Single-payer could be key issue for Iowa Democratic caucus-goers

Health policy differences between Democratic presidential hopefuls Hillary Clinton and Vermont Sen. Bernie Sanders could be a deciding factor in Monday night's Iowa presidential caucuses.

Sanders supports a Medicare-for-all type plan that would provide universal coverage, though he has released only a sketchy outline of his proposal. He says he would fund it by raising taxes.

Clinton favors improving the Affordable Care Act with measures to reduce cost-sharing and make drugs more affordable. She says Sanders' plan isn't affordable or politically feasible. She has alienated some liberal Democrats for rejecting their preferred single-payer approach.

Clinton and Sanders are about even in most Iowa polls, while Sanders is ahead in New Hampshire, which will hold its primary on Feb. 9. Clinton tops Sanders in national polls.

Mack Shelley, department chairman of political science at Iowa State University, said Sanders' single-payer coverage plan is an important element in his appeal to Iowa voters.

“He uses that issue to communicate both his political position and his devotion to principles,” said Henry Aaron, a senior fellow at the Brookings Institution.

Meanwhile, Clinton, who long ago favored the single-payer approach, is likely to stick to her fix-the-ACA strategy. “It would be imprudent to appear to be switching positions based on election returns,” Aaron said.

The Republican candidates rarely address healthcare issues other than to denounce Obamacare and call for its repeal.