Until recently, aside from talking about Medicare for All, most Democratic presidential hopefuls haven’t said much about issues of keen interest to older voters. That all changed last week, though, when they answered pointed questions at the AARP Presidential Candidate Forums in Iowa.
As Sen. Amy Klobuchar said: “I’m so glad you’re doing this. Hardly anyone except real people has asked me about senior issues.”
I watched the live-streamed events, where AARP audience members and moderators from The Des Moines Register and Radio Iowa asked about Social Security; the cost of prescription drugs, health care, Medicare and long-term care; caregiving; age discrimination, housing and more.
Sanders, Gillibrand and O’Rourke also said they want to adjust the annual Social Security cost-of-living formula to better reflect the way beneficiaries spend.
Some of the answers were illuminating, some were frustratingly vague (Jùlian Castro said he’d release his Social Security plan soon) and some — particularly from Senators Kirsten Gillibrand, Kamala Harris and Bernie Sanders — were a bit startling.
The Democrats tended to share similar views and policy ideas about prescription drug costs. As South Bend Mayor Pete Buttigieg said on that topic: “There’s not much daylight between us.” And on age discrimination, the candidates agreed that the federal age discrimination law needs stronger enforcement, though none offered specifics.
But the candidates’ proposals on other key issues for older voters varied quite a bit. At times, the candidates got personal and even teary, talking about the health and financial struggles of their parents, grandparents and in-laws.
Here are highlights from the AARP Iowa Forums, grouped by topic:
Social Security and Retirement Security
Several candidates (former Vice President Joe Biden, Sen. Elizabeth Warren, Gillibrand and Sanders) wanted to increase Social Security benefits, particularly for the most vulnerable older Americans. Said Warren: “The reason for me is not just economic, it’s moral. After a lifetime of hard work, people are entitled to retire in dignity with a benefit that covers their basic expenses.”
Sanders, Gillibrand and Beto O’Rourke also said they want to adjust the annual Social Security cost-of-living formula to one that better reflects how beneficiaries spend.
To boost the solvency of the Social Security Trust Fund (currently expected to be shaky as of 2035), the candidates called for raising or eliminating the Social security payroll-tax cap, but not cutting benefits or raising the retirement age.
Under current law, employment earnings of up to $132,900 are subject to Social Security payroll taxes. Sanders, Warren and Gillibrand would “scrap the cap” and eliminate a ceiling on earnings subject to payroll taxes. Sanders maintained doing so would “extend the life of Social Security for fifty-two years.”
Klobuchar, Harris, Biden and Buttigieg would take a “donut hole” approach; Klobuchar, Harris and Buttigieg wouldn’t tax earnings between $133,000 and $250,000, but would levy the payroll tax on earnings over $250,000. Biden’s donut hole would close at $400,000.
Sen. Cory Booker said only that he would “lift the cap for a small number of people” and Castro said “at the very least, we need to significantly increase” the cap. O’Rourke said we should “lift that arbitrary cap so the wealthiest pay their fair share.”
Buttigieg and Booker also talked more broadly about improving retirement security in America.
Said Booker: “Many people may think they are saving for retirement but may not have the resources they need. This is a whistle we should be blowing. We are an aging society and we need to have a plan to deal with retirement security.”
Booker and Buttigieg said they’d soon have more plans to bolster retirement security. Booker said he’d have one on “portable benefits, more secure pension funds and more public vesting of retirement benefits to augment Social Security.
Buttigieg said: “I think we should take a bigger look at how we organize benefits, from retirement savings to beyond Social Security, employer-based retirement savings, to vacation, family leave, sick leave. All of these things — because we are still designed around the idea that you could have one employer for your whole career. And for my generation or folks younger than me, we’re likely to change professions more often than our parents changed job titles.” Then, he joked, “As the youngest candidate in the race, I am actually excited to be the one talking about retirement.”
Health Care and Medicare
Sanders and Warren described their Medicare for All idea and Sanders pooh-poohed critics who complained that moving to his system would take four years. He said: “In 1965, LBJ and Congress had the radical ideal to provide public health insurance for people 65 or older, called Medicare…They got it going within one year. How does anyone think over a four-year period we cannot take the existing program of Medicare and provide health care to every man, woman and child in this country?”
Harris, Gillibrand, Buttigieg and Castro talked about a moderate version of Medicare For All, with a public option. Said Buttigieg: “Even in countries that have something like Medicare for All there is a private sector with private clinics.”
Biden and Klobuchar discussed improving the Affordable Care Act, ensuring that pre-existing conditions are covered and that children can continue to stay on their parents’ health plans until age 26.
Booker and Harris would continue to allow private Medicare Advantage plans with benefits that aren’t part of traditional Medicare. Booker said he’d also lower the Medicare enrollment age to 55.
Sanders, Gillibrand and Harris called for including vision, dental and hearing aid coverage in traditional Medicare.
Agreement was widespread for the following: let Medicare negotiate prescription drug prices with pharmaceutical companies; allow for the importation of prescription drugs from countries like Canada and find other ways to lower prescription drug costs, such as tying prices to international indices.
Many candidates also wanted to end what’s known as “pay to delay.” That’s the secret process where drug companies sometimes pay generic competitors to delay marketing their drugs. (Klobuchar said she thought Congress might pass a law this year ending “pay to delay.”)
Sanders — who called himself the pharmaceutical industry’s “worst nightmare” — proposed capping prescription drug co-pays to just $200 a year.
But Gillibrand and Warren had a more revolutionary idea: Let the government manufacture prescription drugs.
“If a drug company won’t produce a generic within a reasonable amount of time, I will ask the National Institutes of Health to create that drug to provide competition,” said Gillibrand.
Added Warren: “If we have a market that’s not working, like insulin drugs, the government should come into contact with a company to make insulin and make it available to the American people at ‘cost-plus’ [reimbursement for expenses plus a specific amount of profit]. Do that a few times and the cost comes way down.”
Another Harris proposal might lead to fewer prescription drug ads. Harris called for “ending the tax breaks pharmaceutical companies receive for advertising prescription medicine.” She also would levy a 100% tax to drug companies charging more than the “fair market price.”
Long-Term Care and Caregiving
Klobuchar called long-term care “one of the elephants in the room.” As the recent Next Avenue article on the Democratic candidates and long-term care noted, many of the Democratic presidential candidates have ideas to help Americans pay for long-term care costs. Under current law, Medicare typically doesn’t cover them; Medicaid does, but, as Buttigieg noted, only for people with very meager incomes and minimal assets.
“I was sitting with a social worker when my dad became very ill,” Buttigieg said. The social worker told his father that “the best way to make this [the long-term care costs] affordable is to spend your entire life savings, so that you are now low-income enough that you qualify for Medicaid and then that will pick it up.” That, Buttigieg said, is no way to run aging in the most advanced country in the world.”
Booker proposed increasing Medicaid’s asset limits for long-term care services to $50,000 for a family of two.
He and several others would also increase or create new tax credits to help cover long-term care expenses.
Booker would expand the Earned Income Tax Credit to $4,000 to help cover family caregivers’ expenses. Warren wants a $3,000 home caregiver’s credit; Biden prefers $5,000 and Klobuchar calls for a $6,000 credit. Klobuchar also wants a tax credit to help offset long-term care and one that’s equal to 20% of long-term care insurance premiums.
One of the loudest applause lines at the AARP Forums came when O’Rourke called for helping family caregivers by boosting their Social Security benefits.
“So if you are a caregiver for a grandparent or a relative, you’re not penalized and Social Security would count your [calendar] quarters [doing this unpaid work],” said O’Rourke. “This would resolve an imbalance that disproportionately hurts women, and I think it’s the right way to go.” The credit would equal 50% of the average earnings of a full-time, year-round worker.
Many of the candidates also endorsed higher pay and better training for home-care aides and nursing home staff.
Buttigieg widened the scope of the long-term care talk to allow Americans to “age in dignity and with comfort as long as possible in their homes.” He said, “It’s things like making sure that we invest in the right kind of public transportation [to help older people get to their doctors], that we unlock the power of telemedicine to help reach people wherever they are.” He has also proposed an intergenerational national service program where younger people would provide caregiving for older ones.
The high cost of housing for older Americans was barely mentioned at the Iowa forums.
But Castro, the former U.S. Secretary of Housing and Urban Development, said he’d create a renter’s tax credit and expand the federal housing choice voucher program for the “rental affordability crisis in this country.”
And Warren noted that she has a housing plan to build 3.2 million housing units in urban America, small towns and rural America and that “a chunk of that money is set aside for senior housing.” That way, she said, people in those places “can live as long as they want to live independently and age in place.”
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