2 Important Healthcare Issues You Need to Know About After Democratic Debate

Democratic presidential candidates Bernie Sanders and Hillary Clinton during Tuesday evening’s debate. (Photo: AP File)

The first debate among the Democrats vying for their party’s nomination for president was held Tuesday night (Oct. 13) in Las Vegas. Just as much of the evening focused on just two of the five candidates — former Secretary of State, New York senator, and First Lady Hillary Clinton and Vermont senator Bernie Sanders — when it came to health policy, the conversation was focused around two primary health issues: Expanding the Affordable Care Act to undocumented immigrants and their children and adopting a federally mandated paid family leave.

Here’s what you need to know about both key issues:

Paid Family Leave

Clinton brought paid leave to the forefront of the conversation immediately, making the issue a key point during the two-minutes she was given to introduce herself.

“And I want to do more to help us balance family and work,” Clinton said, “I believe in equal pay for equal work for women, but I also believe it’s about time we had paid family leave for American families and join the rest of the world.”

Sanders also made mention of paid leave. Both times he discussed the issue he explicitly tied it to the need for leave for new mothers.

In explaining his adherence to what he refers to as “democratic socialism,” Sanders mentioned “You see every other major country saying to moms that, when you have a baby, we’re not gonna separate you from your newborn baby, because we are going to have — we are gonna have medical and family paid leave, like every other country on Earth.”

Later in the debate when the question of paid leave was again raised among the candidates, Sanders said, “Every other major country on Earth, every one, including some small countries, say that when a mother has a baby, she should stay home with that baby. … That is an international embarrassment that we do not provide family — paid family and medical leave.”

Sanders’ latter remark was triggered by a question posed to Clinton by CNN debate moderator Dana Bash, who mentioned that “Carly Fiorina, the first female CEO of a Fortune 50 company, argues, if the government requires paid leave, it will force small businesses to, quote, ‘hire fewer people and create fewer jobs.’ What do you say not only to Carly Fiorina, but also a small-business owner out there who says, you know, I like this idea, but I just can’t afford it?”

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Clinton went on to mention California’s paid leave program and “the incredible challenges that so many parents face, particularly working moms,” ultimately culminating in perhaps her most electric moment of the night, in which she told Bash, “It’s always the Republicans or their sympathizers who say, “You can’t have paid leave, you can’t provide health care.” They don’t mind having big government to interfere with a woman’s right to choose and to try to take down Planned Parenthood. They’re fine with big government when it comes to that. I’m sick of it. … I know we can afford it, because we’re going to make the wealthy pay for it. That is the way to get it done.”

“How the question always gets framed is, How can we possibly afford to do this? Everyone will lose their jobs! No one will want to hire women! It’s always very fatalistic,” Sarah Jane Glynn, the Director of Women’s Economic Policy at the Center for American Progress, tells Yahoo Health.

And yet, she notes, “the United States is the only advanced economy that doesn’t have a paid family leave program. We are an outlier among very wealthy countries. So, a lot of other folks have figured out how to do this and it hasn’t destroyed their economies. To say it would be a death knell to businesses — well, just look north to Canada. This hasn’t been the case. It’s ridiculous on its face [to claim that] given how widespread these policies are across the globe.”

California’s paid family program — which provides workers with partial wage replacement and benefits when they take time off work to care for a child, spouse, parent or close family member and has been in place in the state for over a decade — is a perfect domestic case study on the efficacy of such measures, says Glynn. “Prior to implementation of the program in California, the business community was very nervous. They were especially concerned that workers would constantly be out on leave and that businesses would be forced out of state because of the toll that a paid leave mandate would have on their bottom lines.”

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But, she explains, after the program was implemented, business owners in the state were polled and asked what kind of impact it had on their operations. “And by in large, they all said, Yeah — it’s not a big deal. Some people reported positive effects like increased morale and increased productivity — but most just said, Yeah it’s no big deal. It’s a lot of fear about nothing. But the impact it has on workers and economies is tremendous.”

This kind of benefit is most beneficial to lower income workers, those who are least likely to have any kind of paid leave at all. As Glynn puts it, “If you live in California and you work at Google, you’re fine,” when it comes to paid leave, “but if you work at Target, maybe not.” Thus, paid family leave policies help ensure that individuals — and new parents in particular — are not forced out of the workforce for longer than they would want as a result of not being able to keep a job with a newborn.

The data from California’s paid leave program, says Glynn, has shown that “now people are more likely to go back to the same work, to the same job, to the same salary. … An increase of paid leave availability translates to lower rates of new parents accessing public benefits such as welfare and food stamps because they have this benefit of paid leave. It yields significant economic savings. Yes there are costs to having a new program, but there are immediate savings through other cuts to other benefits.”

This is far from the first time that paid leave — a term that can encompass both paid sick leave and paid family leave — has been thrust into the national spotlight. In January, President Obama called attention to the issue during his State of the Union address, noting that the U.S. is “the only advanced country on Earth that doesn’t guarantee paid sick leave or paid maternity leave to our workers.” The President urged Congress to send him a bill that would give every U.S. worker the opportunity to earn seven days of paid sick leave.

Sen. Patty Murray (D-WA), the ranking member of the Senate’s Health, Education, Labor and Pensions (HELP) committee, introduced the Healthy Families Act this spring, outlining a plan for American workers to earn seven paid days of sick leave a year. If passed, the bill would be the first major expansion of leave policies since the passage of the Family and Medical Leave ACT (FMLA) in 1993 under President Bill Clinton, a measure that allowed workers up to 12 weeks of unpaid leave without losing their jobs.

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Another proposed federal paid family plan is the The FAMILY Act, introduced by Sen. Kirsten Gillibrand (D-NY), which would create an independent trust fund within the Social Security Administration that would be funded by employee and employer contributions of 0.2 percent of wages each, creating a self-sufficient program that would not add to the federal budget. This proposal would make leave available to every individual regardless of the size of their current employers — and regardless of that person’s current employment status.

The FAMILY Act, which Sanders co-sponsored in the Senate, covers not just new baby leave for moms, but family leave for dads, as well as time off for care for children or aging parents and covering an individual’s own medical leave.

Which is why, Glynn says, it’s important when we talk about paid leave to remember that paid family leave is far from being a policy issue that only pertains to women.

“When men have a baby, they have a tendency to take two weeks or less of work. You can tell a story that these are such bad dads — or you can tell a story of if a mom is forced to take unpaid leave, then dads are forced back to work earlier than they would want to because they can’t afford to have their family income drop to zero. Women are more likely to have parental leave then men. Men are getting the short end of the stick,” Glynn says.

She adds, “If you poll men, they say they want to be involved parents. It’s important to them and their sense of identity. … Men are reporting more work/life conflicts than women. They feel less able to speak up around it. When men have access to paid leave, they can afford to stay home. Dads under those circumstances become much more involved in the day to day routine of children.”

An effect, Glynn points out, that has a much larger systemic effect. “We talk about how we need to have involved dads. But that needs to be coupled with policies to help fathers be more involved.”

And if you look at the broader array of family care – caring for aging parents, too – men have a lot of need. “As our population ages, we are seeing more and more people, men and women, who are employed, have children of their own, and are providing elder care for relatives,” says Glynn. “It’s only going to become a bigger and bigger issue.”

ACA and CHIP Expansion to Undocumented Children

Another topic raised last night particularly relevant to the healthcare needs of American families was Clinton’s repeated mentions of the Children’s Health Insurance Program (CHIP).

“No one ever talks about kids [during a debate]. Ever. And they’re a quarter of the population, but no one ever talks about them,” Bruce Lesley, the Executive Director of First Focus, a bi-partisan group focused on prioritizing children in families in federal policy, tells Yahoo Health. “And [Clinton] brought up CHIP twice. It’s great that people are finally thinking about a quarter of the population.”

Clinton mentioned how she wants “to make sure every child gets healthcare. That’s why I helped to create the Children’s Health Insurance Program, and I want to support states that are expanding health care and including undocumented children and others. I want to open up the opportunity for immigrants to be able to buy into the exchanges under the Affordable Care Act.”

CHIP was created during the Clinton administration in 1997, sponsored by Senators Edward Kennedy (D-MA) and Orrin Hatch (R-UT) with the guidance of then First Lady Clinton. The program provides matching federal funds to states to unsure children in low-income families with incomes that are too high to qualify for Medicaid. Every state has their own state-run CHIP program, many of which take on different names within their own state. Some states run wholly independent CHIP programs, some utilize their CHIP funds to offer Medicaid expansion, and some offer some combination of both approaches. In 2009, the bill was renewed and expanded to include coverage of legal immigrants with no waiting period — a measure initially proposed by then Senator Clinton.

Lesley tells Yahoo Health that about 6 percent of the uninsured are children, and about 1-2 percent of those children are undocumented. “We support universal coverage for kids,” he explains, documented and undocumented, so any movement to ensure more coverage for more children is greatly welcomed.

In 2007, Clinton introduced with Sen. Olympia Snowe (R-ME) the Legal Immigrant Children Health Improvement Act, which would allow states to eliminate the previous five-year waiting period for new legal immigrants before the federal government would reimburse their states for providing Medicaid and CHIP services to them. At the time, Clinton said, “We should do everything we can to expand access to affordable healthcare and ensure that legal immigrant children and pregnant women are getting the proper healthcare they need.” Since its passage, about half of all states have opted-in to eliminating this waiting period and providing immediate coverage for new citizens through Medicaid and CHIP.

“There is so much cynicism about the role of government and whether government works,” says Lesley, “But here is this huge success story. When Congress passed CHIP in 1997, they more than cut in half the uninsured rate for kids. During the recession, the number of children in poverty dramatically increased, but yet uninsured rates for kids dropped.” [CHIP] is a government program that is incredibly successful. It’s a private-public partnership, so Republicans like it too. Governors unanimously wanted to renew it. It’s something that is bipartisan, it works, and it’s been successful — and it’s a good story that the public doesn’t really know a lot about.”

Looking ahead, Lesley notes that he would like to see CHIP not only extended, and expanded, but also made permanent.

Whether that happens, however, remains to be seen as the race to see who will be the next president continues. Of note, though, is that while Clinton, Sanders and the three other Democratic contenders all spoke emphatically for paid family leave and ACA expansion last night, Sen. Marco Rubio (R-FL), who is quickly rising in Republican polls, told Fox & Friends on Wednesday morning that last night’s Democratic debate was, “basically a liberal verses liberal debate about who was going to give away the most free stuff: Free college education, free college education for people illegally in this country, free health care, free everything.“

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