Democratic Candidates for 2020: Biden Advances Plan to Assist Military Families, Caregivers, Survivors

Vice President Joe Biden with Dr. Jill Biden are proposing an expansive plan to assist military families, caregivers and survivors © Karen Rubin/news-photos-features.com

As Second Lady in the Obama Administration, Dr. Jill Biden worked closely with First Lady Michelle Obama on behalf of bettering lives for military families. VP Joe Biden, candidate for President, is proposing a plan to reinvigorate and expand that program for military families, caregivers and survivors. This is from the Biden campaign:

FACT SHEET:
The Biden Plan to Fulfill Our Commitment to Military Families, Caregivers and Survivors

As parents of a service member who deployed to Iraq, Vice President Joe Biden and Dr. Jill Biden understand that it’s not just military members who sign up to serve our nation, their families do too. The Bidens understand the sleepless nights, wondering if your deployed loved one is safe; the difficulties children experience while their parent is serving far away; and all the added sacrifices and challenges, big and small, military families face because they choose selfless service. Our military families never fail to give their best to the United States, and we owe them our best in return.
 
Less than one percent of Americans sign up to serve. They volunteer to shoulder the sacrifices necessary to keep our country safe. That’s why Vice President Biden has long been adamant that, as a nation, our one truly sacred obligation is to properly prepare and equip our troops when we send them to war, and to take care of them and their families — during deployments and when they return home.  
 


Building on the Biden Commitment to Military Families  
The Obama-Biden Administration made support for our military families a signature issue–and a personal priority. Together with First Lady Michelle Obama, Dr. Biden created Joining Forces, a national initiative driving top-level focus on the issues that matter to military families, service members, and veterans including employment, education, and wellness. Joining Forces supported opportunities that led to the hiring or training of more than 1.5 million veterans and military spouses and drove reforms in all 50 states to reduce credentialing barriers for qualified military spouses seeking employment. Dr. Biden also supported the Department of Defense’s (DoD’s) Military Spouse Employment Partnership, which brought together hundreds of companies to help 100,000 military spouses find jobs.
 
As a life-long educator, Dr. Biden spearheaded “Educate the Educators”–a commitment from more than 100 colleges and universities to take steps to meet the unique needs of military-connected children–and championed the GI Comparison tool to help veterans and military family members choose high-quality post-secondary educational institutions. She also worked to make sure that all 50 states signed the Interstate Compact on Educational Opportunity for Military Children to better address relocation challenges facing military school-aged children. 
Vice President Biden and Dr. Biden continued this commitment after leaving office, making support for military families a key focus of their continued public service. The Biden Foundation sought to drive economic opportunity for military spouses, create supportive educational environments for military-connected children, and change the conversation around mental health for service members, veterans, and their families.

As President and First Lady, the Bidens will ensure we keep our national commitment to military families by relaunching and strengthening Joining Forces, making it a priority for a Biden Administration.
 

 
We know that many future service members come from military families. So family readiness is integral to mission readiness, both now and in the future. This cannot be an afterthought. It is a national security imperative, and it should be resourced and supported as such.
 
Through nearly two decades of sustained warfare, military families have met many challenges and sacrificed much for our country. They have answered the call to duty again and again. To sustain the world’s finest fighting force, Biden will ensure that families on the homefront receive our full support and the benefits they have earned and deserve through:

Paying Service Members a Competitive Wage

Providing Resources for Military Spouses, Caregivers, and Survivors

Prioritizing Support for Military Children  

President Biden will inspire a future generation of Americans to volunteer for military service by ensuring we fulfill our obligations to the generations who have already answered the call to serve our country and by supporting the well-being of ALL military families.
 
Modernize Compensation to Keep Pace with the Current Economy: Today, more military families are struggling to make ends meet, and some report food insecurity, lack of quality childcare, and poor financial health. That is totally unacceptable. Military service members and their families risk everything for our country–they must be guaranteed a living wage. But the existing compensation framework simply does not allow military families–especially those who are young and more vulnerable–to thrive in today’s modern economy. President Biden will work aggressively to update the federal workforce compensation framework for service members so that the government leads the way in ensuring hard-working families can attain a middle class life, and he will support legislation which will, in the meantime, provide an additional allowance for military families living below the poverty line.
 
Create Stability by Increasing Time between Permanent Change of Station (PCS) Moves: Every year, more than 400,000 Permanent Change of Station (PCS) moves occur for service members and their families. This system is expensive, and it is broken. Military families consider frequent relocation as a driver for negative outcomes in career opportunities for military spouses, military child education, and the development of supportive social networks. While every service member and family understands that mission is paramount, we must invest in solutions that build stability for families and set conditions for service member retention and military family well-being.
 
As president, Biden will commission research and develop solutions to support the increase of time between PCS moves while ensuring we meet targets for Operational and Personnel Tempo in order to meet our national security demands. This will require that we comprehensively examine the potential positive and negative impacts of any changes to deployment cycles, unit assignment policies, and force size calculations. One such solution could be investing in the creation of virtual or hybrid learning scenarios for mandatory Professional Military Education (PME) so that service members and their families can remain in place, rather than PCS to a new base for a short educational tour.
 
Ensure Military Spouse Professional and Economic Opportunity: Military spouses are often more highly educated than their civilian peers, yet they face an unemployment rate of around 30%. Frequent relocation and high operational tempos often stifle their career trajectory. The military personnel system was designed with the single-earner family in mind, but many military families, like their civilian counterparts, depend on earning a second income or simply want the opportunity for the military spouse to pursue a career. Military families are increasingly experiencing challenges such as food insecurity or insufficient savings for emergencies, and with far too many military spouses unemployed or underemployed, meeting these needs is a challenge. LGBTQ military spouses may also be disproportionately affected when they reside in states that are allowed to discriminate based on an individual’s sexual orientation or gender identity. The Trump Administration has not only allowed but encouraged these discriminatory practices, all while claiming to support the military. It’s hypocritical and just plain wrong.
 
To increase economic opportunity for military spouses, President Biden will:

Invest $500 million in a 3-year Department of Defense (DOD) military spouse entrepreneurship pilot program, which will provide micro-grants, mentorship, and technical assistance to military spouses who are interested in starting or growing small businesses.

Ensure that the DoD’s Military Spouse Education and Career Opportunity office is fully funded and staffed so that effective programming such as the Military Spouse Employment Partnership (MSEP), My Career Advancement Account (MyCAA) scholarships, and the Military Spouse Transition Program (MySTeP) have the opportunity to deliver results and raise awareness and utilization among military families.

Build bridges between the private sector and the U.S. government to help educate employers about the value of military spouse talent, drive commitments to hire, retain, and promote them, and create concrete career opportunities, as Joining Forces did.

Expand the Work Opportunity Tax Credit (WOTC) to include military spouses.

Undo the Trump administration’s discriminatory policies and redouble efforts with state officials to ensure that LGBTQ military spouses have the support they need to pursue successful careers.

Continue efforts begun during the Obama-Biden Administration to put an end to unnecessary occupational licensing requirements. While licensing is important in some occupations to protect consumers, in many occupations licensing does nothing but thwart economic opportunity. If a military spouse who works in an occupation that requires a license or credential and has to move because of their military member’s career, they may have to get certified all over again. As president, Biden will build on the Obama-Biden Administration’s efforts to incentivize states to reduce unnecessary licensing requirements and to ensure licenses are transferable from one state to the next.

Fully fund installation-based child care facilities and expand awareness of the DoD fee assistance program, as supported by leading advocates for military families,, so that military spouses can more easily pursue their educations and careers and tap into respite care to relieve stressors of deployments.

Improve Support for Caregivers: Caregivers of wounded, ill, or injured service members and veterans face a variety of challenges, including negative health outcomes, lost wages, and difficulties planning their future. They are essential to military families and our veterans, and we owe them the same commitment and support that they show to our wounded, ill, or injured service members and veterans. 
 
As president, Biden will:

Ensure that caregivers of active duty service members receive adequate professional and peer support, including competent mental health care, financial readiness training, and transition support throughout the rehabilitation timeline (whether that is leading to the service member’s medical retirement or a return to duty).

Provide transparency and high-touch case management via in-person or telehealth sessions with caregiver coordinators for those caregivers enrolled in the Department of Veterans Affairs (VA) Caregiver Support Program, especially to provide personalized assistance as they navigate dual eligibility for benefits and services from both the DoD and VA.

A critical part of meeting our commitment to military families is to do so on time, something the Trump Administration has failed to do. President Biden will ensure that the eligibility expansion for the VA Caregiver Support Program meets its timelines and collects longitudinal satisfaction data through regular surveying of those enrolled or enrolling in the program.

Help caregivers of wounded, ill, injured, or elderly veterans pay for long-term care by providing relief through the creation of a $5,000 tax credit for informal caregivers, modeled off of legislation supported by AARP. This tax credit will be in addition to the financial support provided by the VA Caregiver program.

Support proposals to expand opportunities for much needed respite care for caregivers, to include those offered within DoD, VA, and through the Department of Health and Human Services (HHS).

Institute a waiver for the Survivors’ and Dependents’ Educational Assistance Program (Chapter 35), so that spouses and survivors who have not accessed their benefits in the allotted time frame will have the opportunity to request additional time.

End Needless Financial Burdens Facing Survivors: As President, Joe Biden will end the needless financial burdens caused by the Survivor Benefit Plan/Dependency Indemnity Compensation Offset (SBP/DIC Offset) or “Widow’s Tax.” It is wrong that we punish the families of the fallen financially in the wake of their extreme sacrifice. 
 
Improve Military Child Education: There are more than 1 million children of active duty service members worldwide. Whether they are educated in Department of Defense Education Activity (DoDEA) schools, local school districts, parochial schools, home schools, or online schools, military children require support to ensure they have every opportunity to succeed in their education. 
 
As president, Biden will:

Propose legislation to expand the Military Student Identifier (MSI) to all military-connected children (to include children of National Guard and Reserve personnel regardless of activation/order status), children of veterans, and children of deceased service members or veterans, who are often impacted by the service of their parents. Under the Obama-Biden Administration, we passed into law the Every Student Succeeds Act, which included the MSI, a designation that allows educators and schools to better understand where military-connected children are receiving their education, and how we can better support them. Currently, the MSI extends only to children of active duty service members, excluding children of National Guard, Reserve, veterans, caregivers, and children of the fallen. But these children face unique challenges too, and we need to know who they are so we can determine what support they need .

Promote efforts across states to streamline enrollment requirements, standardize educational resources, and train teachers and school-based leadership to ensure we are meeting the unique needs of military children effectively, no matter where they study or how often they have to move.

Promote greater awareness of the Interstate Compact on Educational Opportunity for Military Children among military families, teachers, and administrators.

Create and disseminate training tools that empower military-connected parents to better advocate for their children.

Provide financial incentives for school districts to train educators on the unique needs and barriers faced by military-connected youth so that they are able to help military children thrive, no matter where they receive their education.

Support and protect post-9/11 GI benefits for veterans and qualified family members by strengthening the GI Bill Comparison Tool and School Feedback Tool to help put an end to post-secondary institutions’ predatory practices.

Enact legislation eliminating the so-called 90/10 loophole that gives for-profit schools an incentive to enroll veterans, service members, and military family members who are using the GI Bill or Tuition Assistance in programs that aren’t delivering results. 

Expand and Improve Behavioral Health Services for Military Dependents: Children and spouses in military families are resilient, but they do experience high levels of stress, whether due to frequent moves, deployment and training schedules of the service member, or weak social/emotional support networks. School-age children and adolescents who experience separation from a parent (either through deployment or other assignments) show higher levels of emotional and behavioral distress. About 25 percent of high school freshmen and juniors in a military family have reported suicidal thoughts during the previous year, and the stresses of military life can exacerbate health issues, among them depression, anxiety, or substance use disorders.
 
Biden has committed to achieving mental health parity, expanding access to behavioral health care, and removing the stigma surrounding behavioral health issues. He will redouble our efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.
 
It is also essential that we invest in an infrastructure that promotes health and well-being, reduces risky behaviors, and provides timely, convenient access to high-quality mental health and substance use/abuse services for military dependents. We must ensure that DoD facilities are fully staffed, equipped, resourced, and able to support the behavioral health of military dependents. If this capacity is not in place, we must invest in solutions to create additional affordable, accessible, and high-quality capacity in the civilian sector. Care must be effective and grounded in evidence-based treatments. Providers must be culturally competent, educated in the unique needs of military families. And families who seek support should never go into debt for treatment or be concerned about confidentiality.
 
The Biden Administration will:

Increase funding for and expand access to telehealth for military families, particularly in areas not able to access timely care.

Expand the number of free, non-medical Military OneSource counseling sessions for military families from 12 sessions to 18 and expand access to Coast Guard families regardless of activation status.

Invest in recruiting and retaining behavioral health care professionals in military treatment facilities to ensure there are enough clinicians to support the needs of not only our active duty force, but military dependents.

Redefine the federal “Health Professional Shortage Areas” (HPSAs) to specifically include military-impacted geographies.

Expand the National Health Services Corps to incentivize early professional behavioral health providers to serve this population.

Re-prioritize and expand the work of the Substance Abuse and Mental Health Services Administration (SAMHSA) interagency task force on the behavioral health needs of veterans and military families, to include issues related to traumatic brain injury, substance use disorder and addiction, and other related conditions. Additionally, President Biden will fully restore SAMHSA’s focus on evidence-based solutions and appoint a specific position on the Domestic Policy Council to drive a whole-of-government focus on these issues. 

Direct the Department of Defense to produce a robust, annual report on the state of military family behavioral health, in coordination with VA and SAMHSA.

Guarantee Safe Housing: The government has broken its trust with military families by providing sub-par housing. Now, we have to work twice as hard to rebuild this trust. That will require the utmost transparency and accountability from both the government and the private sector partners charged with housing the families of our service members.
 
The Biden Administration will:

Enforce a comprehensive and standardized tenant bill of rights for all military families, and as advocates have rightly demanded, ensure DoD senior leadership enforces compliance. We won’t be making more empty promises to military families. We will hold these landlords, and ourselves, accountable.

Require regular, standardized, objective, and published reporting of military family satisfaction and concerns from all housing.

Establish a public-facing document outlining expectations of quality and consequences for all housing providers and, when necessary, terminate long-term leases held by private companies.

Know our Families: Long periods of sustained war-fighting have made us reactive in our responses to military family needs. To best support these families and optimize their health and well-being, we must improve our understanding of their current and emerging needs. We can’t be caught on our heels. We must anticipate and prepare solutions that respond to the evolving needs of military families across the military life cycle. We must be able to track and identify emerging trends so that we can be nimble and responsive to the changing needs of our military families.
 
As president, Biden will:

Convene a multi-disciplinary working group of policy makers, program leaders, and research and subject-matter experts to construct a strategic research plan to inform solutions to support military families.

Designate specific resources for research and development related to military families outcomes within the budget of the Office of the Under Secretary of Defense for Personnel and Readiness, to include resources for research within both the Military Family and Community Policy and the Defense Health Program.

Require that DoD work across the federal government to leverage national and state-level assessments of health and well-being to ensure they appropriately assess military affiliation in ongoing data collections across the United States. It is imperative that all national surveys include variables that allow us to examine how well military families fare relative to others.

Democratic Candidates for 2020: On Veterans Day, Biden Releases Personal Reflection, Detailed Agenda

Vice President Joe Biden released a detail plan for veterans © Karen Rubin/news-photos-features.com

Vice President Joe Biden, candidate for president, with Dr. Jill Biden, issued a statement on Veterans Day, and his campaign issued a detailed plan about what a Biden Administration would do for veterans. Here are is the statement and fact sheet from the campaign:

John Steinbeck memorably wrote that, “A soldier is the most holy of all humans, because [they are] the most tested.” From Fort McHenry to San Juan Hill, from the Argonne Forest to Midway, from the Mekong Delta to Fallujah, and on every battlefield between, America’s veterans have always been the most tested among us — and they have never failed in their duty.
 
In each generation, a small fraction of Americans serve and sacrifice on behalf of us all. Less than one percent of our population risks everything to protect our country, incurring in the rest of us a debt far greater than our nation could ever repay. We have always believed that the most sacred obligation of our government is to do right by the men and women who defend our nation at war — to care for them and their families, both while they are deployed and after they come home. It’s an obligation we are honor-bound to keep.
 
Veterans Day offers us a moment to reflect on that obligation, and to recommit ourselves to all that it truly means. Every one of our veterans deserves timely, world-class health care — the very best of what our country has to offer. They deserve comprehensive mental health support, and a thoughtful, well-funded plan to address the ongoing tragedy of veteran suicides. They deserve a serious approach to ending veteran homelessness, and greater resources to help them readjust to life at home once their service concludes. Not only do they deserve these things — their families and caregivers do, too.
 
Our veterans also deserve a leg up when it comes to educational and economic opportunities — everything from tuition assistance to skills training to entrepreneurship programs. That isn’t just for their benefit; America benefits enormously from the leadership, talent, and experience of veterans who gird every sector of our economy with sinew and smarts. The GI Bill was one of the greatest engines of widespread prosperity our country has ever conceived, helping to cement the most resilient middle class in the history of the world in the wake of World War II. Our veterans and our country deserve that commitment to be upheld and advanced.
 
Most of all, our veterans deserve leaders who will fight for them as ardently and as forcefully as they have fought for us.
 
That’s why, on this Veterans Day, we are proud to release a detailed and comprehensive plan to honor the full breadth of our obligation to veterans and their families — and to restore the sacred commitments that this White House has seen fit to ignore.
 
This plan and this cause are personal to us. Over the course of many years, it has been our honor to visit our troops in Bosnia, Kosovo, Iraq, and Afghanistan, and to witness their incredible strength of character firsthand. We have been blessed to visit with wounded veterans in Landstuhl, Germany, and at the Brooke Army Medical Center in San Antonio, and to welcome troops to our home for Thanksgiving dinners and spend many Christmas Days with the heroes at Walter Reed. When our son Beau was deployed to Iraq for a year, we whispered prayers, and learned a small portion of what sacrifice means to the families of those who serve.
 
Every one of the more than 18 million veterans in our country has earned our admiration and our gratitude — but it is our duty to repay them with something more than that. We must honor their service with bold policies that meet our sacred obligation, with opportunities commensurate to the sacrifices they and their families have made, and with trustworthy national leadership.

FACT SHEET:
The Biden Plan to Keep Our Sacred Obligation to Our Veterans
  

Joe Biden believes that as a nation, we have many obligations, but we have only one truly sacred obligation: to properly prepare and equip our troops when we send them into harm’s way, and to care for them and their families–both while they are deployed and after they return home. As the parents of a son who deployed to Iraq, Joe and Jill Biden understand the gravity of this promise. Our service members ensure our freedoms, our security, and the very future of our country. They are willing to sacrifice everything. Many do. And each of them deserves our respect and enduring gratitude, both while on active duty and after separating from service. 
 
President Trump has repeatedly failed our veterans and ignored this sacred obligation. From the outrage of deporting undocumented veterans without checking their record of military service, to allowing his wealthy Mar-a-Lago friends to drive veterans policy, to pursuing policies designed to privatize and dismantle the Department of Veterans Affairs (VA), Trump neither understands nor respects the idea of “duty, honor, country” that inspires our brave military members to serve and imbues our veterans with pride. 
 
Less than one percent of Americans currently serve in the military, and the other 99 percent of us owe them the secure futures they have earned. As president, Joe Biden will keep faith with our veterans and their families. He will meet our sacred obligation.


The Biden Record of Delivering for Our Veterans  
Joe Biden has fought aggressively for our service members and veterans throughout his career in public service. His record speaks for itself. On the broad range of issues that matter to our brave military members and our veterans, Joe Biden has always had their back.
 
As a senator, Joe Biden was an early advocate for Vietnam veterans who were exposed to Agent Orange and other toxins to be able to access the care and benefits they deserve.
He championed funding for prosthetics for veterans and mammogram coverage for female veterans, fought for proper burial allowances, and supported the concurrent receipt of retirement and disability pay for veterans. He co-sponsored the legislation to establish the Vietnam, Korean, and WWII memorials in Washington, D.C., as well as the post-9/11 GI Bill to provide educational benefits to a new generation of heroes.
 
Biden also led the way in the Senate on critical issues to protect the health of our military, most notably driving the fight to increase funding for up-armored Mine-Resistant Ambush Protected vehicles (MRAPs) by $23.6 billion, which saved thousands of lives and limbs of U.S. service members in Iraq and Afghanistan. And he introduced legislation to prohibit cuts to military medical care during times of war.
 
In the White House, Biden continued to be a clarion voice advocating for our veterans. The Obama-Biden Administration accomplished major milestones, including cutting the population of homeless veterans by almost half and reducing the unemployment rate for veterans by more than half. In 2013, when an unacceptable backlog of veterans’ disability claims was uncovered at the VA, the Obama-Biden Administration took aggressive action to rectify the failures and ultimately reduced the backlog by nearly 90 percent in just over three years. The Obama-Biden Administration also increased the overall funding request for the VA by more than 85 percent during its years in office, including a 76 percent increase in funding devoted to the critical issue of veterans’ mental health. It successfully implemented the new GI Bill and approved the long overdue expansion of benefits to those suffering from Agent Orange-related conditions.
 
During the Obama-Biden Administration, the VA also led in creating the Blue Button app to help veterans access their health data and medical records more easily. Today, Blue Button is used by more than million veterans.
 
Additionally, Dr. Jill Biden and First Lady Michelle Obama created and led the Joining Forces initiative to build support for our veterans and military families, including a focus on increasing employment opportunities. Between April 2011 and the end of the Administration, Joining Forces supported programs and secured commitments from employers that led to the hiring or training of more than 1.5 million veterans and military spouses.
 

 
Our longest wars have taken their toll, both on our newest generation of veterans and on the system built to support them and previous generations of veterans. According to the most recent census data, there are more than 18 million veterans in the United States, and today’s veterans population has needs that the VA has never before addressed. This is reflected both in the growing interest for “anywhere, anytime” health care service models and in our growing understanding of behavioral health challenges, the harmful impacts of burn pits, environmental toxins, traumatic brain injury, and the devastating epidemic of opioid addiction and suicide. The VA must adapt to meet the ever-evolving needs of the veteran community. 
 
At the same time, the VA continues to struggle with poor organizational performance, staff shortfalls, leadership gaps, and IT systems failures. The integration of a new generation of veterans into the VA system has added a substantial number of veterans eligible for health care and other benefits as overall demand for services has surged, with the combination creating capacity challenges across the system. Too often, the VA’s performance in terms of access, outcomes, cost, and accountability is mixed. There have been both important successes and intolerable failures or gaps in service. Solving these challenges will require a substantial investment in talent, leadership time, budget, and public attention. It’s what we owe our veterans. It is past time to rethink and reinvent a better VA.
 
There is nothing partisan about improving support for service members, veterans, their families, caregivers, and survivors. As president, Joe Biden will unite the country and restore the VA as the premier agency for ensuring our veterans’ overall well-being by:

Providing Veterans World Class Health Care to Meet Their Specific Needs

Driving Progress to Eliminate Veterans Homelessness and Bring Down Suicide Rates

Creating Meaningful Employment and Educational Opportunities

Improving VA Management and Accountability. 

To support the VA mission, a Biden Administration will ensure coordination with the Department of Defense (DoD), Department of Housing and Urban Development (HUD), state agencies, and the thousands of non-governmental organizations that support this vital community. It will work faithfully to restore public trust in the VA so that no one in the military community or beyond will ever again question whether the United States of America keeps its promises to those who serve our country.
 
Providing Veterans World Class Health Care to Meet Their Specific Needs
The Veterans Health Administration serves upwards of 9 million veterans and is responsible for their whole health, physical and mental. Studies have found that health outcomes at VA hospitals are often better than their non-VA counterpart, and more than 90 percent of those who receive their health services through the VA report that they would recommend it to a fellow veteran. As president, Joe Biden will work to ensure that the VA provides the world class health care that our veterans have earned and deserve and sets the example for private sector care.
 
In the area of mental health, the VA and DoD have done pioneering work to address the specific needs of veterans, deploying innovative treatment solutions such as telehealth and other platforms to address a variety of conditions. The private sector trails the VA in its ability to provide behavioral health services to the nation as a whole, much less to understand the unique needs of veterans.
 
At the same time, the VA is also struggling with a rapidly deteriorating infrastructure, and many VA facilities are more than 60 years old. Further, across the system, the variance in quality of — and access to — care is unacceptable. As the demand for treatment has increased, the VA must continually strive to improve services and outcomes for veterans, especially in the areas of pain, polytrauma recovery, substance-use disorder (SUD), post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and general behavioral health, in the most effective and cost-efficient way possible.
 
In addition to protecting and building on the Affordable Care Act with a public option to expand access to quality, affordable health care and lower costs, and commitments to keep rural hospitals open and expand health care delivery models for rural areas, a Biden Administration will:

Rebuild trust in the Department of Veterans Affairs. During the Obama-Biden Administration, we improved access to health care offerings for veterans in their communities, but there is still more work to do. Private sector points of care were designed to provide care to veterans when it was faster, closer, or offered superior services for a particular veteran’s needs. We must ensure that health care purchased in the community actually improves access and convenience and does not compromise the health of our veterans. President Biden will establish the right balance of VA care and purchased care, region by region, based on veteran needs, existing VA capacity, and availability of market alternatives.

Conduct a thorough assessment of the staffing needs and requirements across the VA to inform specific hiring initiatives and programs for attracting and retaining medical professionals. This includes ensuring that professionals are working to the full scope of their license and creating incentives to support health care professionals joining the VA workforce.

Refine and update Community Care Guidelines, ensuring that if a veteran is referred to a community care provider that does not meet the same level of access and quality as the VA, the veteran will be referred back to the VA. This full-circle referral process will better ensure that veterans are seen in a timely manner and receive the best possible quality of care.

Establish cultural competency training protocols to ensure that providers in VA facilities and in community care settings understand and are equipped to support the needs of LGBTQ veterans in the health care setting.

Work with Congress to improve health services for women veterans. Biden will ensure that each VA Medical Center has at least one full-time women’s primary care physician; and, within 200 days of taking office, make available a women veterans training module for community health care providers. And, Biden will work with Congress to enact the Deborah Sampson Act and ensure that the safety and privacy concerns of women veterans are addressed throughout his Administration.

Provide funding to ensure there is safe, reliable child care at all VA Medical Centers.

Work with Congress to eliminate co-pays for preventive health care for veterans, which can create unnecessary barriers to seeking basic preventive care. 

Expand the list of presumptive conditions to ensure no veteran who experienced a TBI or had exposure to burn pits or other environmental toxins goes without access to VA health care and benefits. We cannot ask our veterans who are suffering to wait decades, as we did with Agent Orange. President Biden will also increase access to VA care beyond the 5-year eligibility window for combat veterans, as conditions related to toxic exposure may take many years to manifest.

Increase research dollars by $300 million to invest in better understanding the impact of TBI and toxic exposures (including burn pits) on long-term health outcomes, and continue to drive research focused on the needs of disabled veterans.

Ensure that disabled veterans that require a prosthesis are able to access the most modern prosthetics technology available, and that they are able to upgrade their equipment at no cost as new developments occur.

Expand funding for direct and purchase-care treatment for disorders related to the misuse of alcohol and opioids in order to reduce unacceptably long wait-times for treatment.

A Biden Administration will support the legalization of cannabis for medical purposes and reschedule cannabis as a schedule II drug so researchers can study its positive and negative impacts. This will include allowing the VA to research the use of medical cannabis to treat veteran-specific health needs.

Ensure the full integration of veteran caregivers as members of the health care team for veterans. The VA offers a diverse array of programs and supports for caregivers, however, we must ensure that the VA remains a caregiver-friendly environment and respects their role in ensuring the recovery and rehabilitation of their loved one. 

Increase funding for and expand access to telehealth through the VA, particularly in rural areas not able to access timely care.

Modernize VA hospitals and clinics to serve our veterans better through a nationwide infrastructure plan that provides a comprehensive refresh of VA health facilities. Biden will retrofit VA’s existing brick and mortar physical locations, where patient volume warrants, and repurpose older facilities to meet new needs such as assisted-living facilities and long-term care alternatives. Biden will improve both the buildings and equipment, so the VA continues to lead in providing 21st century care.  

Create safe, modern, clean, and recovery-oriented housing for veterans being treated for SUDs and those who are homeless by refurbishing buildings condemned or not in use, such as the massive VA Los Angeles campus.

 
Driving Progress to Promote Veterans’ Mental Health and Well-Being
Suicide is a public health crisis–the 10th leading cause of death in the United States. As a society, we need to work together to eliminate the stigma felt by those who are suffering and struggling with their mental health. There is no shame in asking for help. As president, Joe Biden will increase access to mental health treatment by enforcing full mental health parity and ensuring all Americans have access to high-quality mental health care, regardless of their insurance coverage status. Service members and veterans are at an elevated risk of dying by suicide. Recent data show that, on average, 20 veterans and service members die by suicide every day, and among some groups, the rate of suicide is rising alarmingly. Even one death by suicide is devastating, and we must do more to stem the tide. The Trump administration has grossly mismanaged this crisis, at one point leaving millions of VA dollars dedicated to suicide prevention efforts unused, and that’s just not right. This is a serious challenge, and our goal must be to remove the stigma in military communities to seek help, ensure that every veteran that reaches out is immediately connected to support and services, and to ultimately end the suicide crisis among veterans. As president, Biden will ensure a multi-faceted, substantive, and sustained commitment that addresses this as the public health emergency that it is.
 
The same is true when it comes to veterans experiencing homelessness. The Obama-Biden Administration proved that we can make huge inroads to address this persistent challenge with sustained attention and cross-coordination among government departments. But with just over 23,000 veterans without shelter on any given night, we have much more work to do.
 
A Biden Administration will:

Publish within the first 200 days in office a comprehensive public health and cross-sector approach to addressing suicide in veterans, service members, and their families.

Work aggressively to facilitate immediate access to mental health services for veterans in crisis, to include standardizing performance expectations around same day, walk-in and urgent mental health services; hiring more ER psychiatric staff and peer specialists; expanding crisis line capacity to ensure all calls are answered and appropriate referrals occur within hours; and implementing specific programs to encourage veterans to prioritize their mental health by reaching out to the VA when they need support. Within the first year in office, President Biden will have a goal of completely eliminating wait times for veterans who reach out with suicidal ideation so that they are immediately taken into treatment.

Together with states, community-based organizations, and employers, implement public education and outreach initiatives to help veterans understand that care is available and effective. We must work to end the culture of silence around mental health issues and remove the stigma associated with getting mental health treatment, particularly among service members who are more used to helping others than asking for it themselves.

Ensure the DoD’s Suicide Prevention Office and the VA have the resources and staff they need to make smart investments with allocated funds–and that money dedicated to suicide prevention efforts never goes unused.

Create a national center of excellence for reducing veteran suicide, similar to the National Center on Homelessness among Veterans. Biden will recruit top-level leadership to build strategic partnerships and solutions that extend beyond the VA’s health care system.

Require all providers of veterans services funded by the VA to receive training on suicide risk identification and safety planning, to include lethal means restriction and appropriate response and reporting about suicide. 

Enact policies that promote the value and dignity of life by supporting programs that increase economic stability; promote connectedness through structured social support; and reduce risky behaviors, such as substance use, poor sleep, and improper firearm storage.

Expand capacity at Vet Centers to ensure veterans in communities can access readjustment counseling services and resources, including financial and long-term planning. President Biden will specifically expand outreach and resources for veterans as they experience periods of transition, not just out of the military, but throughout their life, including into post-career retirement.

Tackle issues that contribute to higher suicide risk. This includes implementing programs to disseminate high-quality treatments for PTSD, ensuring that veterans have access to the best treatments available no matter where they receive care, and instituting policies that seek to eliminate discrimination, end harassment and hold perpetuators of sexual assault in the military accountable. A Biden Administration will not tolerate the sexual assault culture that has become all too common in the military and veteran sector.

Work with Congress to continue to drive down veteran homelessness by permanently authorizing the Supportive Services for Veterans Families (SSVF) program, which provides critical funding for wrap-around services for those facing homelessness. President Biden will also work to ensure that we better understand the unique needs of women and LGBTQ veterans experiencing homelessness.

Reform the policy and review processes for veterans so that less-than-honorable discharges will not be unjustly awarded for conduct directly linked to the behavioral health effects of PTSD, TBI, or other trauma experienced while serving.

 
Creating Civilian Lives of Meaning and Opportunity
The Obama-Biden Administration worked tirelessly to bring down high unemployment levels among our veterans. Over the course of 8 years, the Obama-Biden administration cut the veteran unemployment rate by more than half. That is vitally important progress, but now, we have to think about empowering our veterans and their future employers with the tools they need to build pathways to successful, long-term careers. Recent data indicate that veterans are more likely than their civilian counterparts to take a job at lower skill-level. As president, Biden will keep his foot on the gas to ensure that service members transitioning back to civilian lives have the best opportunities to succeed and build fulfilling futures.
 
A Biden Administration will:

Work closely with DoD to ensure that the Transition Assistance Program (TAP) is implemented effectively and that outcomes are regularly reported.

Ensure that more transitioning service members are able to access job training and placement services prior to their end of active duty service. By expanding private sector relationships through programs like the SkillBridge program, Biden will give qualified transitioning service members the opportunity to start building a meaningful civilian career as early as possible.

Work with the Department of Labor to enforce the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA) hiring benchmark among federal contractors and subcontractors, and provide preferences and incentives to corporations that meet the benchmark.

Promote corporate mentorship programs between veteran-owned businesses and existing contractors to support veteran entrepreneurship.

Ensure careful implementation of the Forever GI Bill so that veterans receive the educational benefits they have earned on time.

Implement annual reporting to be led by the VA in partnership with the Department of Education and promote interagency cooperation and data sharing to better understand academic outcomes for all GI Bill users.

Develop best-practice guidelines for supporting veterans in higher education to assist higher education institutions to improve graduation rates among GI Bill recipients and provide financial incentivizes for campuses that follow guidelines and transparently report their outcomes.

Work aggressively to close the 90/10 loophole on GI Bill and Tuition Assistance dollars to keep for-profit bad actors from raiding the benefits service members and veterans have earned.

Support and protect post-9/11 GI benefits for veterans and qualified family members by strengthening the GI Bill Comparison Tool and School Feedback Tool to put an end to post-secondary institutions’ predatory practices.

Protect undocumented members of our armed services, veterans, and their spouses from deportation, because if you are willing to risk your life for this country, you and your family have earned the chance to live safe, healthy, and productive lives in America.

Work with DoD and the Department of Homeland Security to provide timely naturalization for those who have served honorably in our military, with an earned path to citizenship prior to discharge or retirement.

 
Improving VA Management and Accountability
The agency charged with meeting the needs of our veterans–not only their health care needs, but administering their full range of benefits and overseeing the cemeteries that guard their honor in death–should not be limited by outdated management tools and practices. Our veterans deserve the best services available. As president, Biden will enhance the capacity of the VA to serve our veterans as efficiently as possible by overseeing a generational upgrade to clinical and management systems, by leveraging commercial best-practices and modern technologies to meet the unique demands of public sector mission.
 
A Biden Administration will:

Improve health care access, quality, and customer experience by seamlessly augmenting direct care with purchase care enabled under the Mission Act. Enhance the administrative, financial, and operational systems that underpin the provision of care in the network model by improving vital case management systems, quality oversight, integrative health treatments and supporting administrative, financial and IT systems. These reforms will help ensure access to high-quality care and a first-rate customer experience that satisfies all veterans, regardless of where they receive care.

Create standards of health record interoperability that ensure a comprehensive health record is provided by community care organizations back to the VA.

Invest in improving human resource and management practices across the VA to strengthen the customer experience for our veterans and deliver services more efficiently. This will include a focus on workforce training and cultivating a culture across the VA that places a premium on quality and service.

Leverage options under the Mission Act to pilot alternative payment models and prioritize care models that improve the quality of care, not just the volume of services. Veterans should be able to access care in a way that works best for them, not the way that is most convenient for the system, in particular when it comes to meeting specific needs such as rehabilitation services, SUD, and behavioral health.  

Reduce delays and errors in claims processing and in scheduling the medical exams necessary for veterans to complete their disability claims. This has been a constant source of frustration for veterans. The long delays in the system, and rates of error — in both Regional Offices and the Board of Veterans’ Appeals — are too long and too high, and unfairly delay adjudication of veterans claims. A Biden VA will identify the sources of the problem and undertake the investments in personnel and training needed to ensure that veterans receive accurate decisions in a more timely manner. 

Help more veterans gain access to their own health data and medical records through the Blue Button app. Blue Button has been downloaded by more than 2 million veterans and is increasingly being used by Medicare beneficiaries and the private sector. By making Blue Button easier to use, the VA will continue to lead the movement of patient-centered models of care.

Implement a VA-hosted health record that can serve any and every American who wants one. We can leverage Blue Button to access health information no matter where it is, to allow veterans and citizens to manage and use it as they see fit. By putting our veterans first, we can make the VA the nexus of the best care everywhere.

Create a national health database for non-profit research scientists and the commercial sector that would accelerate discovery of the best therapies against the devastating diseases of our time: cancer, heart disease, and Alzheimer’s, and dementia. Biden will direct the VA to support the database using its infrastructure, making access available to all. Veterans will be able to choose, on an individual basis, whether or not to contribute their data. This national repository for longitudinal health data will enable us to use technological innovations to see patterns that people don’t easily recognize and make connections we don’t normally make for the U.S. population as a whole.

Democratic Candidates for 2020: Sanders Releases ‘Honoring Our Commitment’ Veterans Agenda

Senator Bernie Sanders, candidate for president, released his ‘Honoring Our Commitment’ veterans agenda © Karen Rubin/news-photos-features.com

WASHINGTON – Senator Bernie Sanders on Veterans Day released his veterans agenda, called “Honoring Our Commitment to Veterans,” which will guarantee veterans the benefits and services they were promised, protect and expand disability benefits for veterans, guarantee justice for veterans and expand opportunities for veterans. The proposal comes as Americans around the country honor Veterans Day. 

This is from the Sanders campaign:

“As a nation, we have a moral obligation to provide the best quality care to those who put their lives on the line to defend us,” Sanders, who served as Chairman of the Senate Veterans’ Affairs Committee from 2013 to 2015, said. “Just as planes and tanks and guns are a cost of war, so is taking care of the men and women who we sent off to fight the wars. It includes caring for the spouses and children who have to rebuild their lives after the loss of a loved one. It includes caring for the hundreds of thousands of veterans with multiple amputations or loss of eyesight, post-traumatic stress disorder and traumatic brain injury. It includes veterans who are having difficulty keeping jobs in order to pay their bills, and it includes the terrible tragedy of veterans committing suicide. As president, I will do everything that I can to make sure that every veteran gets the benefits that they are entitled to receive on time and without delay. Further, we will not dismantle or privatize the VA. We will expand and improve the VA.”

During Sanders’ time as Chairman of the Senate Veterans’ Affairs Committee, a series of reports revealed that the Veterans Health Administration was failing veterans, leaving many to wait too long for care and putting lives in danger. Sanders worked with Sen. John McCain to successfully negotiate and pass a bill that invested billions into the VA system. The landmark legislation authorized twenty-seven new medical facilities and provided $5 billion to hire more doctors and nurses to care for the surging number of veterans returning from the wars in Iraq and Afghanistan and those veterans from earlier eras in need of more complex care.  

The Sanders campaign on Monday also released a new video, “Keeping Our Promise,” which highlights Sanders’ work on that landmark legislation. 

Sanders’ plan will: 

Fill the nearly 50,000 vacancies at the VA during your first year in office. Under a Bernie Sanders administration, the VA will hire the doctors, nurses and medical professionals necessary to provide the care that veterans need when they need it. 

Provide at least $62 billion in new funding to repair, modernize and rebuild the infrastructure at the VA in order to provide the cutting-edge health care services our veterans have earned and deserve. 

Ensure that all those with prior military service in every state and territory have access to the full complement of health care services they need to stay healthy and well. 

Improve and simplify the claims process so veterans receive the compensation they have earned quickly, accurately, and without bureaucratic red tape. 

Reform harmful VA regulations that restrict access to care and benefits based on character of discharge. 

Ensure veterans can use the full complement of benefits through the G.I. Bill without hassle or red tape. 

The full plan can be here

Warren Releases Plan to Keep Our Promises to Servicemembers, Veterans, and Military Families

Senator Elizabeth Warren, candidate for president, detailed her plan for servicemembers, veterans and military families © Karen Rubin/news-photos-features.com

Senator Elizabeth Warren released her plan to support and protect America’s veterans, service members and military families ahead of Veterans Day. 

“All three of my brothers served, so I know the responsibility we have to our service members, military families, and veterans. As Commander-in-Chief, I will lead our Armed Forces with awareness of the unique challenges service members and military families face, and the difficulties veterans encounter as they navigate VA during their transition to civilian life. I will honor our troops not only by executing sound military strategy, but also by caring for our veterans after they take off the uniform. And I will prioritize our most important strategic asset – our people – as I reform Pentagon spending and address our most pressing national security crises. The way I see it, this is not complicated. It’s about a government that keeps its promises to those who served — it’s about our values. “

This is from the Warren campaign:

Charlestown, MA – As President, Senator Elizabeth Warren pledged to: 

Raise service members’ pay at or above the Employment Cost Index and protect earned benefits, ensuring that total compensation remains competitive with the civilian sector and that it reflects the unique demands of military life

Prioritize family readiness by addressing spouse employment, housing, child care and education, and take care of military caregivers

Expand mental health services and work to end military suicide by setting a goal of cutting veterans’ suicides in half within her first term

Tackle sexual assault and prosecute sexual harassment as a stand-alone crime under military law

Enforce equal treatment for all who serve, including women, immigrants, and LGBTQ+ service members

Ease the transition for veterans by eliminating the benefits backlog and establishing a “warm hand-off” between DOD and VA

Reject attempts to privatize the VA by investing in a VA worthy of the veterans it serves — to provide the high-quality, evidence-based, culturally competent programs that our veterans rely on for years to come.

As a member of the Senate Armed Services Committee, Elizabeth has worked to achieve pay raises for senior enlisted personnel, fix repeated promotion delays for our National Guard, and fought to protect military families from fraud and abuse. Major provisions of her bill with Congresswoman Deb Haaland (D-N.M.) to address unsafe and unsanitary housing conditions on military bases were included as part of the Senate-passed FY2020 NDAA.

Keeping Our Promises to Our Service Members, Veterans, and Military Families

This Veterans Day, Americans will gather in towns and cities across our country to thank our military personnel past and present. With three brothers who served, this day is especially meaningful to me.

Less than 1% of the U.S. population currently serves in uniform. And while Americans rightly honor their service on November 11, too often the day-to-day sacrifices of military families go unseen and unremarked. Parades and salutes to the troops are important ways that Americans express their gratitude, but they’re only platitudes if they’re not backed up with meaningful action and policies that support our military both during and after service — not just on Veterans Day, but every day. 

For me, that starts with care in how we deploy our forces abroad. Defense policy is veterans policy. For decades, we have been mired in a series of wars that have sapped our strength and skewed our priorities. As a member of the Senate Armed Services Committee, I have seen up close how 18 years of conflict have degraded equipment, eroded our forces’ readiness, and postponed investment in critical military capabilities.

The burden of these wars has fallen primarily on our military personnel, who have endured repeated deployments in dangerous places around the globe year after year, and their families. 7,027 American service members have lost their lives, almost 60,000 have been injured, and countless more live every day with the invisible wounds of war.

I know our service members and their families are smart, tough, and resourceful — they will accomplish any mission we ask of them, whatever the cost. But it’s not fair to our men and women in uniform to ask them to solve problems that don’t have a military solution. Nor is it fair to them when we refuse to make the tough calls to change course when our strategies aren’t working. 

A strong military should act as a deterrent so that most of the time, we won’t have to use it. We can honor our veterans by ending these endless wars, reining in our bloated defense budget and reducing the influence of defense contractors at the Pentagon, and bringing our troops home responsibly — and then providing our veterans with the benefits they’ve earned. That’s why today I’m introducing my plan to care for our nation’s veterans, service members, military families, and survivors. 

Protecting Earned Benefits for Those Who Serve

In prior generations, America experienced a tight relationship between people in uniform and the rest of our nation. For a host of reasons, however, our all-volunteer military is becoming more and more distant from the population it serves. In recent years the military has sometimes struggled to attract and retain sufficient personnel to meet recruitment targets, in both raw numbers and increasingly technical skill sets. A majority of young people are ineligible to serve, and low unemployment rates and declining propensity for military service mean that even fewer apply to serve in today’s military. Many who enlist do so because they have a family member who served. 

It is clear that the services must do more to compete with 21st century careers and employers to continue to attract and retain the best for the All Volunteer Force. That means more flexible talent management systems and improved quality of life for service members and their families — and it also means preserving best-in-class benefits for our military personnel. But it’s about more than recruitment and readiness. It’s about honoring the commitment of those who choose to serve with commitments of our own. 

Guaranteeing Pay and Benefits

In past years, Congress and the Pentagon have too often sought to balance the budget on the backs of our service members through proposals for lower pay raises, increased out-of-pocket costs, and cuts to benefits like housing and commissaries. Proposals that undermine total compensation are a betrayal of our obligation to our service members, and they undermine our ability to recruit and retain the best possible All Volunteer Force.

In the Senate, I’ve worked across the aisle to achieve pay raises for senior enlisted personnel and restrict the president from reducing pay raises promised to our troops. I’ve also fought to fix repeated promotion delays for our National Guard. 

To ensure that compensation remains competitive with the civilian sector and that it reflects the unique demands of military life, as President I will propose pay raises at or above the Employment Cost Index. I’ll ensure that benefits such as housing allowances keep pace with market rates in base communities, and work to ensure that service members are educated and empowered to make decisions about their retirement and savings choices in light of new options for blended retirement. 

Empowering Military Students 

Over the past 70 years, the GI Bill has helped send millions of veterans to college, easing their transition to civilian life, and contributing to our economic growth. I am committed to ensuring these benefits are guaranteed and protected in the future — for our veterans and their family members. I’ve fought to expand eligibility for educational benefits, including by working to provide Post-9/11 GI Bill benefits for Purple Heart recipients who were not previously eligible, and expanding the Yellow Ribbon education program to cover families of fallen service members.

As benefits have increased — and increased in complexity — as a result of GI Bill expansions, VA has scrambled at times to keep up, leaving military students in the lurch. I’ve worked to ensure that delays at VA don’t negatively impact student veterans, including by helping to pass a bipartisan measure to protect student veterans’ access to education in the event of delayed GI Bill disbursements. 

Too often, the benefits provided to military and veteran students have made them targets for predatory lenders and shady for-profit schools. I’ve fought to protect students from these scams, including by obtaining refunds for military borrowers cheated by loan servicers like Navient. I also fought to restore GI benefits to those cheated by fraudulent for-profit colleges like ITT Tech and Corinthian Colleges. 

But there is more to be done. My plan for affordable higher education will make two- and four-year public college free, and cancel student loan debt up to $50,000 for 42 million Americans — helping thousands of military families burdened with higher education expenses beyond what is covered by the GI Bill, and ensuring all of our veterans and their families have the chance to get essential job training and degrees without taking on a dime of student loan debt. My plan also completely cuts shady for-profit colleges off from federal aid dollars, which will end their abuse of veteran students for their GI Bill benefits once and for all. 

Preventing Fraud and Abuse  

When I set up the Consumer Financial Protection Bureau, I made protecting service members and veterans a priority. We established an Office of Servicemember Affairs, and I recruited Holly Petraeus to run it. Together, we met with active-duty service members and families to discuss financial issues, including the base where two of my brothers completed their basic training.

I saw firsthand that today’s military families face difficult financial challenges as they try to make ends meet, balancing multiple deployments with raising a family. Some even told me that they felt like they were fighting two wars at once – one in a distant war zone and another here at home against creditors. But I’m proud to say that since 2011, the office we established has heard from over 90,000 service members from all 50 states and saved them nearly $230 million, providing some measure of relief for our military families. 

I’ve made fighting for military families a similar priority in the Senate. I fought to prevent predatory lenders from “loan churning,” or repeatedly refinancing VA-backed mortgages to pocket hefty fees. I successfully expanded financial protections for Gold Star spouses, passing a bipartisan bill to allow a survivor to terminate a residential lease within one year of a service member’s death. And I worked with my Republican colleagues in Congress to pass my Veterans Care Financial Protection Act to protect low-income and older veterans in assisted care from scams targeting their pension benefits. 

As President, I’ll work with Congress to give the CFPB new tools and additional authority to enforce the Servicemembers Civil Relief Act. And I’ll appoint individuals at the CFPB and DOJ who will use the full extent of those authorities to aggressively go after scammers and protect our men and women in uniform. Criminals and predators will keep coming up with new and creative ways to target the military community. We must be vigilant — but military families can feel confident that a Warren Administration will always have their backs. 

Prioritizing Family Readiness

Military families form the backbone of our armed forces. Just like other middle-class families, they worry about making ends meet: finding child care, giving their children a good education, retiring with dignity. But military families — particularly dual military couples — also face special challenges, like regular moves from assignment to assignment and the anxiety of a loved one’s deployment. And too often, the unique needs of military communities are overlooked by Washington. 

A Warren Administration will continue and expand current policy of weighing basing and force structure decisions to account for quality of life factors in the surrounding communities, including safe living environments, available child care, quality of public schools, and employment opportunities and licensing reciprocity for military spouses. There’s also a lot more we can do to support and uplift our military families. 

Increasing Military Spouse Employment 

majority of military families report two incomes as vital to their family’s well-being. But employment opportunities for military spouses are hindered by a variety of factors, including frequent moves and lack of available child care at some posts. Last year 30% of military spouses were unemployed, and 56% of working spouses reported being underemployed. Spouses in fields that require professional licenses face an additional challenge, as occupational licensing and credentialing standards vary from state to state. 

Reduced spousal employment isn’t just bad for military families — it results in up to $1 billion annually in lost income and associated costs. We need to make spousal employment a priority. 

The Obama Administration made real progress in encouraging states to offer licensing and credentialing reciprocity for the military community — now we need to finish those efforts to remove barriers to military spouse employment. 

We can start by making permanent the program to reimburse military spouses for professional relicensing. I’ll also work with states to provide military families with a one-stop shop where they can review licensing requirements before a move. 

I’ll also work with Congress to expand and better communicate about special hiring preferences for on-base jobs for military spouses and at American Job Centers. These preferences not only benefit spouses, they help build communities on military installations.

We’ll expand educational opportunities like MyCAA for military spouses, and provide targeted training for high-demand, high-growth sectors and to help military spouses find careers that can move with them. 

Military spouses bring unique strengths to the workforce — it’s time we leverage those strengths to benefit not only our military families but our economy. 

Ensuring High Quality Childcare and Education

As a young working mother, child care almost sank me — until my Aunt Bee stepped in to help. But finding affordable and high-quality child care has gotten even harder since my children were growing up, and not everyone is lucky enough to have an Aunt Bee of their own. 

That’s why I have a plan to provide universal child care for every single one of our babies from birth to school age. It will be free for millions of American families, and affordable for everyone. The federal government will partner with local providers to create a network of child care options that would be available to every family. These options would be held to high federal standards, and we’ll pay child care and preschool workers the wages they deserve. And rather than diverting funding from military daycare programs for a needless wall, I’ll invest again in growing DOD child care centers and modernizing schools on base.

We’ll move forward with efforts to introduce more flexibility into the personnel system for families who want to limit moves for assignments, while ensuring that option does not hamper the service member’s ability to get promoted and advance their military career. We’ll invest the resources necessary to ensure families (and their household goods) are no longer subjected to chaos and mistakes that can impact the experience of transitioning to a new assignment. And we’ll seek to limit family moves during the academic year — when they must occur, we’ll provide dedicated support to families as they navigate transferring educational credits. 

Every military family is unique, and some have unique needs. I’ll work to improve oversight and standardize DOD’s Exceptional Family Member Program to care for dependents with special needs. We need to do more to empower military families to make informed decisions, taking  their individual circumstances into account during relocation and providing dedicated case management to help military families identify appropriate programs and interventions regardless of their location. Supporting these families isn’t just the right thing to do, it’s also good for military readiness.

Wounded Warriors and their Families

About 30% of veterans between the ages of 21 and 64 have a disability. As president, I will keep fighting for the rights of people with disabilities and to ensure their full inclusion through policy reforms and enforcement priorities. This includes prioritizing the unique challenges that face veterans with disabilities. 

As part of my plan to empower American workers, I have committed to substantially increasing funding for the Equal Employment Opportunity Commission to uphold the rights of veterans with disabilities at work. I will also ensure that the Department of Labor is enforcing the law to protect disabled veterans againist work discrimination. I support the Raise the Wage Act to guarantee workers with disabilities a minimum wage of $15 an hour, and I will push to pass the Transformation to Competitive Employment Act, which would provide grants and assistance to support a transition towards competitive, integrated employment for people with disabilities.

It is often family members who care for injured service members and veterans — in some cases, putting aside careers and other opportunities to provide assistance to our wounded warriors. According to a 2014 report, there were approximately 5.5 million military caregivers in the United States — but the physical and emotional strain on this population is understudied and overlooked. 

Medicare for All will expand access to long-term home and community-based care, offering critical support and relieving the financial burden on veterans and their families. A Warren Administration will also empower our nation’s military caregivers by fully implementing the recommendations of the federal advisory panel on caregiving. We’ll create an office within VA focused on the needs of caregivers, ensuring that their voices are heard in the policymaking process and that VA is fully communicating available resources. We’ll ensure that caregivers are formally designated in a patient’s medical record, so that they can be consistently included in medical planning about the course of care. We’ll collect better data on the caregiver population and their needs, including the impact on military children. And we’ll make sure we’re also caring for the caregivers, themselves, including respite care. 

To recognize caregiving for the valuable work it is, my plan to expand Social Security creates a new credit for caregiving for people who qualify for Social Security benefits. This credit raises Social Security benefits for people who take time out of the workforce to care for a family member at least 80 hours a month, including designated “primary family caregivers” of eligible veterans in the Caregiver Support Program. For every month of caregiving that meets these requirements, the caregiver will be credited for Social Security purposes with a month of income equal to the monthly average of that year’s median annual wage.

Lastly, I support eliminating the so-called “Widow’s Tax” and efforts to ensure that all families of veterans who died or became totally disabled from a service-connected condition receive the Dependency and Indemnity Compensation (DIC) benefits that they are entitled to.

Providing Safe and Affordable Housing

In the mid-1990s, the Department of Defense agreed to privatize the majority of the 300,000 houses it owned and operated on base, many of which were in need of renovation after decades of neglect. It was a good deal for the private developers, but this system has turned out to be a lousy bargain for military families. With their focus on short-term payoffs, private developers failed to invest in and maintain the properties with which they were entrusted. That’s why earlier this year, I released my plan to improve military housing by ensuring that every base has a housing office staffed with advocates for the service member and establishing a “bill of rights” that all military tenants will receive when they move in. 

And for those families who choose to live off base, and for veterans, my plan to increase affordable housing makes a historic federal investment to increase affordable housing supply, lowering rents around the country by 10%. And while cost is a major challenge to finding safe and affordable housing, too many service members and veterans face additional obstacles, including landlords who don’t understand the housing benefits they receive for their service and those who turn away service members and veterans because of discriminatory stereotypes.  My affordable housing plan extends protection against discrimination under the Fair Housing Act to include veteran status, which would include those using HUD-VASH vouchers. I have also pushed hard for more resources for programs to end veterans’ homelessness, including the successful Tribal HUD-VASH program to assist Native American veterans who are homeless or at risk of homelessness find homes in Indian country. 

Putting Service Members and Veterans First

Nearly two decades of combat has put significant stress on the force, and this will continue to manifest itself long after combat operations are over. Our first priority must be the care and safety of those who serve or have served in uniform. 

Eliminating Military Sexual Assault 

For decades, the military has affirmed a “zero tolerance policy” — and yet reports of sexual assault in the military have spiked. In 2018 alone, the Department of Defense estimated that more than 20,000 service members experienced assault or unwanted sexual contact. These statistics are a shameful breach of trust with those who serve. Annual promises from senior military leaders to address the issue increasingly ring hollow — we owe it to our service members to make real change. 

Currently, skilled military prosecutors make an evidence-based recommendation on whether or not a case should proceed to trial, but then military commanders get to decide whether or not they want to listen. That’s why I supported Senator Gillibrand’s effort to remove cases of sexual assault from the chain of command and place trained prosecutors in charge instead. It’s simple – if evidence of a crime warrants a trial, then the case should go to trial. We need to reform the military justice system so that the lawyers and judges trying cases have the necessary experience and expertise, and so that every victim of a sexually-based crime benefits from a competent, empowered advocate from the very first day they report.

We need to change the culture. Sexual harassment and sexual assault are correlated— and 24% of military women and 6% of military men said they had been sexually harassed in the past year. In the Senate, I worked to make so-called “revenge pornography” prosecutable under the Uniform Code of Military Justice. We should also prosecute sexual harassment as a stand-alone crime under military law. We should push to expose and prevent sexual harassment in the civilian workforce as well, recognizing that our entire culture has work to do.

And we need to invest in survivors, helping them to get the care they need so that they can recover, and so they can continue to serve. Often, survivors worry that reporting a sexual assault may also bring to light other misconduct, such as underage drinking or fraternization. Sometimes, military commanders will distribute punishment for these offenses by survivors while the sexual assault itself goes unaddressed.  Even worse, more than 20% of those who reported an assault also reported experiencing retaliation. If we want to increase reporting and hold perpetrators of sexual assault accountable, we need to exercise much wider discretion in the way we approach collateral misconduct as part of instances of sexual assault. Until reporting an assault is not perceived as a possible end to someone’s career, we will never fully address this scourge. 

Ending Veteran and Military Suicide

Our service members are resilient, but even the strongest warriors need care. In 2017, 6,139 U.S. veterans died by suicide, an average of nearly 17 each day, and 1.5 times the rate for non-veteran adults. But only half of veterans of the wars in Iraq and Afghanistan who may need mental health services — including many with diagnoses that increase the risk of suicide, like PTSDtraumatic brain injurysubstance use disorders, or depression — actually access them. 

Every single one of these deaths is a tragedy that could have been prevented. As President, I will set a goal of cutting veteran suicides in half within my first term — and pursue a suite of concrete policies to make sure we get there. 

To get there, we need to invest more in research into the causes of suicide, with a specific focus on contributing factors that are specific to the military experience and a concerted effort to collect the data that will save lives. We should conduct research targeting subgroups of veterans who may be at higher risk of suicide, and evaluate the efficacy of suicide prevention pilot programs and invest in those that make a meaningful difference. 

Veterans account for one in five firearm suicides. My plan to prevent gun violence includes a waiting period before purchase and a federal extreme risk protection law, both of which have been shown to reduce suicides by gun.

We also need to provide consistent, accessible, high-quality mental health care for all of our service members and veterans. Under Medicare for All every person will have this essential care covered. But we must also address the shortfall of mental health providers at DOD and VA, and in the areas where veterans live. 

In the last Congress, I led the fight to prevent budget cuts to the Mental Health Block Grant and secured an additional $160 million for the program, and I urged appropriators to designate $1 billion to mental health programs through the Substance Abuse and Mental Health Administration. I have also proposed significant expansions of Community Health Centers and the National Health Service Corps, which would help increase the supply of primary care and mental health providers in underserved areas. We need to make it easier for service members and veterans to see a mental health professional, including by significantly increasing the number of mental health specialists at DOD and VA, streamlining appointment processes, and enhancing access to telehealth options for those who cannot come to a VA facility. 

We should also focus on preventive care — early and often throughout a military career, including by incorporating annual mental health exams for service members in the same way they receive annual physical exams. We should clearly communicate benefits and eligibility, raising awareness about available care. And we must continue to remove the stigma around warfighters seeking help, and do more to support military families who lose someone to suicide. 

Treating the Opioid and Addiction Crisis

In 2017, over 70,000 people died from a drug overdose — the highest year on record, with the majority due to opioids. And the opioid crisis that has devastated so many American families has not spared our military community. Stressors including deployment, combat exposure, injury, and post-deployment reintegration have been shown to increase the risk of substance abuse. Our military population has a higher risk of substance use disorders, with 11% of veterans from Afghanistan and Iraq treated by the VA being diagnosed with a substance use disorder. 

My CARE Act to end the opioid crisis — introduced in partnership with my late friend Congressman Elijah Cummings of Baltimore — is a comprehensive plan to provide the resources needed to begin treating this epidemic like the public health crisis that it is. It would provide $100 billion in federal funding to states and communities over the next ten years, because that’s what’s needed to make sure every single person gets the treatment they need. 

Under my plan, VA facilities will be able to participate in planning councils to address the opioid crisis in order to ensure that veterans are prioritized in our response and organizations serving veterans have a voice in how the funding is spent. We will expand the number of inpatient beds available to veterans for treatment and recovery. We’ll fund community-based organizations, including eligible veteran-serving nonprofits, working to help prevent and treat addicted veterans. And we’ll provide vocational training for people struggling with addiction, helping them to get back into the civilian workforce after their military careers.

Addressing the “Invisible Wounds” of War

17% of post-9/11 military veterans experience some form of traumatic brain injury during their military service. TBI is associated with higher rates of PTSD, depression, and substance abuse. While our knowledge of these conditions has improved dramatically, it is still incomplete. Moreover, too many veterans don’t receive the treatment they so badly need. While TBI is often associated with blunt physical injuries to the head, research has shown that the blast wave produced by even minor explosions, such as firing heavy weapons, can result in TBI — even if the individual does not exhibit outward physical signs of head injury. 

In the Senate, I worked with my Republican colleagues to establish a longitudinal study at DOD to track the impact of blast exposure and brain health over time, and to push DOD to track service member blast exposure. We’ll use this data to improve our understanding of blast exposure injuries, improve protective equipment, and develop innovative new treatments. We’ll also use it to inform the safety guidance provided to our troops, including by limiting non-combat exposure during training exercises. 

Many states have established veterans’ courts or other diversion programs to provide treatment rather than incarceration for veterans with behavioral issues as a result of trauma, and I support the expansion of these programs. I also support legalizing marijuana. I’ve co-sponsored legislation to study the use of medical cannabis to treat veterans as an alternative to opioids, because we need to pursue all evidence-based opportunities for treatment and response.

The prevalence of certain rare cancers has been increasing steadily among military personnel and veterans who have served overseas. It took years for Vietnam veterans to receive treatment for exposure to Agent Orange — and some, including Blue Water Navy veterans, are still fighting for healthcare and benefits. Some veterans of more recent wars attribute their illness to exposure to toxic burn pits used by the military to dispose of waste, and at least one veterans group has projected that deaths from cancer and other illnesses could outpace suicide deaths in the military population by 2020.

As President, I will ensure that DOD tracks and records potential toxic exposure by integrating it into the post-deployment checklist. We need to ensure that adequate funding is allocated to research diseases that may be connected to certain kinds of exposure. And we must treat those affected without delay — we cannot allow today’s veterans to wait for earned health care. 

Equal Treatment For All Who Serve

The diversity of our force is one of its unique strengths — it allows us to incorporate different perspectives and experiences and to look at problems in new ways. The data are clear: inclusive, diverse militaries simply perform better. When we discriminate or treat classes of service members as less worthy than their peers, we fail to honor that diversity and we do enormous harm to our ability to recruit a strong future force. Minority communities in the military — particularly LGBTQ+, women, Black and Latinx service members — are significantly under-represented in the leadership ranks. Here’s what I’ll do to protect and honor everyone who volunteers to serve. 

LGBTQ+ Service Members

The only thing that should matter when it comes to allowing military personnel to serve is whether or not they can handle the job. Our national security community is weaker when LGBTQ+ Americans are excluded. I have opposed the Trump Administration’s shameful ban on transgender service members from the start — and I’ll reverse it on the first day of my presidency. In addition, advances in care and treatment have made it possible for individuals living with HIV to serve and deploy, and the Pentagon’s policies should be updated to reflect these advances in medical science. 

I’ve also supported efforts to review and correct the military records of service members discharged solely due to their sexual orientation, both before and during the Don’t Ask Don’t Tell era. As Commander-in-Chief, I’ll prioritize this effort, ensuring that we reflect their honorable service and reinstate the benefits they earned.

I’ll include the LGBTQ+ population in the VA’s Center for Minority Veterans, ensuring that they receive targeted outreach and equal care and are treated with dignity and respect. A Warren VA will ensure that every LGBTQ+ person can get the equitable, gender-affirming, and culturally-competent health care they need. That means providing all medically necessary care related to the health of transgender people, including transition-related surgery, and allowing providers discretion to deem gender-affirming procedures as medically necessary based on an individualized assessment. This care will also be available under Medicare for All. Professional medical associations recognize the need for transition-related surgery. VA’s blanket exclusion policy of medically necessary treatment is not grounded in medicine; it should be repealed. 

Empowering Women Service Members 

Women make up 17.5% of the total force. But they can face unique professional and personal challenges over the course of a military career, including higher rates of sexual harassment and assault, higher rates of divorce, challenges starting a family, and fewer opportunities for career advancement

I supported then-Defense Secretary Carter’s decision to open combat positions to women across the services, because the only thing that should matter is an individual’s ability to meet the standards. I’m proud of the women who have risen to that challenge. Now we must do more to recruit women into service, and then ensure that they are given equal opportunities to compete for command and promotions. We’ll invest in research on appropriate gear and injury prevention for women — over one hundred years after being allowed to enlist, women still perform their duties wearing equipment that doesn’t fit them, and therefore doesn’t adequately protect them. And both DOD and VA should enhance the quality of and access to care for women service members, including for preventive and reproductive care and mental health. 

A 21st century VA must also adapt to the modern fabric of our veteran population, ensuring that gender-specific care is the norm. There are about 2 million women veterans today, and women represent the fastest growing veteran subgroup — that’s why I successfully fought to ensure VA has sufficient resources and expertise in its peer counseling program for women veterans. I’ll also ensure that VA provides full reproductive health care for all veterans, in addition to the full reproductive health coverage they will have under Medicare for All. This includes IVF, which is currently only available to married veterans with service-connected infertility who don’t need donor sperm or eggs — discriminating against unmarried veterans, those who delayed pregnancy during their service, and same-sex couples. It also includes contraception, for which VA continues to charge veterans despite the fact that the Affordable Care Act made it available without cost to their civilian counterparts. This also includes abortions. I’ve called to repeal the Hyde Amendment, which blocks federal funds from being used to pay for abortions except in cases of rape, incest, or the life of the woman. VA’s restrictions go even further, prohibiting coverage for all abortions and all abortion counseling with no exemptions, an extreme policy I will eliminate. 

Too often, women veterans experience sexually explicit comments and other forms of harassment that make them feel unsafe and unwelcome and cause them to delay seeking care at their local VA or miss appointments altogether. This is shameful and it has to stop. I’ll ensure that a Warren VA has a comprehensive policy to eliminate sexual harassment and assault and hold perpetrators — VA personnel or anyone else — accountable, so that women veterans do not have to feel unsafe at their VA medical center when they seek the care they’ve earned. 

Immigrant Service Members 

Immigrants to our country have a proud history of honorable military service and often become citizens. But the Trump Administration has done everything it can to make these patriotic individuals who volunteer to serve and defend the United States of America feel unwelcome in our ranks.

In recent years, ICE has deported noncitizen veterans in violation of its own policies, which require additional review before proceeding with a removal case against a veteran. The Trump Administration has taken steps to withdraw deportation protections from military family members, including family of service members deployed in combat overseas. And under DOD’s current policies, immigrant troops are being denied citizenship at a rate higher than their civilian counterparts, and applications for naturalization as a result of military service dropped 72% between 2017 and 2018.

This is a disgrace. It also undermines military readiness. It’s not reasonable to expect service members to be able to concentrate on their jobs when their families are being deported, which is why I’ve used my position as a member of the Senate Armed Services Committee to urge the Trump Administration to maintain critical programs like Parole in Place and Deferred Action for undocumented family members of service members. Further, many noncitizen veterans come to the attention of immigration enforcement as a result of PTSD or other trauma associated with their military service; others fear seeking treatment for that reason. Everyone who serves our country deserves equal treatment and benefits, regardless of their citizenship status.

A Warren Administration will make it clear that we will protect veterans and family members of serving military personnel from deportation, and we will review the cases of those who have been deported for possible return to the United States. Consistent with our national security interests, I’ll restart the Military Accessions Vital to the National Interest (MAVNI) program, which recruits non-citizens with specialized skills or language abilities, paired with appropriate security and counterintelligence protections. I’ll also make it easier for noncitizens who serve honorably in our military to naturalize and become citizens. And we will heed the call of veterans to honor our commitment to translators and others who supported them in combat by re-launching the Direct Access Program for these vulnerable refugees.

Easing the Transition for Veterans

Nearly 200,000 personnel separate from military service every year. The initial transition away from military service can be a challenging period, as veterans work to start school or find a job, and readjust to family after time overseas. Many new veterans struggle to find a sense of purpose or connection in new civilian careers and communities. While DOD has improved its transition counseling in recent years, we can do more to prepare service members to return to civilian life. 

Ensuring a “Warm Hand-Off” 

The key to an effective transition is a seamless connection between DOD and the VA — but too often, veterans fall through the cracks. I’ll direct DOD to require that service members pre-enroll and complete processing at the VA before they leave active service. I’ll set a goal of completing interoperable electronic records between DOD and VA by the end of my first term. And I’ll direct VA to expand the vets.gov online portal for veterans and provide veterans access to a VA-provided email, so that the government can continue to communicate with them about their eligibility even if they move physical addresses over time. 

Eliminating the Benefits Backlog

While the VA has made progress in addressing its backlog of benefits cases waiting for adjudication, today there are over 70,000 veterans who have been waiting more than 125 days for a status determination. Moreover, VA itself acknowledges it takes between 12-18 months to review a new appeal, and 5-7 years to get a decision from a Veterans Law Judge. As President, I’ll fully eliminate the initial claims and appeals backlog. And in the interim, we’ll provide a presumption of eligibility for certain interim benefits to all those waiting for a final status determination. 

Our understanding of traumatic brain injury and other complex injuries has improved dramatically in recent years, but VA’s disability compensation process has not kept pace with those developments. I’ll task the National Academy of Public Administration to review and overhaul the disability ratings system to better accommodate “invisible” wounds like TBI. I’ll direct them to take into account recommendations for best practices, including training additional staff to evaluate cases and taking into account symptoms that are closely-associated with undiagnosed TBI. 

A key concern among veterans is that the benefits adjudication process is byzantine and lacks transparency. I’ll make sure that veterans automatically get full access to the results of their examinations and put in place rigorous processes to ensure claims are granted consistently nationwide. And to help veterans navigate the system and obtain the benefits they deserve, I’ll also establish a grant program to fund additional caseworkers at Veterans Service Organizations and other community-based organizations.

Clearing “Bad Paper” Discharges 

As the research into PTSD and traumatic brain injuries has improved, we’ve come to learn that these often invisible injuries lie behind many less-than-honorable discharges. Nearly 6% of post-9/11 discharges have been other-than-honorable — and one study estimated that 62% of service members separated for misconduct had been diagnosed within the 2 years prior to separation with PTSD, TBI, or related conditions. These so-called “bad paper” discharges can have a lasting negative impact, preventing the most vulnerable veterans from accessing benefits, obtaining employment, and other earned and necessary services.

I’ll create a DOD appeals board for veterans seeking to upgrade their discharges to give those denied by the services another opportunity for review and to ensure consistency across the services. I’ll direct that board to expand “liberal consideration” and consider a broader array of potentially mitigating evidence. I’ll direct the VA to provide certain interim benefits to individuals with other-than-honorable discharges until their appeals are adjudicated. And I’ll direct DOD to establish guidance for commanders to ensure that individuals first receive care for underlying conditions that may be contributing to behavioral problems, rather than merely processed for administrative discharge.  

Providing Good Jobs 

Service members gain valuable skills in the military, but often don’t know how to translate their skills into civilian life or receive appropriate “credit” for military service in a civilian context. And while public-private partnerships and other efforts have broken down the stigma around hiring veterans, we can do more to set veterans up for long-term success.

It starts by making it easier for civilian employers to identify military skill sets that most closely match their needs, and helping veterans to describe their military experiences in language that resonates with civilian employers. In the Senate, I’ve prioritized improving the employment transition for retiring service members, for example by passing a bipartisan bill that made it easier for service members to use their experience operating large military vehicles to obtain a commercial driver’s license. 

As President, I’ll direct DOD to expand resume and career coaching opportunities for military personnel considering transition. To encourage veteran entrepreneurship, I’m proposing a new program to allow veterans to cash out their GI education benefits for a small business loan. And we’ll invest in collaborative programs — like labor’s Helmets to Hardhats program — to connect transitioning service members with federally-recognized apprenticeship opportunities and good, union jobs. 

Ending Veterans’ Homelessness 

While the number of veterans experiencing homelessness has dropped over the last decade, nearly 38,000 were still homeless in January 2018. Veterans constituted nearly 9% of the total adult homeless population. Even one homeless veteran is one too many. I’ll restore SNAP benefits that the Trump administration seeks to cut that support 1.4 million low-income veterans, including those who are unemployed or with disabilities. SNAP is a particularly critical support for young veterans and those recently who have recently transitioned from active service. We’ll fully fund rapid re-housing and permanent supportive housing through Supportive Services for Veteran Families (SSVF) and HUD-VASH. And we’ll create a new competitive grant program for communities to provide wrap-around services for veterans and their families. We know that access to housing can be a barrier to many veterans – and can enhance the scale of other challenges they face.  By strengthening and expanding programs like HUD-VASH, we can end veteran homelessness and allow our veterans to focus on finding meaningful employment, receiving healthcare for service-connected conditions, and building resilient lives.

Creating a 21st Century VA Health Care System

The Veterans Health Administration is America’s largest health care system, providing care at over 1,200 health care facilities nationwide and serving 9 million enrolled veterans each year.

In recent years, attacks on VA have intensified as Republicans have pressed to privatize large chunks of VA service. My Administration will be clear-eyed about leadership challenges at VA. We will hold accountable leaders who fail to put veterans first or misuse resources, and we will empower whistleblowers who report wrongdoing to address their concerns and protect them from retaliation. But the truth is that care provided by VA outperforms care at non-VA hospitals, as multiple studies have shown. And in a recent survey, 91% of veterans who use VA care said they would recommend it to their fellow veterans. VA has pioneered innovations in medical care and service delivery. It provides world-class care for uniquely service-connected injuries, including treatment for polytrauma, amputations, and spinal cord injuries. 

While community care is appropriate where specialists are unavailable or geographically inaccessible, let me be clear: a Warren Administration will invest in the VA, not further dismantle it. We will not cut the high-quality, evidence-based, culturally competent programs that our veterans rely on. And under Medicare for All, veterans will all have high-quality health coverage that gives them the option to seek care from non-VA doctors and hospitals for no additional cost. If there isn’t a VA close to where they live, Medicare for All will ensure that veterans still get the care they need when they need it. 

In the immediate-term, here’s what we can do to revitalize our VA for the 21st century–

Work with Congress to implement more flexible hiring authorities, with a goal of filling the nearly 49,000 staffing vacancies, the vast majority of which are in the health administration. 

Expand the number of physician recruiters and provide additional financial incentives for physicians in hard-to-recruit specialties and rural VA centers or those near tribal lands.

Reinvigorate VA’s training partnership program — nearly 70% of U.S. doctors receive some training at a VA facility, but VA is hindered from converting those into full-time positions because of the cumbersome hiring processes. 

Fully implement the VA MISSION Act — on-time, and in collaboration with veteran’s groups, ensuring community providers are held to the same high standards of care as VA providers and that the direct care system is not weakened by siphoning away money into the private sector. 

We’ll invest in modernizing aging infrastructure and state-of-the-art medical equipment. 

We’ll work to fill gaps in care, benefits, or other services in underserved regions, including on tribal lands; and further integrating federally-qualified health centers, DOD facilities, and the Indian Health System as appropriate.

Read more about Warren’s plan for service members, veterans and military families here:

With Latest North Korean Missile Test, Biden Attacks Trump for Foreign Policy Failures

Former Vice President Joe Biden, in a hotly contested race for President, attacked Donald Trump for his failed foreign policy in the wake of yet another missile test by North Korea. © Karen Rubin/news-photos-features.com

Former Vice President Joe Biden, in a hotly contested race for President, attacked Donald Trump for his failed foreign policy in the wake of yet another missile test by North Korea.  Foreign policy is Biden’s greatest strength among the Democratic rivals for 2020. Here is his statement:

This morning, North Korea fired two missiles in a deliberate attempt to provoke its neighbors and intimidate the United States — again. It was the 12th such test the regime has conducted since May in violation of UN resolutions, and which President Trump has down-played. After the latest round of denuclearization talks collapsed almost immediately in Stockholm earlier this month, these tests are a stark reminder that Donald Trump — a self-proclaimed deal maker — has achieved nothing but a string of spectacular diplomatic failures that are making the American people less safe.    

His “love letters” to murderous dictator Kim Jong Un have delivered little more than made-for-TV moments. North Korea today has more fissile material and more capability than when talks began, and Trump has given away our leverage — including suspending military exercises with our allies and granting Kim co-equal status at two summits with the president of the United States of America — for practically nothing in return. Now a more confident Kim is ticking up the pace of his violations because he believes he can pressure Trump to bend to his will. There is no deal, because there is no strategy and no patience for the kind of tough, hard diplomacy that actually produces results.

It’s a pattern we see over and over again. Donald Trump talks a big game, promises the greatest deal ever, then gives away America’s best negotiating tools in exchange for a photo op for himself. He only cares about his own self-aggrandizement and self-enrichment. And every single time, it’s the American people who end up paying. 

He pulled us out of the successful Iran nuclear deal, promising he’d get a better one. He hasn’t. And now, Iran has taken its nuclear program out of the deep-freeze and ramped up its aggressive acts across the region — and Trump has no strategy to deal with these predictable responses.

He pulled us out of the Paris climate accord and dismisses climate change as a hoax. In less than a week, we will officially notify our departure from Paris, even as California is on fire and states throughout the Midwest are still recovering from record flooding over the summer.

He scuttled negotiations with the Taliban that might have opened the door to a peace settlement, reportedly because he didn’t get the Camp David moment of glory he wanted. Meanwhile he’s significantly weakened our negotiating position by imposing a possibly politically-motivated timeline for removing our troops from Afghanistan, without extracting any concessions from the Taliban in return.

His vaunted Middle East peace deal has yet to emerge. He gave away our strongest asset to take on ISIS by precipitously withdrawing our troops from Northeast Syria. He promised to get tough with China, saying trade wars were “good and easy to win.” But at more than a year in, what do we have to show for it? Nothing but pain for American farming and manufacturing, and vague promises that would only restore trade levels with China back to where they were before Trump’s irresponsible trade war.

The American people can’t afford four more years of Donald Trump’s art of no deals.

Democratic Candidates for 2020: Warren Details How She Would Finance Medicare for All

Sen. Elizabeth Warren, 2020 Democratic candidate for president detailed how she would finance her most controversial proposal, Medicare for All, without increasing taxes on middle class families. © Karen Rubin/news-photos-features.com

Senator Elizabeth Warren, Democratic candidate for President, has released details of her most controversial proposal, Medicare for All, promising that it will cover every person in America with health care, including long-term care, vision and dental, without increasing taxes on middle class families. Warren focuses on an overall restructuring taxes and spending – going after the loopholes and tax cheats and reining in military spending as well as drug costs and cutting healthcare costs by removing the for-profit insurance companies (gatekeepers) as middlemen. What her plan misses, though, is the obvious: collect the Medicare tax (1.45%, plus an extra 0.9% on income over $200,000) on all income, not just wages, and, if necessary raise the surcharge for incomes over $250,000. Interestingly, while employers would no longer pick and choose the private health insurance they subsidize, employers would still subsidize their employees’ Medicare cost. Health care is considered the leading issue for voters in 2020. Here is the detailed plan, from the Warren campaign: –Karen Rubin/news-photos-features.com.

Charlestown, MA – Today, Senator Elizabeth Warren, candidate for President, released her plan to finance Medicare for All. The coverage is identical to the coverage in the Medicare for All legislation in the Senate and it will cover every single person in America with excellent, high-quality health care, including long-term care and vision and dental. 

Elizabeth will pay for this plan without raising taxes one penny on middle class families. Instead, she will put about $11 trillion in the pockets of American families by eliminating what they would pay in premiums, deductibles, co-pays, and other out-of-pocket costs over the next ten years. 

Her numbers add up and are backed by experts including: 

Simon Johnson, the former Chief Economist at the International Monetary Fund and a professor at MIT

Dr. Donald Berwick, one of the nation’s top experts in health system management and improvement, who ran the Medicare and Medicaid programs under President Barack Obama

Mark Zandi, Chief Economist of Moody’s Analytics

Betsey Stevenson, former Chief Economist for the Obama Labor Department

Elizabeth’s plan to dramatically improve health care and cut family costs would cost the United States less than our current broken system. It would require $20.5 trillion in new revenue, nearly half of which comes simply from having employers pay Medicare instead of private insurance companies.

Elizabeth will finance the remainder of Medicare for All with targeted defense spending cuts, new taxes on financial firms, giant corporations, and the richest 1% of Americans, and by cracking down on tax evasion and fraud. The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people — substantially larger than the largest tax cut in American history — and no middle class tax increases.

My daddy’s heart attack nearly sent our family skidding over a financial cliff. Today I think about all the kids this year who will face the double blow of nearly losing a parent and then watching their lives turn upside down as their families struggle to pay a growing stack of medical bills.  

I spent my career studying why so many hard-working middle class families were going broke. For years, my research partners and I traveled the country from bankruptcy courtroom to bankruptcy courtroom, talking directly to people who’d seen their lives turned upside down. We interviewed lawyers, judges, and families involved in bankruptcy cases. To save on printing costs, we lugged around a Xerox machine (I nicknamed him “R2-D2”) to save money on photocopying court records. 

Eventually, we built the largest and most comprehensive database of consumer bankruptcy data ever assembled. That first study surprised us: we found that 90% of families went bankrupt because of job loss, medical problems, and marital disruption. That finding was confirmed in 2007 by my later research, which found that the number one reason families were going broke was health care – and three quarters of those who declared bankruptcy after an illness were people who already had health insurance. 

It’s been nearly thirty years since we published that first groundbreaking study. And after all that time, here’s where we are: between 2013 and 2016, the number one reason families went broke was still because of health care – even though 91.2% of Americans had health insurance in 2016.

Families are getting crushed by health costs. Just look at the numbers. 

$12,378. That’s how much an average family of four with employer-sponsored insurance personally spent per year on employee premium contributions and out-of-pocket costs in 2018. And this figure has increased each year.

87 million. That’s how many American adults in 2018 were uninsured or “underinsured” – meaning either they have no insurance or their so-called health insurance is like a car with the engine missing. It looks fine sitting on the lot, but inadequate if they actually need to use it. Nearly one in every two adults not currently on Medicare has no insurance or unreliable insurance.

37 millionAmerican adults didn’t fill a prescription last year because of costs. 36 millionpeopleskipped a recommended test, treatment, or follow-up because of costs. 40 millionpeople didn’t go to a doctor to check out a health problem because of costs. 57 millionpeople had trouble covering their medical bills. 

Today, in 2019, in the United States of America, the wealthiest nation in the history of the world, inadequate health coverage is crushing the finances and ruining the lives of tens of millions of American families. 

I’m running for President based on a radical idea – calling out what’s broken and speaking plainly about how to fix it. 

All my plans start with our shared values. There are two absolute non-negotiables when it comes to health care:

One: No American should ever, ever die or go bankrupt because of health care costs. No more GoFundMe campaigns to pay for care. No more rationing insulin. No more choosing between medicine and groceries.

Two: Every American should be able to see the doctors they need and get their recommended treatments, without having to figure out who is in-network. No for-profit insurance company should be able to stop anyone from seeing the expert or getting the treatment they need.

Health care is a human right, and we need a system that reflects our values. That system is Medicare for All.

Let’s be clear: America’s medical professionals are among the best in the world. Health care in America is world-class. Medicare for All isn’t about changing any of that. 

It’s about fixing what is broken – how we pay for that care.

And when it comes to health care, what’s broken is obvious. A fractured system that allows private interests to profiteer off the health crises of the American people. A system that crushes our families with costs they can’t possibly bear, forcing tens of millions to go without coverage or to choose between basic necessities like food, rent, and health – or bankruptcy.

We must fix this system. And over the long-term, the best way to achieve that goal is to move from the system we have now to a system of Medicare for All. 

Medicare for All is about where doctors, hospitals, and care providers send the bill – to a collection of private insurance companies who make billions off denying people care or to the Medicare program for fair compensation. Under Medicare for All, everyone gets the care they need, when they need it, and nobody goes broke. 

A key step in winning the public debate over Medicare for All will be explaining what this plan costs – and how to pay for it. This task is made a hundred times harder by powerful health insurance and drug companies that make billions of dollars off the current bloated, inadequate system – and would be perfectly happy to leave things exactly the way they are. 

In 2017 alone, health industry players whose profiteering would end under Medicare for All unleashed more than 2,500 lobbyists on Washington. These industries will spend freely on shady TV ads and lobbying to convince people that a program that saves them massive sums of money will somehow cost them money. That being able to see the doctors and get the treatments they need regardless of what their employer or their insurance company thinks is somehow actually a loss of choice. That a program that covers more services, more people, and costs the American people less than what we currently spend on health care is somehow too expensive.

Meanwhile, where are the 2,500 lobbyists for the people who get sick and can’t pay their medical bills?  Where are the hundreds of millions being spent so that people who are trying to balance a budget around rising health care premiums and growing deductibles and copays can make their voices heard in Washington?  Washington hears plenty from the giant health insurance and giant drug industries, but not so much from families being squeezed to the breaking point.

So let’s focus on families’ expenses and families’ health care. 

Start with the Medicare for All Act – which I have cosponsored. The bill provides a detailed proposal for how to achieve our end goal. But as economists and advocates have noted, the legislation leaves open a number of key design decisions that will affect its overall cost, and the bill does not directly incorporate specific revenue measures. While much of this ambiguity results from the reasonable choice to delegate significant implementation discretion to the Executive Branch, it has also allowed opponents of Medicare for All to make up their own price tags and try to scare middle class families about the prospect of tax increases – despite the conclusions of expert after expert after expert that it is possible to eventually move to a Medicare for All system that gives both high quality coverage for everybody and dramatically lowers costs for middle class families.

The best way to fight misinformation is with facts. That’s why today, I’m filling in the details and releasing a plan that describes how I would implement the long-term policy prescriptions of the Medicare for All Act and how to pay for it. 

Under my plan, Medicare for All will cover the full list of benefits outlined in the Medicare for All Act, including long-term care, audio, vision, and dental benefits. My plan will cover every single person in the U.S., and includes common-sense payment reforms that make Medicare for All possible without spending any more money overall than we spend now. 

My plan reflects careful, detailed analyses from key national experts in health policy, tax policy, and economics. By filling in the details, we can strip away all the misleading political attacks and make plain the choice facing the American people: 

Option 1: Maintain our current system, which will cost the country $52 trillion over ten years. And under that current system – 

24 million people won’t have coverage, and millions can’t get long-term care.

63 million have coverage gaps or substandard coverage that could break down if they actually get sick. And millions who have health insurance will end up going broke at least in part from medical costs anyway. 

Together, the American people will pay $11 trillion of that bill themselves in the form of premiums, deductibles, copays, out-of-network, and other expensive medical equipment and care they pay for out-of-pocket – all while America’s wealthiest individuals and biggest companies pay far less in taxes than in other major countries.

Option 2: Switch to my approach to Medicare for All, which would cost the country just under $52 trillion over ten years. Under this new system –

Every person in America – all 331 million people – will have full health coverage, and coverage for long-term care.

Everybody gets the doctors and the treatments they need, when they need them. No more restrictive provider networks, no more insurance companies denying coverage for prescribed treatments, and no more going broke over medical bills.

The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people. And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases. 

That’s it. That’s the choice. A broken system that leaves millions behind while costs keep going up and insurance companies keep sucking billions of dollars in profits out of the system – or, for about the same amount of money, a new system that drives down overall health costs and, on average, relieves the typical middle class families of $12,400 in insurance premiums and other related health care costs. 

No middle class tax increases. $11 trillion in household expenses back in the pockets of American families. That’s substantially larger than the largest tax cut in American history.

Not every candidate for president supports moving to a system of Medicare for All. Some who support Medicare for All will have different ideas about how to finance and structure it. And everybody knows that there must be a real transition. But you don’t get what you don’t fight for – and my view is clear.  

Every candidate who opposes my long-term goal of Medicare for All should explain why the “choice” of private insurance plans is more important than being able to choose the doctor that’s best for you without worrying about whether they are in-network or not. Why it’s more important than being able to choose the right prescription drug for you without worrying about massive differences in copays. Why it’s more important than being able to choose to start a small business or choose the job you want without worrying about where your health care coverage will be coming from and how much it will cost.

Every candidate who opposes my long-term goal of Medicare for All should put forward their own plan to cover everyone, without costing the country anything more in health care spending, and while putting $11 trillion back in the pockets of the American people by eliminating premiums and virtually eliminating out-of-pocket costs. Or, if they are unwilling to do that, they should concede that they think it’s more important to protect the eye-popping profits of private insurers and drug companies and the immense fortunes of the top 1% and giant corporations, rather than provide transformative financial relief for hundreds of millions of American families. 

And every candidate who opposes my long-term goal of Medicare for All should put forward their own plan to make sure every single person in America can get high-quality health care and won’t go broke – and fully explain how they intend to pay for it. Or, if they are unwilling to do that, concede that their half-measures will leave millions behind.  

And make no mistake – any candidate who opposes my long-term goal of Medicare for All and refuses to answer these questions directly should concede that they have no real strategy for helping the American people address the crushing costs of health care in this country. We need plans, not slogans. 

THE COST OF MEDICARE FOR ALL

A serious conversation about how to pay for Medicare for All requires, first, determining how much such a system would cost. 

In recent years, several economists and think tanks have attempted to estimate the cost of a single-payer system in the United States. Those estimates consider how much our nation’s health care spending will change over a ten year window, and range from a $12.5 trillion decrease to a $7 trillion increase. They also consider how much additional money the federal government would need to fund this system, and those estimates range from a low of $13.5 trillion to a high of $34 trillion over ten years. 

Because nobody can actually see the future, some of this variation results from different assumptions about how parts of our health care system might work differently under Medicare for All. But most of the difference comes from policy choices. And while the Medicare for All Act is clear about some of these choices – for example, generous benefits, long-term care coverage, and virtually no out-of-pocket expenses – it is silent on a number of really important ones. How much will we pay for medical care and for prescription drugs? What do we do with the existing money that states spend on Medicaid? How aggressively will we cut administrative costs? Aggressive choices mean a lower total cost. Less aggressive choices result in a higher total cost. 

Serious candidates for president should speak plainly about these issues and set out their plans for cost control – especially those who are skeptical of Medicare for All. Because whether or not we make modest or transformative changes to our health care system, cancer, diabetes, strokes, Alzheimer’s, and Parkinson’s aren’t going to simply disappear. And without leadership from the top, neither will the mushrooming cost of care in America that’s bankrupting our families. 

I’ve asked top experts to consider the long-term cost of my plan to implement Medicare for All over ten years – Dr. Donald Berwick, one of the nation’s top experts in health system improvement and who ran the Medicare and Medicaid programs under President Obama; and Simon Johnson, the former Chief Economist at the International Monetary Fund and a professor at MIT. Their analysis begins with the assumptions of a recent study by the Urban Institute and then examines how that cost estimate would change as certain new key policy choices are applied. These experts conclude that my plan would slightly reduce the projected amount of money that the United States would otherwise spend on health care over the next 10 years, while covering everyone and giving them vastly better coverage. 

REDUCING INSURER ADMINISTRATIVE COSTS 

The business model of private insurers is straightforward: pay out less for medical care than they take in as premiums. This model is located right in the center of our health care system, wasting huge amounts of time and money documenting and arguing over who is owed what. Incredibly, insurance companies spend a whopping $350 billion on administration costs annually—and then, in turn, push huge additional administrative costs onto hospitals, doctors, and millions of other health care professionals in the from of complex billing—and then, in turn, drive up costs incurred by employers as they attempt to navigate the complexity of providing their employees with insurance.

Medicare for All will save money by bringing down the staggering administrative costs for insurers in our current system. As the experts I asked to evaluate my plan noted, private insurers had administrative costs of 12% of premiums collected in 2017, while Medicare kept its administrative costs down to 2.3%. My plan will ensure that Medicare for All functions just as efficiently as traditional Medicare by setting net administrative spending at 2.3%.

COMPREHENSIVE PAYMENT REFORM 

In 2016, the United States spent nearly twice as much on health care as ten high-income countries, and these costs have been steadily rising for decades, growing from 5.2% of U.S. GDP in 1963 to 17.9% in 2017. But instead of resulting in better health outcomes, Americans have the lowest life expectancy of residents in high-income countries, the highest infant mortality rate, and the highest obesity rates. 

Why? As a group of health economists famously wrote, “It’s the prices, stupid.” 

Studies have continued to show that it’s not how much people use the health care system, often referred to as “utilization,” but rather how much people pay that drives our high spending. Compared to other high income countries, Americans simply pay more for health care. We pay more for physicians and nurses. We pay more in administrative costs. We pay more for prescription drugs. 

A heart bypass surgery that costs nearly $16,000 in the Netherlands costs an average of $75,000 in the United States. A CT scan that costs $97 in Canada costs an average of $896 here. And in the United States, hospitals can charge new parents for holding their newborn after delivery. 

Meanwhile, private equity firms fight bipartisan legislation in Washington that might undermine the profitability of their investments or prevent their hospitals from sending patients surprise bills. And health care CEO salaries continue to soar. Between 2005 and 2015, non-profit hospital CEO salaries increased by 93% to an average of over $3 million, and last year, 62 health care CEOs raked in a combined $1.1 billion – more than the CDC spent on chronic disease prevention. 

If we expect the American people to be able to afford health care, we need to rein in these costs. Comprehensive payment reform, as part of Medicare for All, will reduce this component of health care spending. Under my approach, Medicare for All will sharply reduce administrative spending and reimburse physicians and other non-hospital providers at current Medicare rates. My plan will also rebalance rates in a budget neutral way that increases reimbursements for primary care providers and lowers reimbursements for overpaid specialties. While private insurance companies pay higher rates, this system would be expected to continue compensating providers at roughly the same overall rate that they are currently receiving. Why? This is partially because providers will now get paid Medicare rates for their Medicaid patients – a substantial raise. But it’s also because providers spend an enormous amount of time on billing and interacting with insurance companies that reduces their efficiency and takes away from time with patients. Some estimate that hospitals will spend $210 billion on average annually on these costs. 

The nonpartisan Institute of Medicine estimates that these wasted expenses account for 13% of the revenue for physician practices, 8.5% for hospitals, and 10% for other providers. Together, the improved efficiency will save doctors time and money – helping significantly offset  the revenue they will lose from getting rid of higher private insurance rates.

Under my approach, Medicare for All will sharply reduce administrative spending and reimburse hospitals at an average of 110% of current Medicare rates, with appropriate adjustments for rural hospitals, teaching hospitals, and other care providers with challenging cost structures. In 2017, hospitals that treated Medicare patients were paid about 9.9% less than what it cost to care for that patient. The increase I am proposing under Medicare for All will cover hospitals’ current costs of care – but hospital costs will also substantially decrease as a result of simpler administrative processes, lower prescription drug prices, the end of bad debt from uncompensated care, and more patients with insurance seeking care. 

Of course, as Medicare currently recognizes, not every provider situation is the same, and my Medicare for All program maintains these base rate adjustments for geography and other factors. In my plan for Rural America, for example, I have committed to creating a new designation under Medicare for rural hospitals due to the unique challenges health systems face in rural communities. That’s why my plan allows for adjustments above the 110% average rate for certain hospitals, like rural and teaching hospitals, and below this amount for hospitals that are already doing fine with current Medicare rates.Universal coverage will also have a disproportionately positive effect on rural hospitals. Because people living in rural counties are more likely to be uninsured than people living in urban counties, these hospitals currently provide a lot of uncompensated care. Medicare for All fixes that problem. And I’ve previously laid out additional investments to increase the number of Community Health Centers and grow our health care workforce in rural and Native American communities, while cracking down on anti-competitive mergers that lead to worse outcomes and higher costs for rural communities. 

We can also apply a number of common-sense, bipartisan reforms that have been proposed for Medicare. Today, for example, insurers can charge dramatically different prices for the exact same service based on where the service was performed. Under Medicare for All, providers will receive the same amount for the same procedure, saving hundreds of billions of dollars. We can also make adjustments to things that we know Medicare currently pays too much for – like post-acute care – by adjusting those payments down slightly while accounting for the patient’s health status, bringing health care costs down even more.  

We will also shift payment rates so that we are paying for better outcomes, instead of simply reimbursing for more services. We build on the success of value-based reforms enabled by the Affordable Care Act, including by instituting bundled payments for inpatient care and for 90 days of post-acute care. Instead of paying providers for each individual service, bundled payments reimburse providers for an entire “episode” of care and have been shown to both improve outcomes and control costs. These bundles help ensure that a patient’s different providers all communicate because they are all tied to the same payment.

RESTORING HEALTH CARE COMPETITION

Health care consolidation has also contributed to rising health care costs. One analysis found that over 90% of metropolitan areas had health care provider markets that were either highly concentrated or super concentrated in 2016. And despite the same kinds of empty promises we see every time there’s industry consolidation – in this case, that bigger hospitals would lead to better care – the data have not borne this out. In fact, it’s the opposite: more competition between providers creates incentives to improve care, and that incentive will only increase under a Medicare for All system where quality, not price, is the main differentiator in the system.

Under Medicare for All, hospitals won’t be able to force some patients to pay more because the hospital can’t agree with their insurance company. Instead, because everyone has good insurance, providers will have to compete on better care and reduced wait times in order to attract more patients. 

That’s why I will appoint aggressive antitrust enforcers to the Department of Justice and Federal Trade Commission and allow hospitals to voluntarily divest holdings to restore competition to hospital markets. I’ve also previously committed to strengthening FTC oversight over health care organizations, including non-profit hospitals, to crack down on anti-competitive behavior. And I will direct my FTC to block all future hospital mergers unless the merging companies can prove that the newly-merged entity will maintain or improve care. 

REINING IN OUT-OF-CONTROL PRESCRIPTION DRUG COSTS

Americans pay more for prescription drugs than anyone in the world – $333 billion in 2017 alone. Americans spent $1,220 per person on average for prescription drugs, while the next highest spending country, Switzerland, spent $963 per person. That’s not because Americans use more prescription medication – it’s because lax laws have allowed pharmaceutical companies to charge insurance companies and patients exorbitant rates. In a now-infamous example, when Turing Pharmaceuticals purchased the rights to the HIV medication Daraprim, the company raised the price of this life-saving drug from $13.50 per pill to a stunning $750 per tablet overnight. The price of insulin has skyrocketed, forcing people to risk their lives by rationing. And as prices continue to rise, more Americans are turning to Canada in search of affordable prices. 

Reining in prescription drug costs should be a top priority for any President – and there’s no better way to do it than through Medicare for All. My administration will use a suite of aggressive policy tools to set a net savings target that will bring down Medicare prices for brand name prescription drugs by 70% and prices for generics by 30%, with an initial focus on more expensive drugs. 

Under Medicare for All, the federal government would have real bargaining power to negotiate lower prices for patients. I will adopt an altered version of the mechanism outlined in the Lower Prescription Drug Costs Now Act which leverages excise taxes to bring manufacturers to the table to negotiate prices for both branded and generic drugs, with no drug exceeding 110% of the average international market price, but removes the limit of the number of drugs Medicare can negotiate for and eliminates the “target price” so Medicare could potentially negotiate prices lower than other countries. 

If negotiations fail, I will use two tools – compulsory licensing and public manufacturing – to allow my administration to ensure patient access to medicines by either overriding the patent, as modeled in the Medicare Negotiation and Competitive Licensing Act, or by providing public funds to support manufacturing of these drugs, as modeled in my Affordable Drug Manufacturing Act. Medicare for All will also incentivize pharmaceutical companies to develop the drugs we need – like antibiotics, cancer cures, and vaccines. And it’s not just about driving down drug prices. Making sure patients get important drug therapies up front that keep them healthy and cost a fraction compared to more severe treatment down the line can save money overall. Insurers, who may only cover individuals for a few years of their lives, see those investments in long-term health as a cost they’ll never recoup – so they have a financial incentive to deny patients these treatments. But Medicare for All covers each patient for their entire lifespan. There’s no perverse incentive to deny the prescriptions they need today because the long-term benefits to their health won’t benefit their current private insurance company. 

STEMMING THE GROWTH OF MEDICAL COSTS

Year after year, U.S. health spending has grown at rates above GDP growth, reaching a whopping 17.9% of GDP in 2017. Experts believe the changes to prescription drug spending and value-based payment systems that I’ve already outlined will bring growth rates in line with U.S. GDP, which CBO projects to be an average of 3.9% for the next decade. And if growth rates exceed this rate, I will use available policy tools, which include global budgets, population-based budgets, and automatic rate reductions, to bring it back into line.   

REDIRECTING TAXPAYER-FUNDED HEALTH SPENDING

Through Medicaid and public health plans for state employees, state and local governments play a significant role in financing health care coverage in America. Under my approach to Medicare for All, we will redirect $6 trillion in existing state and local government insurance spending into the Medicare for All system. This is similar to the mechanism that the George W. Bush Administration used to redirect Medicaid spending to the federal government under the Medicare prescription drug program.Under this maintenance-of-effort requirement, state and local governments will redirect $3.3 trillion of what they currently spend to support Medicaid and the Children’s Health Insurance Program and $2.7 trillion of what they currently spend on employer contributions to private insurance premiums for their employees into Medicare for All. Because we bring down the growth rate of overall health spending, states will pay less than they would have without Medicare for All. They’ll also have far more predictable budgets, resulting in improved long-term planning for state and community priorities. 

Together, these policy choices represent significant reductions in health care spending over current levels. Compared to the estimate by the Urban Institute, they will save over $7 trillion over ten years, bringing the expected share of additional federal revenue to just over $26 trillion for that period. After incorporating the $6 trillion we will redirect from states to help fund Medicare, the experts conclude that total new federal spending required to enact Medicare for All will be $20.5 trillion.

PAYING FOR MEDICARE FOR ALL

Medicare for All puts all health care spending on the government’s books. But Medicare for All is about the same price as our current path – and cheaper over time. That means the debate isn’t really about whether the United States should pay more or less. It’s about who should pay. 

Right now, America’s total bill for health care is projected to be $52 trillion for the next ten years. That money will come from four places: the federal government, state governments, employers, and individuals who need care. Under my approach to Medicare for All, most of these funding sources will remain the same, too. 

Existing federal spending on Medicare and Medicaid will help fund Medicare for All.

Existing state spending on health insurance will continue in the form of payments to Medicare – but states would be better off because they’d have more long-term predictability, and they’d pay less over time because these costs will grow more slowly than they do today.

Existing total private sector employer contributions to health insurance will continue in the form of contributions to Medicare – but employers would be better off because under the design of my plan, they’d pay less than they would have otherwise. 

Here’s the main difference: Individual health care spending. 

Over the next ten years, individuals will spend $11 trillion on health care in the form of premiums, deductibles, copays, and out-of-pocket costs. Under my Medicare for All plan, that amount will drop from $11 trillion to practically zero. 

I asked top experts – Mark Zandi, the Chief Economist of Moody’s Analytics; Betsey Stevenson, the former Chief Economist for the Obama Labor Department; and Simon Johnson – to examine options for how we can make up that $11 trillion difference. They conclude that it can be done largely with new taxes on financial firms, giant corporations, and the top 1% – and making sure the rich stop evading the taxes we already have.

That’s right: We don’t need to raise taxes on the middle class by one penny to finance Medicare for All. 

Here’s how it would work.

REPLACING EMPLOYER HEALTH SPENDING WITH A NEW EMPLOYER MEDICARE CONTRIBUTION 

Let’s start with a basic fact: American companies are already paying a lot for health care for their employees. They are projected to pay nearly $9 trillion over the next ten years, mostly on employer contributions for employee health insurance and on health-related expenses for employees under workers’ compensation and long-term disability. My idea is that instead of these companies sending those payments to private insurance companies, they would send payments to the federal government for Medicare in the form of an Employer Medicare Contribution. 

In fact, it’ll be a better deal than what they have now: companies will pay less than they otherwise would have, saving $200 billion over the next ten years. 

To calculate their new Employer Medicare Contribution, employers would determine what they spent on health care over the last few years and divide that by the number of employees of the company in those years to arrive at an average health care cost per employee at the company. (Companies would count part-time employees towards the total based on the number of hours they worked during a year.) Under the first year of Medicare for All, employers would then take that average cost, adjust it upwards to account for the overall increase in national health care spending, and multiply it by their total number of employees that year. Their Employer Medicare Contribution would be 98% of that amount – ensuring that every company paying for health care today will pay less than they would have if they were still offering their employees comparable private insurance. 

A similar calculation would apply to pass-through entities, like law firms or private equity funds, even though many of the people that work there technically aren’t employees. People who are self-employed would be exempt from making Employer Medicare Contributions unless they exceed an income threshold. 

Small businesses – companies with under 50 employees – would be exempt from this requirement too if they aren’t paying for employee health care today. When either new or existing firms exceed this employee threshold, we would phase in a requirement that companies make Employer Medicare Contributions equal to the national average cost of health care per employee for every employee at that company. Merging firms would pay the weighted average cost of health care per employee of the two firms that are merging.  

Employers currently offering health benefits under a collective bargaining agreement will be able to reduce their Employer Medicare Contribution if they pass along those savings to workers in the form of increased wages, pensions, or other collectively-bargained benefits. New companies or existing companies who enter into a collective bargaining agreement with their employees after the enactment of Medicare for All will be able to reduce their Employer Medicare Contributions in the same way. Employers can reduce their contribution requirements all the way down to the national average health care cost per employee. 

That way, my plan helps unions that have bargained for good health care already, and creates a significant new incentive for unionization generally by making collective bargaining appealing for both workers and employers as a way of potentially reducing the employer’s Employer Medicare Contributions.

Over time, an employer’s health care cost-per-employee would be gradually shifted to converge at the average health care cost-per-employee nationally. That helps make sure the system is fair but also gives employers and employees time to adapt to the new system.  

If we’re falling short of the $8.8 trillion revenue target for the next ten years, we will make up lost revenue with a Supplemental Employer Medicare Contribution requirement for big companies with extremely high executive compensation and stock buyback rates.    

There are a variety of ways to structure an employer contribution to Medicare for All. This particular approach has the benefit of helping American employers in a few ways:

Employers would collectively save $200 billion over the next ten years.

Employers receive far more certainty about how their health care costs will vary over time and affect their finances.

Small businesses – who often suffer when competing for employees because they can’t afford to offer health care coverage – would no longer be at a competitive disadvantage against bigger businesses.

Employers can reduce their Employer Medicare Contribution by supporting unionization efforts and negotiating with workers to provide better wages and benefits – reducing costs and promoting collective bargaining at the same time.

Because my plan holds health care cost growth to GDP levels, businesses will have stable balance sheets that grow with the economy instead of crowding out other priorities.

By asking employers to pay a little less than what they are already projected to pay for health care, we can get almost halfway to where we need to go to cover the cost of my Medicare for All plan. 

Automatic Increases in Take-Home Pay 

Medicare for All puts a whole lot of money back in the American people’s pockets. One way it does that is by taking the share of premiums employees are responsible for paying through employer-sponsored insurance – that line on pay stubs each week or month that says “health insurance” – and returning it to working people. Congratulations on the raise! 

And higher take-home pay for workers also means additional tax revenue just from applying our existing taxes – approximately $1.15 trillion if we apply average effective tax rates.  

Medicare for All saves people money in other ways too. With Medicare for All, nobody would need to put money in Health Savings Accounts or medical savings accounts to try and protect themselves against the unthinkable. And because individual spending on premiums, deductibles, copays, and out-of-pocket costs will basically disappear, the tax break for medical expenses in excess of 10% of Adjusted Gross Income becomes irrelevant. Together, those changes would generate another $250 billion in revenue.

All told, another $1.4 trillion in funding for Medicare for All is generated automatically through existing taxes on the enormous amount of money that will now be returned to individuals’ pockets from moving to a Medicare for All system with virtually no individual spending on health care. 

Here’s what that means: we can generate almost half of what we need to cover Medicare for All just by asking employers to pay slightly less than what they are projected to pay today, and through existing taxes.  

So where does the rest of the money come from that allows us to eliminate premiums, deductibles, copays, and most out-of-pocket spending for every American? Four sources: (1) better enforcement of our existing tax laws so we stop letting people evade their tax obligations; (2) targeted taxes on the financial sector, large corporations, and the top 1% of individuals; (3) my approach to immigration; and (4) shutting down a slush fund for defense spending. 

CRACKING DOWN ON TAX EVASION AND FRAUD

The federal government has a nearly 15% “tax gap” between what it collects in taxes what is actually owed because of systematic under-enforcement of our tax laws, tax evasion, and fraud. If that 15% gap persists for the next ten years, we will collect a whopping $7.7 trillion less in federal taxes than the law requires. By investing in stronger enforcement and adopting best practices on tax reporting, withholding, and filing, experts predict that we can close the tax gap by a third – generating about $2.3 trillion in additional federal revenue without a single new tax. 

A big part of our current tax gap problem is that we’re letting wealthier taxpayers get away with paying less than what they owe. Studies show that the wealthiest 5% of taxpayers misrepresent their income more frequently than the bottom 90%. 

The wealthy and their allies in Washington have worked to slash the IRS budget, leaving it without the resources it needs. The agency today has about the same number of revenue agents as it did when the economy was one-seventh its current size in the 1950s. And the IRS insists on targeting low-income taxpayers rather than wealthy ones, even though the amount of revenue we can recover from wealthy taxpayers is far more. 

We know how to fix this problem. We can draw lessons from what works in other countries with much lower tax gaps and rely on the recommendations of tax experts. Here’s a game plan:

Substantially increase funding for the IRS, including the Criminal Investigation Division. The Treasury Department estimated in its Fiscal Year 2017 budget request that every $1 invested in IRS enforcement brings in nearly $6 in additional revenue – not even including an indirect deterrence effect three times that amount.

Expand third-party reporting and withholding requirements. Research shows that third-party reporting and withholding cuts down on the tax misreporting rate substantially.

Strengthen enforcement of the Foreign Account Tax Compliance Act (FATCA). FATCA requires foreign financial institutions to report the holdings and income of U.S. taxpayers, but the IRS is generally not systematically matching these reports to individual tax returns. We also don’t hold foreign financial firms truly accountable for ignoring their reporting obligations. Automatically matching FATCA reports to tax returns and instituting sanctions for non-compliant foreign financial institutions would help narrow the tax gap.

Simplify tax filing obligations in line with other comparable countries with lower tax gaps, including by adopting my Tax Filing Simplification Act and using “smart returns” to improve honest reporting.

Redirect enforcement resources away from low-income taxpayers towards high-income taxpayers. 

Increase the nonfiler compliance program, strengthen reporting requirements for international income, use existing currency transaction reports to enforce cash income compliance, and increase reporting requirements for virtual- or crypto-currencies, as suggested by the Treasury Department’s Inspector General.

Allow employees who disclose tax evasion and abuse to use the protections of the False Claims Act and other whistleblower protections. 

The experts who reviewed these ideas estimated that if we implemented them, we could close the tax gap by one-third from 15% to 10%, bringing us closer to the tax gap in countries like the United Kingdom (5.6%). That will produce another $2.3 trillion in net federal revenue – without imposing a single new tax. 

TARGETED TAXES ON THE FINANCIAL SECTOR, LARGE CORPORATIONS, AND THE TOP 1% 

We can generate a whole lot of the remaining revenue we need for Medicare for All just by eliminating bad incentives in our current tax system and asking those who have done really well in the last few decades to pay their fair share.

Let’s start with the financial sector. It’s been more than ten years since the 2008 financial crisis, and while a lot of families are still dealing with the aftereffects, the financial sector is making record, eye-popping profits. Meanwhile, the risk of another financial crisis remains unacceptably high. By imposing targeted taxes and fees on financial firms, we can generate needed revenue and also make our financial system safer and more secure.

For example, a small tax on financial transactions – one-tenth of one percent on the sale of bonds, stocks, or derivatives – would generate about $800 billion in revenue over the next ten years. The tax would be assessed on and collected from financial firms, and would likely have little to no effect on most investors. Instead, according to experts, the tax could help decrease what Americans pay in fees for their investments and reduce the size of relatively unproductive parts of the financial sector. 

We can also impose a fee on big banks that encourages them to take on fewer liabilities and reduce the risk they pose to the financial system. A small fee that applies only to the forty or so largest banks in the country would generate an additional $100 billion over the next ten years – while making our financial system more safe and resilient. 

Next, we can make some basic changes to ensure that large corporations pay their fair share and to fix some fundamental problems with our current approach that actually encourage companies to shift jobs and investment overseas. These changes will generate an estimated $2.9 trillion over the next ten years. 

For instance, our current tax system lets companies deduct the cost of certain investments they make in assets faster than those assets actually lose value. That means that if a company buys a machine for a million dollars, it gets to deduct a million dollars from its taxes that same year – even if the machine only loses $100,000 in value a year. Letting the company write off the extra $900,000 all at once is like giving them an interest-free loan from the government. 

That might be worth it if the company responded to this tax break by investing more and building out their businesses. But the data suggest this isn’t happening because companies don’t actually value these tax deferrals as much as policymakers assume. Companies are mostly making the same investments they would’ve made anyways – sometimes with small changes in timing – and getting a write-off in exchange. Some experts even suggest that accelerated expensing could induce less domestic investment, not more. 

That’s why I’m proposing to get rid of this loophole. Under my plan, businesses will still write off the depreciation of their assets – they’ll just do it in a way that more accurately reflects the actual loss in value. This would generate $1.25 trillion over ten years.

We can also stop giant multinational corporations from calling themselves American companies while sheltering their profits in foreign tax havens to avoid paying their share for American investments. 

Currently, a U.S. multinational corporation can make billions in profits and attribute it to a company it set up in a tax haven like the Cayman Islands, which has no corporate taxes. The Trump tax bill claimed to address that problem by creating a global minimum tax rate for corporations, but that minimum tax – the result of heavy lobbying by multinationals – is too low and easily gamed. While Trump and congressional Republicans claimed their minimum tax would keep companies from shifting profits to tax havens and limit offshoring, the opposite is happening. The current approach both encourages companies to shift their profits to tax havens and actually incentivizes American companies to outsource their operations overseas. 

That’s why I’m proposing to institute a country-by-country minimum tax on foreign earnings of 35% – equal to a restored top corporate tax rate for U.S. firms – without permitting corporations to defer those payments. Under my plan, corporations would have to pay the difference between the minimum tax and the rate in the countries where they book their profits. For example, an American corporation booking a billion dollars in profits in the Cayman Islands, taxed at 0% there, would need to pay the federal government a 35% tax rate – the difference between the new minimum rate (35%) and the foreign rate (0%) – on the billion dollars in profits. 

My plan would also collect America’s fair share of profits that foreign companies make by selling their products to Americans. Today, we have a “global tax deficit”: companies that sell their goods abroad don’t have to pay the extra taxes that they would have to pay if they were subject to a minimum effective tax rate in each country they operated in. Making U.S. firms pay a country-by-country minimum tax effectively collects their whole global tax deficit – but foreign companies should have to pay their fair share, too. That’s why I’m proposing that the U.S. collect the fraction of this global tax deficit that corresponds to the percentage of that company’s sales in the U.S. In other words, if a foreign company should owe an additional $1 billion in taxes if it were subject to a country-by-country minimum tax, the U.S. would collect a fraction of that $1 billion based on the amount of sales that company made in the United States. 

Together, the country-by-country minimum tax and the taxation of foreign firms based on their domestic sales would result in an additional $1.65 trillion in revenue. 

Finally, we can raise another $3 trillion over ten years by asking the top 1% of households in America to pay a little more. 

The tax burden on ultra-millionaires and billionaires is less than half that of working families in the United States. In 2019, the bottom 99% of families will pay 7.2% of their wealth in taxes, while the top 0.1% of households will pay just 3.2%. My Ultra-Millionaire Tax, a 2-cent tax on the wealth of fortunes above $50 million, tackles this head on. Under this tax, the top 0.1% – the wealthiest 75,000 Americans – would have to pitch in two cents for every dollar of net worth above $50 million and three cents for every dollar on net worth over $1 billion. With this version of the Ultra-Millionaire Tax in place, the tax burden on the wealthiest households would increase from 3.2% to 4.3% of total wealth – better, but still below the 7.2% that the bottom 99% are projected to pay.

Today, I’m going one step further. By asking billionaires to pitch in six cents on each dollar of net worth above $1 billion, we can raise an additional $1 trillion in revenue and further close the gap between what middle-class families pay as a percentage of their wealth and what the top one-tenth of one percent pay. 

Yes, billionaires will have to pay a little more, but they will still likely pay less than what they would earn just from putting their assets into an index fund and doing nothing. The average annual rate of return of the S&P 500 has regularly topped 10%. And billionaires have access to the kinds of fancy investment opportunities that can generate even higher returns on average. Put it this way – should we ask billionaires to pitch in an extra three cents on every dollar above $1 billion, or force middle-class families to bear another $1 trillion in health care costs?

We can also change the way the government taxes investment income for the top 1%. Today, taxes are only assessed on capital gains when securities are sold. That means wealthy investors can put their money in the stock market, see it grow, and not pay a dime in taxes on those earnings unless or until it is taken out of the market. Under the current system, they can then pass along those shares to their heirs when they die and their heirs will be able to pay even less when they choose to sell.

I’ve already proposed closing that loophole for how capital gains are treated when shares are passed on to heirs. But we can go a step further. Under “mark-to-market” system for the wealthiest 1% of households, we will tax capital gains income (excluding retirement accounts) annually, rather than at the time of sale, and raise the rates on capital gains to match the tax rates for labor income. Individuals would still only pay taxes on gains and could use current losses to offset future taxes.

Under this system, investment income will no longer be treated differently than labor income for the top 1% of households. Ultra-millionaires and billionaires won’t be able to earn income on giant fortunes year after year without paying a penny in taxes. And we can raise another $2 trillion over ten years to pay for my Medicare for All plan.

IMMIGRATION REFORM 

I support immigration reform that’s consistent with our values, including a pathway to citizenship for undocumented immigrants and expanded legal immigration consistent with my principles. That’s not only the right thing to do – it also increases federal revenue we can dedicate to Medicare for All as new people come into the system and pay taxes. Based on CBO’s analysis of the 2013 comprehensive immigration reform bill, experts project that immigration reform would generate an additional $400 billion in direct federal revenue. 

REINING IN DEFENSE SPENDING 

Since the attacks of 9/11, the United States has appropriated $2 trillion to fund combat and counterterrorism operations around the world via the Overseas Contingency Operations fund, or OCO. On average this spending has amounted to $116 billion per year – and in total, an amount equivalent to nearly 10 percent of all federal discretionary spending over that same time period. 

Republicans – including the President’s current Chief of Staff – and Democrats alike agree that OCO is a budget gimmick that masks the true impact of war spending. The emergency supplemental funding mechanism was never intended to fund the costs of long-scale, long-term operations outside of the normal appropriations process. And in recent years, OCO has also been used to fund so-called “base” requirements unrelated to the wars, outside of the Budget Control Act caps – in effect acting as a slush fund for increased Pentagon spending. And as everything from more F-35s to massive bombs never used in combat have migrated into the OCO account, the Department of Defense has been spared from having to prioritize or live within its means. It’s not just bad budgetary practice – it’s wasteful spending. 

I’ve called out this slush fund for what it is. I’ve also called for an end to endless combat engagements in places like Afghanistan, Iraq, and Syria, and to responsibly bring our combat troops home from these nations. These open-ended commitments are not necessary to advance American foreign policy or counterterrorism interests, their human cost has been staggering, and their financial cost has created a drag on our economy by diverting money better invested in critical domestic priorities. 

I’ve also called to reduce defense spending overall. The Pentagon budget will cost more this year than everything else in the discretionary budget put together. That’s wrong, and it’s unsustainable. We need to identify which programs actually benefit American security in the 21st century, and which programs merely line the pockets of defense contractors – then pull out a sharp knife and make some cuts. 

We can start by shutting down this slush fund and balancing with our overall defense priorities in the context of the actual defense budget. And as we end these wars, eliminating the Overseas Contingency Operations fund and forcing the Pentagon to fund any such priorities through its regular budgetary process will provide $798 billion over the ten-year period relative to current spending levels. 

As I have said repeatedly, under my Medicare for All plan, costs will go up for the very wealthy and big corporations, and costs will go down for middle-class families. I will not sign a bill that violates these commitments. And as my plan to pay for Medicare for All makes clear, we can meet these commitments without a tax increase on the middle class – and, in fact, without any increase in income taxes at all. 

America’s middle class is facing a crisis. For a generation, wages have remained largely flat while family costs have exploded. I’ve spent decades sounding the alarm about it. I’m running for President to fix it. That means doing whatever we can to reduce the overall strain on family budgets. 

Medicare for All can be a huge part of the solution. When fully implemented, my approach to Medicare for All would mark one of the greatest federal expansions of middle class wealth in our history. And if Medicare for All can be financed without any new taxes on the middle class, and instead by asking giant corporations, the wealthy, and the well-connected to pay their fair share, that’s exactly what we should do.

ACHIEVING MEDICARE FOR ALL

Of course, moving to this kind of system will not be easy and will not happen overnight. This is why every serious proposal for Medicare for All contemplates a significant transition period. 

In the weeks ahead, I will propose a transition plan that will specifically address how I would use this time to begin providing immediate financial relief to struggling families, rein in out-of-control health care costs, increase coverage, and save lives. My transition plan will take seriously and address substantively the concerns of unions, individuals with private insurance, hospitals, people who work for private health insurers, and medical professionals who worry about what a new system will mean for them. It will also grapple directly with the entrenched political and economic interests that would spend freely, as they have throughout modern American history, to influence politicians and try to frighten the American people into rejecting a plan that would save them thousands of dollars a year on premiums and deductibles while making sure they can always see the health care providers they need with false claims and scare tactics.  

But there’s a reason former President Barack Obama has called Medicare for All a good idea. There’s a reason the American people support it. It’s because when it comes to the cost of health care, we are in the middle of a full-blown crisis. 

We are paying twice as much as any other major nation for care – even as tens of millions lack coverage, and even as family after family sees its finances destroyed by a health issue. And the American people know that in the long-term, a simple system that covers everybody, provides the care they need when they need it, puts $11 trillion back in their pockets and uses all of the public’s leverage to keep costs as low as possible is the best option for their family budgets and for the health of their loved ones.

As President, I’ll fight to get it done.

Read the plan here
Read expert letter on cost estimate of Medicare for All here 
Read expert letter on financing Medicare for All here
Calculator here

Biden: Baghdadi Was Win for National Security Professionals But Trump’s Reckless Foreign Policy Makes Nation Vulnerable to Terrorism

Vice President Joe Biden on the assassination of ISIS leader Abu Bakr al-Baghdadi, praised the skill and commitment of our military, intelligence, and national security professionals “beyond compare,” but criticized Donald Trump saying, “He has no strategy for securing our nation against terrorist threats. He has no strategy for anything. Every day that Donald Trump directs American national security is a dangerous day for the United States.” © Karen Rubin/news-photos-features.com

Vice President Joe Biden, candidate for the 2020 candidate for President, issued a statement criticizing Trump’s “lack of strategy to secure our nation against terrorist threats.”

The successful operation to take Abu Bakr al-Baghdadi off the battlefield was a win for American national security. And it’s an important reminder of the skill and commitment of our military, intelligence, and national security professionals. They are beyond compare. 
 
I’m glad President Trump ordered the mission. But as more details of the raid emerge, it’s clear that this victory was not due to Donald Trump’s leadership. It happened despite his ineptitude as Commander-in-Chief. 

It’s been reported that Trump’s reckless decision to withdraw our troops from northern Syria forced the planning for the mission to be accelerated and the timeline compressed. His erratic behavior made it harder and more dangerous for the special forces carrying it out. And they had to fly through territory that is now hostile to the U.S., taking fire along the way—including territory we controlled just weeks ago. 

Trump has also made it less likely we will be able to successfully replicate a mission like this in the future. The operation leveraged a limited presence of U.S. counterterrorism capabilities in the region, which he keeps trying to dismantle. It was made possible by the work of intelligence professionals, who he has relentlessly attacked. It relied on allies he has belittled, undermined, and in some cases betrayed and abandoned.  

Trump’s total disregard for our alliances and partnerships endanger any future intelligence sharing or cooperation. In fact, the first people he saw fit to thank after our brave troops were the Russians and the Iranian-backed Syrian government. All this makes us less safe and less prepared for whatever terrorist leader emerges next.
 
And make no mistake, the threat is not gone. One man does not constitute an organization, and Trump has opened a path for ISIS to reconstitute itself under new leadership by withdrawing troops from the region. In doing so, he has given up our best asset to keep the pressure on ISIS during a dangerous period of organizational chaos. His fixation on keeping troops in the region to defend the oil fields betrays his true priorities—profit seeking—and will surely serve as a tool for future terrorist recruitment. And with his decision to slash humanitarian assistance to the region, it’s more likely that ISIS will be able to insinuate itself back into areas where we had successfully rooted it out. 

There is a difference between deploying hundreds of thousands of U.S. troops to the Middle East indefinitely, and keeping small numbers of special operations and intelligence assets in place to maintain local partnerships and keep pressure on terrorists. That’s the smart, strong, and sustainable strategy we pioneered during the Obama-Biden Administration. That’s the effective policy we put in place, which laid the groundwork to end ISIS’s territorial caliphate. That’s the way we built the very relationships that ultimately delivered this victory.
 
Now, Trump wants to tear it all down and walk away.
 
He has no strategy for securing our nation against terrorist threats. He has no strategy for anything. Every day that Donald Trump directs American national security is a dangerous day for the United States. 

Democratic Candidates for 2020: Sanders Releases Proposal to Insure Corporations Pay Fair Share of Taxes, Workers Get Ownership Stake

Bernie Sanders for President rally, Queens, New York. Senator Sanders unveiled a plan for make corporations pay their fair share of taxes and give workers an ownership stake in companies where they work, end corrupt corporate mergers and break up monopolies.  © Karen Rubin/news-photos-features.com

The vigorous contest of Democrats seeking the 2020 presidential nomination has produced excellent policy proposals to address major issues. Senator Bernie Sanders, long a crusader to end corporate influence and corruption in the political system, unveiled his “Money Out of Politics” Plan. He has expanded upon it to detail how he would end corporate greed and corruption, ensure corporations pay their fair share of taxes and give workers an ownership stake in companies where they work, end corrupt corporate mergers and break up monopolies. This is from the Sanders campaign:

WASHINGTON – Sen. Bernie Sanders unveiled a plan to end corporate greed and corruption, ensure corporations pay their fair share of taxes, give workers an ownership stake in the companies where they work, end corrupt corporate mergers and break up monopolies.

“For more than 40 years, the largest and most profitable corporations in America have rigged the tax code and our economy to redistribute wealth and income to the richest and most powerful people in this country,” said Sen. Sanders.  “The American people are saying enough is enough. They are sick and tired of companies like Amazon, General Motors and Chevron making billions in profits, but paying nothing in federal income taxes.  Under this plan, we will demand that profitable corporations pay their fair share of taxes.  We will give workers an ownership stake in the companies they work for.  And we will start breaking up some of the largest and most powerful companies in America to lower prices for consumers, help small business and make markets competitive.”    

Bernie’s plan, the boldest and most comprehensive corporate accountability plan in modern presidential history, would bring an end to the era of unchecked corporate greed and return power to American workers.  

As President Bernie would: 

Give Workers an Ownership Stake in Corporate America and End Corporate Greed

Give workers 20 percent of shares in their companies and 45 percent of the seats on their corporate boards.

Ensure all workers and savers have the right to vote the shares they own.

Give workers the right to purchase factories or offices they are employed in from companies that decide to put them up for sale or shut them down.

Establish a U.S. Employee Ownership Bank to provide low-cost financing to employees who want to start their own businesses.

Make large-scale stock buybacks illegal. 

Require companies to provide shares of stock to workers who lose their jobs as a result of outsourcing or automation.

Break Up Monopolies and Make Markets Competitive 

Review all Trump administration mergers and undo improper mergers.

Reinvigorate the Federal Trade Commission to break up conglomerates and monopolies and institute clear, strong merger guidelines.

Establish caps for vertical mergers, horizontal mergers, and total market share.

Ban mandatory arbitration clauses and non-compete clauses that trap workers in low-wage jobs and strip them of their legal rights. 

Make Large Corporations Pay Their Fair Share of Taxes

Repeal all of Trump’s corporate tax breaks

Restore the corporate tax rate to 35% from 21%. 

Ensure that corporations pay 35% by eliminating virtually all corporate tax breaks and loopholes.

Eliminate the use of offshore tax havens by:

Requiring corporations with revenues over $25 million to publicly disclose significant portions of their tax returns and country by country financial information including earnings, financial accounts, and tax payments in other countries. 

Eliminating the 20% deduction on pass-through business income and requiring large pass-through businesses to be subject to corporate taxes.

If this plan had been in effect last year, instead of paying nothing in federal income taxes:

Amazon would have paid up to $3.8 billion in taxes.

Delta would have paid up to $1.8 billion in taxes.

Chevron would have paid up to $1.6 billion in taxes.

GM would have paid up to $1.5 billion in taxes.

The top ten percent of Americans today own an estimated 97 percent of all capital income,  including capital gains, corporate dividends, and interest payments. Since the 2008 Wall Street crash, 49 percent of all new income generated in America has gone to the top one percent. The three wealthiest people in our country now own more wealth than the bottom 160 million Americans.  And the richest family in America – the Walton family, which inherited about half of Walmart’s stock – is worth $200 billion and owns more wealth than the bottom 42 percent of the American people.

The full plan can be read here

Democratic Candidates for 2020: Senator Warren Details Plan to Restore Trust in the Federal Judiciary

Senator Elizabeth Warren holds campaign rally in Washington Square Park, NYC.
Warren’s proposals to restore trust in the federal judiciary are particularly noteworthy in light of widespread concern that the judiciary has been politicized © Karen Rubin/news-photos-features.com

With Attorney General William Barr facing criticism for his direct involvement in extorting Ukraine to engage in a bogus investigation intended to harm Democratic candidate for 2020 Vice President Joe Biden and opening a criminal investigation into the intelligence officers in the CIA and FBI who initially investigated and exposed Russian meddling in the 2016 Election and contacts with the Trump campaign, Senator Elizabeth Warren’s proposals unveiled earlier this month to restore trust in the federal judiciary are particularly noteworthy in light of widespread concern that the judiciary has been politicized. This is from the Warren campaign:

Charlestown, MA – Senator Elizabeth Warren detailed how she will strengthen the ethical integrity and impartiality of the federal judiciary. Her plan will ensure that judges do not hear cases where they have conflicts of interests, strengthen our nation’s ethics rules for judges, and ensure accountability for judges who violate these rules.

Under her plan, investigations into judicial misconduct could continue even when a judge resigns from office or is elevated to the Supreme Court. This provision would allow the judiciary to reopen the investigations into Alex Kozinski, Maryanne Trump Barry, Brett Kavanaugh, and any other judge who benefited from this loophole.

In December 2017, more than 15 female law clerks alleged that Ninth Circuit Judge Alex Kozinski committed sexual misconduct and created a “hostile, demeaning and persistently sexualized environment” for employees. According to their accounts, Kozinski inappropriately touched female clerks and showed them pornography in his chambers. 

It wasn’t the first time he was accused of misconduct. But what did Judge Kozinski do when the judiciary started to investigate? He retired.

And because of inadequate ethics laws, the investigation ended immediately. Meanwhile, Kozinski continues to collect his taxpayer-funded pension for life.

The Kozinski case is just one example of the broader problem of accountability in the federal judiciary.

Donald Trump’s sister Maryanne Trump Barry ended an investigation into the Trump family’s potential tax fraud and other tax schemes by resigning from the bench.

Justices Clarence Thomas and Antonin Scalia did not recuse themselves from Citizens United v. FEC, the case that opened an avalanche of money in politics to the benefit of people like the Koch brothers, who invited the pair to multiple all-expenses paid retreats.

And several judges have ruled on cases while owning stock in a company that was a party to the case, violating existing conflicts-of-interest rules that expressly prohibit this practice.

The basic premise of our legal system is that every person is treated equally in the eyes of the law – including judges. Our judiciary only functions properly when it lives up to this promise, and it risks eroding its legitimacy when the American people lose faith that judges are ethical and fair-minded.

That’s why today I’m announcing my plan to strengthen the ethical integrity and impartiality of the federal judiciary. It’s time to ensure that judges do not hear cases where they have conflicts of interests, strengthen our nation’s ethics rules for judges, and ensure accountability for judges who violate these rules.

Recusing Judges and Supreme Court Justices with Conflicts of Interest.

In 2011, Eleventh Circuit Court of Appeals Judge James Hill ruled in favor of Johnson & Johnson in a case brought by a woman who suffered from a malfunctioning medical implant. He did so while owning as much as $100,000 in the company’s stock. The same judge ruled on three other cases involving companies in which he owned stock – and ruled in favor of the company each time. Judge Hill, unfortunately, is not alone: one study identified 24 cases in which judges owned stock in a company that appeared before them in court.

A basic principle of our federal judicial system is that judges make decisions as disinterested, impartial observers – stepping aside when they may not be able to decide cases objectively. This principle should also bar judges from being the final arbiter of whether they can be objective in the first place. 

It’s time for fundamental reform:

Prohibit judges from deciding for themselves whether they should recuse from a case due to a conflict. When a litigant believes that a judge cannot consider a case in an unbiased manner, the litigant may file a recusal motion asking for another judge to decide the case instead. But our current system gives judges enormous discretion to decide for themselves whether to grant recusal motions where their objectivity is challenged. My plan will instead empower the Chief Judges within regional circuits to establish a binding recusal process. It will also require courts to publish its reasons any time judges are disqualified from a case without a recusal motion, including when judges voluntarily recuse or when an automated conflict-checking software disqualifies them. 

Ban judges from owning or trading individual stocks. It’s not enough for judges like James Hill to recuse in cases with conflicts of interest – my plan would eliminate the appearance of impropriety by banning federal judges from owning or trading individual stocks, while allowing them to instead invest in conflict-free mutual funds or open new investment accounts managed by the Federal Retirement Thrift Investment Board. Law firms follow rules like these to avoid the appearance of financial conflicts with the interests of their clients. Judges should certainly be held to the same standard.

Require Supreme Court Justices to provide written explanations of recusal decisions when a litigant challenges for recusal. If a Supreme Court Justice has a conflict of interest, they are ethically obligated to recuse themselves from considering a case, but the law allows them to deny recusal motions without even providing an explanation. Under my plan, when a party asks for a Justice to recuse, the Judicial Conference will issue a non-binding, public advisory opinion with its recommendation – and the challenged Justice will publicly explain their final recusal decision in writing. Because all recusal decisions will be a matter of public record, future litigants will understand these conflicts and know when to bring recusal decisions of their own.

Strengthening Ethics Rules for All Judges.

Every lawyer in America is subject to ethics rules. Federal judges are generally subject to a Code of Conduct that applies the most basic of these principles to members of the judiciary.

But there is no Code of Conduct for Supreme Court Justices.

That means that Supreme Court Justices can go on trips with litigants, like Justice Scalia did when he heard a case involving Vice President Cheney after going hunting with him – without an independent ruling on whether it was proper to do so. It means Justices can receive large speaking fees and all-expenses paid trips to fancy conferences, like Justice Thomas did when the Federalist Society, an extremist right-wing legal group, flew him to Palm Springs and paid for meals and transportation for four days. And it means that someone like Brett Kavanaugh can face accusations of lying to Congress – without a full and fair investigation by the judiciary. These actions could violate the Judicial Code of Conduct, but because unlike all other federal judges these Justices are not bound by a code of ethics, they are immune from any judicial investigations into misconduct. 

We must act now to fix this – and that means strengthening the Code of Conduct for all judges.

Here’s where I would start:

Extend the Code of Conduct to Supreme Court Justices. When Judge Kavanaugh was elevated to the Supreme Court, 83 ethics complaints that had been lodged against him were dismissed – and because the Supreme Court is not covered by a Code of Conduct, no procedure exists to file new complaints. Questions are often raised about the behavior of Supreme Court Justices, such as Justice Thomas’s 13 years of financial disclosures that failed to list $690,000 in payments to his wife from the Heritage Foundation, a right-wing judicial activist group – but these actions are beyond the scope of current rules. Enough. My plan applies the Code of Conduct for United States Judges to Supreme Court Justices – and places the Judicial Conference in charge of violations. My plan also allows individuals to file complaints against Supreme Court Justices, just like they can against all other federal judges.  

Strengthen the Code of Conduct to ensure a fair and impartial judiciary. When judges accept gifts or financial contributions from interested parties, public trust in a fair-minded judiciary erodes. My plan strengthens the Code of Conduct so that judges generally cannot receive paid speaking fees or all-expenses-paid trips from outside organizations. To ensure that judges continue to interact with the public without the appearance of impropriety, my plan also establishes a modest fund to help cover reasonable expenses.

Real Enforcement for Judicial Misconduct.

When a lawyer violates the ethics rules, their state’s judiciary can investigate their behavior and impose disciplinary punishment, including stripping their licence to practice law.

But the panels of judges that investigate judicial conduct complaints have limited disciplinary power beyond asking the judge to voluntarily resign or asking the House of Representatives to consider impeachment proceedings – a request the House is free to ignore. 

It’s time for real accountability for judges. Here’s how we’ll start:

Continue investigations into judicial misconduct even when a judge resigns from office or is elevated to the Supreme Court.

In 2016, Federal District Court Judge Walter Smith faced a judicial investigation into allegations of sexual harassment of court employees and drinking on the bench while presiding over cases. Judge Smith resigned, and the complaints filed against him were dismissed. 

My plan extends the authority of the Judicial Conference to former judges so that individuals under investigation cannot simply resign from the bench to avoid accountability. This provision would allow the judiciary to reopen the investigations into Alex KozinskiMaryanne Trump-BarryBrett Kavanaugh, and any other judge who benefited from this loophole.

Provide strong disciplinary authority to judicial ethics watchdogs, including the ability to strip non-vested taxpayer-funded pensions from judges.

Under today’s rules, even if retired judges could be investigated, the Judicial Conference has no meaningful tools to discipline them. American taxpayers are paying for the more than $180,000-per-year retirement pay of Judge Smith, Judge Kozinski, Judge Trump-Barry, and several other judges who left office during investigations into their behavior. We need to restore real accountability within our judiciary. 

That’s why my plan provides disciplinary tools to the Judicial Councils and their parent organization, the Judicial Conference, including the ability to strip sitting or retired judges of their non-vested pension benefits by making retirement pay for new judges explicitly contingent on the absence of serious misconduct. In addition to strengthening these disciplinary tools, my administration will also work to prevent judicial misconduct against employees and law clerks by supporting strong climate surveys, questionnaires to court employees about the work environment in our federal courts, to help the judiciary understand how to improve the culture within our courts.

Create a new, fast-track impeachment process for federal judges who commit impeachable offenses. 

The Constitution reserves the impeachment of judges for only the most egregious offenses. But when a judge commits a serious offense or ethical violation, we need to make sure that there is a prompt investigation – and that Congress takes action.

It’s time to fast-track the process for judges who commit impeachable offenses. My plan would strengthen the process to certify that a judge may have committed an impeachable offense, and would ensure that any impeachment referrals will trigger a series of automatic rules under which the House Judiciary Committee will conduct a thorough investigation and vote without unnecessary delay. These reforms will ensure that judges who commit serious, impeachable offenses will more likely be promptly removed from office.

These changes will not only allow us to ensure accountability for bad actors, including reopening inquiries into the conduct of offenders like Brett Kavanaugh. They will also hold the vast majority of judges who act in good faith to the highest ethical standards, and in the process, begin to restore accountability and trust in a fair and impartial federal judiciary.

Read more about her plan here:  

Democratic Candidates for 2020: Sanders Releases Plan to Get Corporate Money Out of Politics

Bernie Sanders for President rally, Queens, New York. Senator Sanders, long a crusader to end corporate influence and corruption in the political system, unveiled his “Money Out of Politics” plan. © Karen Rubin/news-photos-features.com

The vigorous contest of Democrats seeking the 2020 presidential nomination has produced excellent policy proposals to address major issues. Senator Bernie Sanders, long a crusader to end corporate influence and corruption in the political system, unveiled his “Money Out of Politics” Plan. This is from the Sanders campaign:

WASHINGTON – Sen. Bernie Sanders unveiled his Money Out of Politics Plan, a comprehensive proposal to end all corporate influence and corruption in the political system. 

“Our grassroots-funded campaign is proving every single day that you don’t need billionaires and private fundraisers to run for president,” Sanders said. “We’ve received more contributions from more individual contributors than any campaign in the history of American politics because we understand the basic reality that you can’t take on a corrupt system if you take its money. Working people all over the country are responding to that message and demanding a political revolution through their small dollar donations. When we win the Democratic nomination and defeat Donald Trump, we will transform our political system by rejecting the influence of big corporate money.” 

Sanders’ plan will end the greed-fueled, corrupt corporate influence over elections, national party convention, and presidential inaugurations.  

In 2016, seventeen donors gave three-quarters of the Democratic National Convention funding, with large corporations like Comcast, Bank of America and Facebook donating millions. At the 2013 Presidential inauguration, corporate donors including, AT&T, Microsoft, and Chevron donated millions.  

As the Democratic nominee, Sanders would ban all corporate contributions to the Democratic Party Convention and all related committees, and as President he would be ban all corporate donations for inaugural events and cap individual donations at $500.  

Additionally, Sanders’ plan would abolish the now-worthless FEC and replace it with the  Federal Election Administration, a true law enforcement agency originally proposed by former Senators John McCain and Russ Feingold.  

Other key elements Sanders’ Money Out of Politics Plan include:

Enacting mandatory public financing laws for all federal elections. 

Updating and strengthen the Federal Election Campaign Act to return to a system of mandatory public funding for National Party Conventions. 

Passing a Constitutional Amendment that makes clear that money is not speech and corporations are not people.

Ending the influence of corporations at the DNC.

Banning donations from federal lobbyists and corporations. 

Institute a lifetime lobbying ban for National Party Chairs and Co-Chairs

Banning Chairs and Co-Chairs from working for entities with federal contract, that are seeking government approval for projects or mergers, or can reasonably be expected to have business before Congress in the future. 

Banning advertising during presidential primary debates.

Instituting a lifetime lobbying ban for former members of Congress and senior staffers. 

​​​​​​​The full plan can be found here