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Presidential hopefuls for the 2020 election need to establish their health care reform plans now

The announcements this week by California Sen. Kamala Harris and South Bend, Ind., Mayor Pete Buttigieg that they are seeking their party’s nomination for president in the 2020 election brings the number of Democratic candidates — so far — to nine. But as far as health care is concerned, it’s already 2021 for them. How is that possible? Because presidential candidates are formulating their health care positions right now and, if elected, those positions will heavily influence any health care reform the future president makes in 2021.

Health care is so politically fraught — witness the last nine years of furious combat over the Affordable Care Act — that newly elected presidents who want to do big things, whether it’s expanding or constraining coverage, have to move when their power is at its zenith: the moment they step away from the inaugural podium.