Democratic candidate Pete Buttigieg proposes to expand access to health care in rural areas by implementing a "Medicare for All Who Want It" approach. | Ethan Miller/Getty Images Democratic candidates policies How Pete Buttigieg would overhaul rural health

Democratic presidential candidate Pete Buttigieg on Friday rolled out a sweeping plan to expand access to health services in rural communities, while addressing drug addiction and tackling rising maternal mortality rates across the country.

“We need to lift rural communities up as places of opportunity, both for this generation and future ones. That work begins with securing the health of all rural residents,” Buttigieg, the mayor of South Bend, Ind., said in a statement.



What would the plan do?




Buttigieg proposes to expand access to health care in rural areas by implementing a "Medicare for All Who Want It" approach and increasing federal subsidies for plans sold through the Obamacare exchanges. He aims to beef up the health workforce through loan forgiveness programs and proposes increasing Medicare reimbursement rates specifically for providers in underserved communities.

The plan also addresses mental health addiction and maternal mortality. It invests in telehealth and attempts to tackle health disparities across rural communities.



How would it work?



Buttigieg says he would expand access to medical care by offering a form of Medicare through the exchanges that anyone could purchase — a proposal he made earlier in the campaign that separated his ideas on health care from other candidates' single payer proposals.

To build up the rural health workforce, his new proposal would expand the Public Service Loan Forgiveness Program, which currently requires employment by government or non-profits, to include private or for-profit hospitals and practices in rural areas. He also wants to expand the size of the Conrad 30 waiver program, which waives the requirement that foreign doctors on J-1 visas return to their home countries for two years before re-entering the United States if they commit to working for a period of time in underserved or rural areas.

Buttigieg’s plan says it will ensure “universal access” to effective addiction and mental health treatment, and will enforce parity laws that require insurers to cover mental health care at the same level they do other medical care. The plan says the candidate will release a more detailed proposal on addiction and mental health soon.

To address the rising rates of pregnancy-related deaths, Buttigieg says he will ensure coverage and access to reproductive health care and family planning services by increasing funding for Title X family planning and by preserving Medicaid expansion under the Affordable Care Act as well as the ACA’s Essential Health Benefits, which require Medicaid and exchange plans to cover pregnancy and maternity care. He also supports proposals on Capitol Hill that would expand Medicaid to new moms up to one year postpartum.

The plan would address health disparities in rural areas by increasing funding for public health infrastructure and by empowering Medicare and Medicaid to reimburse providers for addressing social determinants of health. Buttigieg also would expand high-speed broadband internet access across the country by the end of his first term — details to be outlined in a forthcoming plan.



What are the weaknesses in the proposal?



The plan does not say how much it will cost, but it’s likely to be a high — and a potential nonstarter for conservatives on Capitol Hill.

It’s unclear how Buttigieg would further enforce mental health parity laws that have been in effect for a decade and still are not always followed. Legislation he supports to expand Medicaid coverage to new mothers for up to a year lacks momentum in Congress.



What have other Democrats proposed?





Joe Biden and Michael Bennet’s rural health proposals include a public option. Biden also proposes expanding access to broadband, and Bennet calls for loan forgiveness of up to $10,000 per year for health providers working in underserved rural areas.

Bennet, Amy Klobuchar and Elizabeth Warren have all proposed new investments to fight drug addiction and address mental health. Bennet, Cory Booker, Kirsten Gillibrand, Kamala Harris, Bernie Sanders and Warren have policy platforms or have co-sponsored legislation aimed at lowering maternal mortality rates.

