaheen (D).

Proposal: The federal subsidies in the Affordable Care Act that help the poor should be increased

Argument in Favor: People with incomes 200 percent of the federal poverty line, about $24,000 per year, still have to put more than 6 percent of their income toward insurance premiums, which amounts to more than $1,500 per year. This doesn’t even cover all health care expenses, and yet they still need to pay for food, shelter, and other necessities. Low-income people, because they have so much less disposable income to put toward insurance, are more likely to be uninsured.

Argument Against: The ACA already helps low-income Americans the most and already limits the amount these individuals have to spend on health insurance. Increasing the subsidies would require the federal government to spend even more money. People also have the option to choose less expensive plans that would lower their out-of-pocket costs. Reforms should focus on reducing the costs of plans, not subsidizing more coverage

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle”, 60% favored (6-10) the proposal, including 82% of Democrats. Among Republicans, just 33% were in support, but 60% did not oppose the proposal (5-10). 

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support increased slightly from the pre-deliberation poll to the post-deliberation poll, overall (55% to 60%), and among Democrats (78% to 82%). Among Republicans, the share in support increased from 24% to 33%, and the share not opposing the proposal (5-10) increased from 48% to 60%. 

Related Standard Poll
Given the options to increase, decrease or not change spending on healthcare subsidies for people who can not afford health insurance, a majority of Democrats have preferred increasing spending, and a plurality of Republicans have preferred decreasing it.

  • Asked whether they favor, “an increase, decrease, or no change in government spending to help people pay for health insurance when they can’t pay for it all themselves,” a majority of 57% chose to increase, including 82% of Democrats. Among Republicans, just 31% chose to increase, and 42% to decrease. (2016, ANES Pilot)
  • Asked the same question in a different survey, a plurality of 46% chose to increase (decrease 26%, no change 27%), including a majority of Democrats (65%). Among Republicans, just 24% increased, and 46% chose to decrease. (2016, ANES Timeseries)

Status of Legislation
The proposal to increase healthcare subsidies for lower income people is in Patient Protection and Affordable Care Enhancement Act (H.R. 1425) by Rep. Angie Craig, which would cap ACA Marketplace insurance premiums at 8.5% for all buyers. This bill passed the House with 232D and 2R voting in favor, and 1D, 177R and 1I voting against.

The proposal is also in three bills which have been reintroduced in the 117th Congress:

  • Medicare-X Choice Act (H.R. 1227, S. 386), sponsored by Rep. Antonio Delgado (D) and Sen. Michael Bennet (D);
  • Choose Medicare Act (S. 1180), sponsored by Sen. Jeff Merkley (D);
  • Improving Health Insurance Affordability Act of 2021 (S. 499) by Sen. Jeanne Shaheen (D).

PRESERVING ACA RULES ON HEALTH INSURANCE COST

To address this concern, the American Health Care Act of 2017 proposed increasing the amount that health insurance companies can charge older insurees relative to younger ones, from three times to five times. This bill passed the House, and then failed in the Senate. 

Respondents were first told the rationale for insurance companies charging older people more—which is a feature of both current law and proposed law:

As you may know, older people tend to use more health services than young people. Therefore,insurance companies charge older people higher insurance rates‐‐specifically people aged 50‐64 who are not yet on Medicare. Before current law went into effect, insurance companies generally charged about five times more for older people than for younger people.

Respondents learned that currently, insurance companies are not allowed to charge older people more than three times more than younger people, while the proposed law would raise this limit to five times more. They were told that CBO has estimated the most likely effects of this increase would be to:

  • Reduce the number of insured older people, as their premiums would be higher
  • Increase the number of insured younger people, as their premiums would be lower
  • Leave the average premium cost ten years from now around 10% lower than it would otherwise be.

The argument in favor of this provision was convincing to a modest majority of 53%.  There was a sharp partisan difference with 73% of Republicans finding it convincing, but only one third of Democrats.

The argument for preserving current law was found convincing, by 68%, including 57% of Republicans and four in five Democrats. Interestingly, the argument was found convincing by a smaller majority than the one that ultimately opposed the provision, suggesting the argument may not have fully captured some key reasons respondents opposed the provision. 

 Finally, a very large bipartisan majority opposed the proposal to allow insurance companies to charge older people as much as five times more than younger people. Four in five overall (81%) opposed it, including a robust 66% of Republicans as well as 94% of Democrats and 81% of independents.

Related Standard Polls
Large bipartisan majorities have opposed allowing insurance companies to charge older insurees more than is currently allowed under the Affordable Care Act rule, with the question not specifying the the current or proposed differentials:

  • Asked whether, in a “replacement health care law,” they favored including a provision “Allowing insurers to charge older customers higher premiums based on age than what is currently permitted,” 79% opposed, including 75% of Republicans and 85% of Democrats. (July 2017, NORC)

Status of Legislation
The proposal to increase the amount that health insurance companies can charge older insurees relative to younger ones, from three times to five times, was part of the American Health Care Act of 2017 (H.R. 1628), sponsored by Rep. Diane Black (R) in the 115th Congress. This bill passed the House, and then failed in the Senate. In the House, 217 Republicans voted in favor, and 20 Republicans and 193 Democrats voted against. In the Senate, 49 Republicans voted in favor, and 2 Republicans and 49 Democrats voted against.

The American Health Care Act of 2017 proposed removing the rule put in place by the Affordable Care Act which prohibited health insurance companies from considering pre-existing conditions when deciding whether to provide coverage to someone or what their premium should be. This bill passed the House, and then failed in the Senate. 

Respondents were first reminded that under current law, insurance companies cannot decline to cover someone with a pre‐existing health condition or to charge them a higher premium. They were told:

The proposed law gives states the option to get a waiver that would let insurance companies refuse to provide insurance benefits for specific pre‐existing conditions, or for conditions a person is more likely to get based on family history‐‐or to charge a higher premium for benefits covering those conditions.

They then learned about the CBO’s estimate of the outcome should this provision take effect:

  • Some people would not be able to get insurance coverage for certain specific conditions
  • Other people would be charged higher premiums, and some of these people—who would not be able to afford those higher premiums—would lose their insurance coverage.

They also learned that in compensation, the proposed law would dedicate funds to help states set up high‐risk pools for such people—but that CBO estimated the amount set aside would be insufficient and some people would wind up without coverage. However, premiums would be lower for the majority of people with lower health risks, and some of these would get insurance who would not have done so otherwise.

The argument supporting the proposal was found convincing by 46%, including just a quarter of Democrats and just under half of independents. However, seven in ten Republicans found it convincing. The argument for preserving current law was found convincing by 70%, including 53% of Republicans, 84% of Democrats and seven in ten independents.

In conclusion, a large bipartisan majority rejected the proposal to allow state waivers from the ACA, allowing health insurance companies to consider pre‐existing conditions.  This was opposed by 78% nationally, including 60% of Republicans and 93% of Democrats.

Interestingly, for Republicans, though the argument in favor did better than the argument against, 60% opposed the proposal‐‐as did 76% among independents and 93% among Democrats.

Related Standard Polls
Large bipartisan majorities have approved of the ACA’s provision prohibiting insurance companies from considering pre-existing conditions when determining premiums and coverage:

  • Asked whether they approve or disapprove of, “the current law which prevents health insurance companies from raising insurance rates for Americans with pre-existing conditions,” 67% approved, including 63% of Republicans and 67% of Democrats. (September 2017, Quinnipiac University)
  • Told they would be evaluating, “a list of policies that could be part of a replacement for Obamacare,” 87% favored, “Maintaining the protections offered to people with pre-existing conditions under Obamacare,” including 87% of Republicans, 90% of Democrats and 76% of independents. (March 2017, CNN/ORC)
  • Asked how they felt towards, “The law [which] prohibits insurance companies from denying coverage because of a person’s medical history,” 69% felt favorably, including 75% of Democrats and 63% of Republicans. (November 2016, Kaiser Family Foundation)

Without mentioning the existing law, large bipartisan majorities oppose allowing insurance companies to consider pre-existing conditions. 

  • Asked whether they favored or opposed, “a health care plan that allows health insurance companies to charge people with pre-existing health conditions more for their coverage than healthier people,” 77% opposed, including 92% of Democrats and 57% of Republicans. (May 2017, Kaiser Family Foundation)
  • Asked whether they favored “Prohibiting insurance companies from denying coverage because of a person’s medical history,” 66% favored it, including 67% of both Democrats and Republicans. (March 2017, NORC)

Asked about repealing the ACA rule prohibiting insurance companies from considering pre-existing conditions, there is majority opposition, but Republican opposition is just half. 

  • Asked whether they wanted, “to see the Supreme Court overturn the protections for people with pre-existing conditions established by the 2010 health care law,” 68% did not, including 81% of Democrats and 52% of Republicans (43% did) (April 2019, Kaiser Family Foundation)

When asked to choose between keeping the protections for people with pre-existing conditions as a federal rule, or letting states decide, majorities preferred keeping it as a federal rule, including among Republicans:

  • Asked to choose between two options, a large bipartisan majority selected “The federal government should continue to prohibit health insurance companies from charging people with pre-existing health conditions more for their coverage,” (70%,  Democrats 82%, Republicans 59%) as opposed to,“States should be able to decide whether insurers can charge people with pre-existing health conditions more if they don’t have continuous coverage,” which was chosen by 27% (Democrats 16%, Republicans 38%). (June 2017, Kaiser Family Foundation).  
  • Told that, “Under the current law, health insurers are not allowed to charge higher prices to--or refuse to cover--people who have pre-existing health conditions,” and asked to choose between two statements,
  • “This should be required in all states,” was chosen by 70% (Democrats 80%, Republicans 55%)
  • “Individual states [should] decide what if any rules about pre-existing conditions should be in place,” was chosen by 26% (Democrats 16%, Republicans 39%). (April 2017, ABC/Washington Post)
  • Asked whether, “as part of a replacement health care law,” they favored, “Allowing individual states to permit insurance companies to charge some people higher premiums because of their medical history,” 73% opposed, including 84% of Democrats and 58% of Republicans. (July 2017, NORC)

Status of Legislation
The proposal to give states waivers for allowing health insurance companies to consider pre-existing conditions when determining premiums and coverage was part of the American Health Care Act of 2017 (H.R. 1628), sponsored by Rep. Diane Black (R) in the 115th Congress. This bill passed the House, and then failed in the Senate. In the House, 217 Republicans voted in favor, and 20 Republicans and 193 Democrats voted against. In the Senate, 49 Republicans voted in favor, and 2 Republicans and 49 Democrats voted against.

REDUCING HEALTHCARE COSTS

In an in-person deliberation by Stanford University’s Center for Deliberative Democracy in September 2019, respondents were presented the following proposal and arguments for and against it:

Proposal: Allow Medicare to negotiate drug prices.

Argument in Favor: Medicare is one of the biggest payers for prescription drugs, but under federal law, it is not allowed to negotiate prices. That means that pharmaceutical companies are able to set the price and force the federal government — and ultimately the taxpayer – to pay it. Lower drug prices would save money for both consumers and the government.

Argument Against: The federal government might not be able to negotiate a better price for drugs than private payers do. If prices were set too low, it might reduce the incentive for pharmaceutical companies to invest in research and development, which could limit innovation and the invention of new drugs. Also, for the government to save a lot of money by negotiating prices, it would have to be willing to limit access to certain drugs that pharmaceutical companies demand too high of a price. This would reduce or eliminate the ability to access these drugs.

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle”, 92% favored (6-10) the proposal, including 92% of both Republicans and Democrats.

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support for the proposal increased from the pre-deliberation poll to the post-deliberation poll, overall (76% to 92%), and among Republicans (73% to 92%) and Democrats (82% to 92%). 

Related Standard Polls
Large bipartisan majorities have favored allowing Medicare to negotiate drug prices:

  • After hearing arguments for and against the police, respondents were asked whether they favor, "allowing the US government to negotiate with drug companies to get a lower price on prescription drugs for people with Medicare and private insurance." Eighty-two percent were in favor (Democrats 95%, independents 82%, Republicans 71%). (October 2021, Kaiser Family Foundation)
  • Asked whether they support “allowing the U.S. to negotiate prescription drug prices through Medicare,” 66% were in support (Democrats 78%, independents 61%, Republicans 56%). (June 2021, Morning Consult/Politico)
  • Asked whether they would support a policy, “allowing the federal government to negotiate with drug companies to get a lower price on medications that would apply to both Medicare and private insurance,” 89% were in support (Democrats 97%, independents 87%, Republicans 84%). (December 2020, Kaiser Family Foundation)
  • Asked the same question in 2016, 82% were in favor (Republicans 71%, Democrats 92%) (September 2016, Kaiser Family Foundation)

Status of Legislation
The proposal to allow Medicare to negotiate drug prices is in the larger drug price reform bill, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), sponsored by Rep. Frank Pallone (D) in the 116th Congress. This bill passed the House, with 228 Democrats and 2 Republicans voting in favor, and 191 Republicans and 1 independent voting against. The bill has yet to be taken up by the Senate.

This proposal is also in numerous pieces of legislation which have been reintroduced in the 117th Congress:

  • Medicare Drug Price Negotiation Act (H.R. 2139, S. 908), sponsored by Rep. Lloyd Doggett (D) and Sen. Bernie Sanders (D);
  • Medicare Prescription Drug Price Negotiation Act of 2021 (H.R. 2071), by Rep. Peter Welch (D);
  • Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), by Rep. Frank Pallone (D);
  • Medicare-X Choice Act (H.R. 1227, S. 386), by Rep. Antonio Delgado (D) and Sen. Michael Bennet (D);
  • Choose Medicare Act (S. 1180), by Sen. Jeff Merkley (D); and
  • CHOICE Act (S. 983), by Sen. Sheldon Whitehouse (D).

None of these bills have made it out of committee.

In an in-person deliberation by Stanford University’s Center for Deliberative Democracy in September 2019, respondents were presented with the following proposal and arguments for and against it:

Proposal: The US government should change the patent system so generic drugs are more quickly introduced into the marketplace.

Argument in Favor: Promoting more competition in the pharmaceutical industry could result in lower prices. Current patent protection goes too far in allowing pharmaceutical companies to extend the life of their patents and prevent competitors from entering the market. The federal government should incentivize the production of generic drugs to the fullest extent. 

Argument Against: The current level of patent protections is necessary to incentivize the research and development of new drugs. Drug development is a risky business with many failures, and pharmaceutical companies rely on patent protections in order to recoup their investment. When generics compete with brand name drugs, the company that owns that drug makes a much smaller profit. Shortening the life of patents could reduce investment in research to develop new drugs.

After receiving the briefing material, respondents deliberated on the proposal in-person. Finally, they were asked for their final recommendation. On a 0-10 scale, with 5 being “in the middle”, 88% favored (6-10) the proposal, including 81% of Republicans and 92% of Democrats.

Pre-Deliberation Poll
Before receiving any briefing materials or engaging in the deliberation process respondents were given the same poll question as those asked afterwards. Support for the proposal increased from the pre-deliberation poll to the post-deliberation, overall (78% to 88%), and among Republicans (69% to 81%) and Democrats (84% to 92%).

Status of Legislation
There are several pieces of legislation that would allow generic drugs to come to market faster, which have been introduced or reintroduced in the 117th Congress: 

  • Lower Cost, More Cures Act (H.R. 19), sponsored by Rep. Greg Walden (R); 
  • Prescription Drug Price Relief Act (H.R. 2148, S. 909) by Rep. Ro Khanna (D) and Sen. Bernie Sanders (I);
  • Short on Competition Act (S. 917) by Sen. Amy Klobuchar (D);
  • H.R. 2853 by Rep. Kurt Schrader (D);
  • H.R. 2891 by Rep. Jerry Nadler (D);
  • Protecting Consumer Access to Generic Drugs Act of 2021 (H.R. 153) by Rep. Bobby Rush (D)
  • Stop STALLING Act (S. 1425) by Sen. Amy Klobuchar (D). 

None of these bills have made it out of committee.