The 2020 Democratic presidential primary debates offer an opportunity for candidates to focus on the health care issues that matter most to Americans – access to high-quality care and lowering their health care costs. While more Americans have health care coverage today than before the Affordable Care Act, much more can be done to improve coverage for those who have slipped through the cracks. Further, efforts to improve coverage must take into account their impact on access. Coverage without access would be meaningless.

Before the Democratic debates kick off tonight and tomorrow, there are a few things FAH hopes to hear from the presidential hopefuls.

Rural Health

In a time when nearly a quarter of rural hospitals are at risk of closure, voters across the country are looking to the 2020 candidates to address health care’s most pressing issues.

A recent survey from the Bipartisan Policy Center found that the majority of Americans, including both Republicans and Democrats, consider access to care in rural communities an important issue heading into the 2020 election. Additionally, the survey found that three in five voters would vote for a candidate who prioritized rural health care in their campaign platform.

Rural hospitals are increasingly vulnerable. These facilities traditionally serve older, low-income populations that rely more heavily on Medicare than their urban counterparts. This creates a dichotomy of a Medicare-dependent population but a lower volume of patients overall.

With nearly one in four Americans residing in rural America, it’s essential for Democratic 2020 candidates to address their plans to protect and increase access to quality, affordable health care in rural communities.

Expanding and Supporting the ACA

The Affordable Care Act allowed millions of Americans to gain access to affordable health care insurance through federal and state health care Marketplaces, as well as through the expansion of existing Medicaid programs. Now is not the time to abandon the current law for government-run, one-size-fits-all health care proposals.

Instead, FAH hopes that candidates will embrace and preserve the ACA and present plans to strengthen the current law. We support building on the strength of the employer-provided health care system that currently serves 180 million Americans. Now is the time to improve the ACA and make it truly universal so that all Americans can have quality coverage and access to care.

Medicare for All

Medicare for All proposals will undoubtedly be discussed at the debates in Miami tonight and tomorrow night. But, will the presidential hopefuls set the record straight on how much the proposal will cost and how much it will dramatically change America’s health care system?

A Kaiser Family Foundation poll of the American awareness of elements in Medicare for All found that 40% of respondents believe private insurers would continue to cover most Americans and 55% say people who are covered through their jobs would be able to keep that coverage. Both are wrong.

It’s clear that the voters are unaware of the devastating impact Medicare for All would have on the health care system. Presidential contenders should be honest with American families tuning in. The truth is under Medicare for All – everyone would be forced into a government-run health care plan that dramatically raises taxes and leads to longer wait times for lower quality care.

It is important that we focus on giving patients and consumers the power to choose the care and coverage that works best for them and their families while keeping the promise of Medicare for our nation’s seniors.

Medicare Public Options and Buy-Ins

Public option proposals or buy-in plans have become very popular among candidates running for president. The problem is they don’t talk about the effects it could have on your access to care.

A recent report by FAH and the American Hospital Association (AHA) looked at the impact a Medicare public option proposal – Medicare X – would have on the ability of hospitals and health systems to continue to provide access to high-quality care to their patients and communities. The study showed that a one-size-fits-all proposal could create the largest ever cut to hospitals – nearly $800 billion – and be particularly disruptive to the employer-sponsored health insurance market.

Instead of supporting these disruptive proposals that would dramatically change the health care system, 2020 contenders should embrace the ACA and build upon what is currently working.