Why Miami Is A Healthcare Trap For 2020 Democratic Candidates

When it comes to healthcare, Amy Klobuchar is something of an outlier among Democrats in the U.S. Senate, where she's the only 2020 presidential candidate who hasn't signed onto Bernie Sanders' new Medicare-for-all bill.

But the Minnesota Democrat seemed right at home in the South Florida heat Tuesday talking about how to improve Obamacare as opposed to how best to overhaul it.

"The Affordable Care Act to me was always a beginning and not an end," Klobuchar told reporters following a healthcare roundtable at at the University of Miami's Life Sciences and Technology Park in Allapattah.

Klobuchar's position -- arguably conservative in a party where more than 100 members of Congress have co-sponsored legislation to implement single-payer healthcare -- has a large audience in Miami-Dade County, far and away the home to the largest number of Obamacare enrollees by county in the country. Add in Affordable Care Act participants in Broward County, and some 664,000 South Floridians are signed up for coverage through the federal government's Health Insurance Marketplace or healthcare.gov.

All of those consumers stand to be dramatically affected should Congress move to repeal the Affordable Care Act as President Donald Trump recently reminded everyone that he'd like to do. But, for better or worse, they all stand to be equally affected should Congress overhaul the nation's healthcare system by replacing private and employer-based health insurance with free Medicare or even tweak the Affordable Care Act to include a universal public option, as Klobuchar would prefer.

And how those proposals are received in the Obamacare capital of the U.S. -- also the Democratic bastion of the nation's largest swing state -- could go a long way toward deciding the Democratic nominee to face Trump, if not the 2020 election itself.

"There are a lot of good ideas out there but they all to me move in the same direction and that is to get to universal healthcare and to make sure we do it in a way that doesn't make things worse for people," Klobuchar told reporters Tuesday in Miami, one of the poorest metro areas in the country. "What's the doctor's mantra? Do no harm? We want to do no harm here. We want to make things better."

Since the Affordable Care Act became law, more than 1.5 million Floridians have gained coverage -- dropping the state's uninsured rate among non-elderly adults from 25.5 percent in 2010 to 16 percent in 2017, according to federal estimates.

But 2.6 million Floridians remain among the nearly 30 million Americans who still lack health insurance coverage, in part because Florida is one of 14 states that has refused to expand eligibility for Medicaid to include all low-income adults.

Meanwhile, while nearly a decade has passed since the Affordable Care Act was adopted, the nation's healthcare system is still struggling to adapt to many of its reforms while consumers contend with higher premiums and out-of-pocket costs. Some Democrats believe Republicans have "sabotaged" Obamacare, as Klobuchar contended Tuesday, but others would move on to a drastically different system.

The Democratic party has been grappling internally for years with how to address healthcare, leaving the issue unresolved as it heads into the meat of the 2020 cycle. Sanders, whose previous proposals were once deemed too radical to gain traction, is now gaining support for a revamped plan to replace employer-sponsored and individual private coverage with a system that would eradicate premiums and largely eliminate co-pays but require increased taxes.

"Do you think it makes sense to spend twice as much per capita as the people of any other nation and be the only country in the world not to guarantee healthcare for all people?" Sanders asked rhetorically Monday night during a town hall televised on FOX News.

But there are plenty of Democrats who believe that the party is better off improving Obamacare rather than once again fundamentally changing the country's healthcare system. Groups like Protect Our Care, a pro-Obamacare non-profit funded by a dark money progressive organization, have campaigned on the premise.

"Why not run as Democrats on the signature achievement of the most progressive president we've had?" asked Michael Hernandez, a South Florida political consultant who worked last year with Protect Our Care. "I wouldn't run away from the Affordable Care Act and into the arms of single-payer" healthcare.

How the tug-of-war will be received in South Florida -- a conundrum of a community that is simultaneously reliant on the government's healthcare exchange and wary of government overreach -- remains less certain than the likelihood that the region's 1.2 million Democratic voters will influence the Democratic primary.

Just this fall, reception to Medicare-for-all seemed mixed.

For instance, Donna Shalala, a former Clinton healthcare czar, won a heated and crowded Democratic primary while criticizing Medicare-for-all legislation, although a feisty and more progressive opponent who supported the bill came close to pulling off an upset. And Democrat Andrew Gillum narrowly lost a governor's race he was favored to win after staking out a liberal platform that included Medicare-for-all and underperforming in Miami-Dade County.

"A majority of Democrats would like the focus to be on improving and protecting the Affordable Care Act versus trying to get Medicare-for-all approved," John Anzalone, Gillum's pollster, said in a recent interview. "Voters want to focus on what can happen to help people now."

But Anzalone, like other pollsters who spoke to The Herald, isn't convinced that Medicare-for-all is a true progressive litmus test issue for voters, even if it's polling well in early primary states. And the healthcare debate is far more comprehensive than just health insurance.

Klobuchar, for instance, favors expanding government-subsidized healthcare to provide a universal public option, and she wants to tweak public health insurance programs to expand coverage. But she says that could be done by lowering the age to qualify for Medicare or by expanding Medicaid in states like Florida.

Klobuchar also talked Tuesday about importing prescription drugs from Canada and changing laws to allow immigrant medical students to remain in the country after earning their degrees. But nowhere in the broad discussion did she either condemn or marry the idea of Medicare-for-all.

"I just want to get to universal healthcare as quickly as possible," she told reporters. "I want to cover more people."

Miami Herald staff writer Daniel Chang contributed to this report.

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