Health Reform in the 2020 Election: What’s on Tap?


In the new issue of Health Affairs, national experts weigh in about the likely contours of Republican and Democratic health care proposals ahead of the 2020 presidential election. Will it be all about single payer and repeal-and-replace? Or is there room for something in between?

Getting Ready for Health Reform 2020: Republicans’ Options for Improving Upon the State Innovation Approach. The Hoover Institution’s Lanhee J. Chen believes that legislation introduced by Senate Republicans at the end of their Affordable Care Act (ACA) repeal-and-replace effort in 2017 might provide the basis for future conservative health reform approaches. The legislation, proposed by four senators, would have promoted state innovation in health care by converting current federal health spending programs into block grants to states. Chen suggests possible ways to address a variety of Republican concerns over the plan.

How Democratic Candidates for the Presidency in 2020 Could Choose Among Public Health Insurance Plans. New York University’s Sherry A. Glied and the Century Foundation’s Jeanne M. Lambrew assess the potential impact and trade-offs of health reform approaches being considered by Democrats. These range from a public plan, or elements of a public plan, including a single-payer system; a public–private choice model; and Medicare-based payment rates for private insurers. The authors say that while Democratic candidates are likely to defend the ACA and propose ways to strengthen it, most will want to go further, with new policies to help cover the remaining uninsured, rein in rising spending, and make health care more affordable.

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