Deval for All
January 29, 2020

Deval Patrick Unveils Reform Agenda

Agenda Addresses Immigration, Civil and Human Rights, Criminal Justice, Gun Safety, Health Care, Taxes, and Veteran's Services

 

BOSTON, MA - Former Governor Deval Patrick today announced his Reform Agenda: policies to repair the government systems so that they align with our values and enable the American Dream. The agenda includes proposals on immigration, civil and human rights, criminal justice, gun safety, health care, taxes, and veteran's services. The Reform Agenda draws on Governor Patrick’s track record from his time as Governor of Massachusetts, and articulates a bold vision for the future.
 
“My Reform Agenda is about making meaningful fixes to big systems that consistently fail to meet modern needs, and have long excluded some Americans.” Governor Patrick said. “Consistent with my record as Governor, my administration will fix these broken systems so that they enable, instead of impair, the American Dream and align with our core values of equality, opportunity, fair play.”
 
The agenda builds on Governor Patrick’s record of results as Governor of Massachusetts. The agenda proposes building on the Affordable Care Act with a public option to ensure access to universal, affordable health care coverage and strengthening coverage for mental health and addiction services. The plan explains how the Patrick Administration will honor the contributions and talent of American service members and their families by improving employment and health care support for veterans, revitalizing the VA, and expanding access to mental health services across the board. The agenda outlines how the Patrick Administration will unwind the Trump and Bush tax cuts that have benefited the wealthy. The administration’s tax plan will treat capital gains like taxable income, increase the estate tax, and increase the corporate tax rate.
 
The Patrick Administration will reform the criminal justice system to end mass incarceration, institute retroactive reforms to sentencing laws, and productively reintegrate individuals who have completed their incarceration. The Agenda also details Governor Patrick’s proposal for strong, common-sense gun laws to stop dangerous people from purchasing firearms, and banning assault weapons altogether. The plan includes a number of proposals to protect and expand civil and human rights, especially those of LGBTQ+ Americans, so that America is governed by laws that more accurately reflect its defining values.

 

Read the full plan here.

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https://medium.com/@DevalPatrick/the-reform-agenda-fda7a2a1af5c

The Reform Agenda

A Reform Agenda is about making meaningful fixes to big systems that consistently fail to meet modern needs and have long excluded some Americans. My administration will reform these big systems so that they align with our fundamental values: equality, opportunity, fair play.

This means a health care system that provides universal access to high-quality, low-cost health services everywhere and for every single individual. It means an immigration system that provides human dignity and border security, and that encourages the determined and creative whose values align with ours to make their home here. And it means, among other things, a justice system that focuses on preparing people to re-enter responsible life instead of just warehousing them.

Consistent with my track record as Governor of Massachusetts, we will fix these systems so that they align with our values and enable, instead of impair, the American Dream.

This agenda includes proposals designed to reform the interconnected systems set out below. Reforms to other areas of governance — such as solutions to address the climate crisis and fixes to our democratic institutions — are addressed in our Opportunity and Democracy Agendas.

• A Compassionate and Modern Immigration System
• Gun Safety Solutions
• Fairness in Criminal Justice
• Civil and Human Rights
• Universal Access to Affordable Health Care
• Simple, Fair, and Adequate Taxes
• Thriving Veterans, Service Members, and Military Families

A Compassionate and Modern Immigration System

Immigrants enrich our economy and invigorate our society. Nearly half of the country’s biggest companies were founded by an immigrant to the United States, or the child of an immigrant. America deserves an immigration system that assures human dignity as well as a secure border, encourages the determined and creative whose values align with ours to make their home here, and welcomes those refugees who have come to our shores in hope and desperation.

Our administration will modernize our system to provide work authorization to students who complete their studies in the United States; smoother, more transparent, more secure and predictable visa application processes and enforcement; and a recommitment to our historic openness to refugees and new Americans. Rather than caging children and demeaning families, we will support comprehensive immigration reform that provides a path to citizenship for undocumented residents of our country, Dreamers and others in the country without legal status. We must also secure our borders and other ports of entry, but with more modern, more effective and less ham-fisted ways than a physical wall.

A top priority from the start of our administration will be to undo the un-American policies pursued by the Trump administration at the southern border with Mexico. We will immediately move to more humane ways of processing refugees, starting with reuniting child refugees with their families. We will take steps to improve and support the asylum process, including by increasing the number of immigration judges. And we will overhaul how immigration enforcement is done in this country, creating a culture within the enforcement agencies consistent with our values and our newly reformed laws.

Evolve and Improve Legal Immigration
America benefits by welcoming and integrating new immigrants into our workforce and talent pool. And we must not turn our back on America’s historic commitment to immigration. Each year, the United States welcomes over one million new lawful permanent residents, who invigorate our economy and strengthen our society.

• Modernize Naturalization. To support new Americans, we will improve the visa process, ending the endless backlog that frustrates the dreams of so many aspiring Americans and pushes others into illegal border crossings rather than legal processes. We will make naturalization more affordable and more attractive for eligible permanent residents.
• Streamline the Visa System. We will expand the employment-based visa system and allow for more flexibility in response to shifting priorities in the economy. We will also address the backlog of family-based visas and increase the annual allotment for family reunification visas.

National Integration
Our entire immigration system must be rebuilt with the purpose of integrating new citizens into full participation in the American Dream. As discussed in our Democracy Agenda, we will reinvent civics education, citizenship courses, and other efforts to promote American values and belonging.

• We need a national policy focused on ensuring that New Americans are fully integrated into our social fabric and full participants in our economy.
• In 2008, as Governor I issued an executive order to create a statewide plan for integrating new Americans and immigrants into the economic and social life of the Commonwealth. We will do the same at the federal level and open an Office of New Americans in the White House to coordinate a comprehensive suite of programs and opportunities designed to positively integrate new Americans into our nation and our workforce. This will include expanded support for English language education, and new attention given to the unique challenged faced by foreign-born professionals.

Create a Pathway to Citizenship
America must have a fair and orderly process for the 11 million undocumented people living within our borders to become citizens of our country. On average, each of these undocumented migrants has been in our country for 15 years. Our economy and our society suffers by forcing millions of immigrants to live in the shadows, preventing them from fully contributing as members of society.

• Comprehensive Reform. We must establish a formal legal process that puts these individuals on a path to citizenship while also ensuring that we never again end up with a substantial portion of our population living here without legal immigration status. I will work with Congress to make that happen, building on the framework of the 2013 bipartisan “Gang of Eight” proposal.
• Reinforce DACA and Protect Dreamers. Short of a legislative solution, the federal government should not deport the children of un-documented parents who have lived their entire lives in the United States. And I would immediately instruct immigration authorities to prioritize deportation only for those undocumented immigrants convicted of a violent offense, while working with Congress on a comprehensive solution.

Restore American Values at the Border
End the inhumane and un-American immigration policies that have resulted in thousands of families being separated and the denial of basic human rights. We will restore compassion and dignity alongside a respect for the rule of law at the Southern border. Our administration will focus on:

• Border Integrity with Compassion and Common Sense. A nation requires borders, and our borders must be secure. There are smart, efficient ways to enforce border security such as surveillance drones and camera systems that don’t require militarizing a massive swath of the country or wasting money on a “wall” that does nothing.
• We will overhaul the culture and priorities of all the relevant enforcement agencies, including ICE, to prepare it for this new mission. Our border patrol and detention officers must treat refugees and asylum seekers with dignity or leave the force. Our administration will give clearer guidelines for asylum, consistent with the larger project of comprehensive immigration reform. Border patrol will prioritize ending human trafficking and other illegal activity rather than the harassment of refugees and families desperate for a better life.
• Reverse Ineffective Executive Orders. Immediately reverse through executive order the current administration’s “Remain in Mexico,” family separation policies, and the Muslim Ban.

Reform the Asylum Process and Protect Refugees
At a time of global crisis and instability, when refugees are being forced from their countries by desperation, America has responded by cutting the cap for refugees from over 100 thousand to 45 thousand. We should immediately raise the cap to the maximum amount we can reliably process, protect, and integrate into our country.

• Fix the Asylum Process. There is currently a backlog of 850 thousand cases with only 450 judges to handle them. We will at least double the number of new judges and substantially increase resources to process asylum applications so that asylum seekers are assured due process. On the southern border, we will ensure that each asylum-seeker receives due process and legal representation — and that asylum claims are heard by asylum officers, not enforcement agents.
• Confront the Regional Challenge. We will organize a comprehensive regional effort to address the violence in Central America that is causing millions of people worldwide to flee their homes in the first place. Working with allies and our diplomatic corps, we will establish a strategy to stabilize countries like Honduras, El Salvador, and Guatemala.

Gun Safety Solutions

America needs better gun safety measures. We must end the epidemic of gun violence in this country. Doing so requires a comprehensive and common-sense set of policies designed to reduce gun violence and protect our most vulnerable citizens.

At a minimum, that means universal background checks and a ban on assault weapons and retrofits like bump stocks, coupled with a voluntary buyback initiative. And it requires vastly expanded and consistent support for research into the causes and sources of gun violence, including the particular challenge of mental health.

Nation-Leading Gun Safety Record

Universal Point-of-Sale Background Checks for Gun Purchases
Dangerous people should not be allowed to purchase firearms, period. We will create a single, unified database for tracking who is too dangerous to own a firearm and step up enforcement of current background checks. We should regulate guns like we do cars, and establish a nationwide licensing system for gun owners.

• We will permanently close the various legal loopholes that allow guns to reach the wrong hands. We will close the “Charlestown Loophole” to ensure that the FBI has time to complete every necessary background check. We will close the “boyfriend loophole” to prevent domestic abusers from gaining firearms.
• We will support states that pass extreme risk or red flag laws, and work with Congress to end the gun industry’s legal immunity for the dangers introduced by the weapons they manufacture.

Ban Assault Weapons
Assault weapons are aptly named — they are designed to violently assault other people. These weapons are used by criminals and terrorists to kill or harm innocent victims. They should not be for sale in America. As President, I will work with Congress to ban assault weapons.

• As necessary, our administration will provide monetary incentives in return for assault weapons to take these firearms out of circulation. We will also restrict the sale of high-capacity magazines that serve as the ammunition for assault-style weapons.

Ghost Guns. Target enforcement and regulatory effort to crack down on untraceable, dangerous “ghost” guns built from kits or made with 3D printers.

Coordinated Response. Assemble an inter-agency taskforce, led by a White House office or official, to coordinate and lead a government-wide effort to address gun violence and safety. This taskforce will be charged with working with states and local communities to design a comprehensive strategy to protect schoolchildren from mass shootings.

Address Root Causes
We will advance an all-out strategy to address the root causes of gun violence, above and beyond access to firearms. I will direct new funding to sponsor research into the nexus between mental health issues and violence, and sponsor programming to de-stigmatize mental health issues. In addition, we will:

• Reintroduce, re-implement and build upon the Obama administration’s 2016 gun control measures, such as the firearm safe storage rule.
• Ban the Tiahrt amendments preventing the government from disclosing data on firearm traces.
• Spark innovation in gun violence research by kicking off a competitive grant-making competition at the NIH and/or CDC to seed the marketplace for the best ideas in solving gun violence.

Fairness in Criminal Justice

Gov. Patrick signs a bill making it easier for offenders to reintegrate and find productive work.
America needs a justice system that focuses less on warehousing people than on preparing them to re-enter productive life. We will achieve a more just system of criminal justice by eliminating racial disparities and providing the imprisoned with a meaningful opportunity to return to society, while ensuring that our communities remain safe and victim rights are protected.

Our country incarcerates too many people, including a disproportionate number of people of color. We are failing ourselves by not investing in rehabilitation, education, and job training programs so that the formerly incarcerated are prepared to reintegrate successfully. And our approach makes no economic sense, as we spend far more to warehouse people rather than to find alternatives that provide a pathway to a productive life for people who have paid their debt to society.

Our system should not punish people for race, mental health disorders including addiction, poverty or youth. An end to private prisons, mass incarceration, and the criminal prohibition on marijuana, a revival of parole earned through good behavior and acquisition of life skills and other programs to prepare the incarcerated for their release, treating those dealing with substance use disorders as patients instead of criminals, and sentencing reform that provides non-violent drug offenders a real chance at re-entering society through diversion, restorative justice and other alternatives to incarceration are all elements of this agenda.

Criminal Justice Results

Eliminate Mandatory Minimum Sentencing
Our country’s mass incarceration of its citizens — particularly of black and brown people — is a profound injustice and a policy failure. Federal sentencing rules — especially mandatory minimums — have been disastrous in many communities and entrenched systemic, racial injustices. These laws need to change, and mass incarceration must end.

We will build on the FIRST STEP Act and other efforts to scale back mandatory minimum sentencing and guidelines that remove sentencing discretion, and work to make the FIRST STEP Act’s reforms retroactive, through the Pardon Power if necessary.

Our administration will:

• End the crack/cocaine sentencing disparity;
• Expand efforts to divert individuals with mental health and substance use disorders away from the criminal system;
• Expand efforts to divert first-time non-violent offenders in diversion and other restorative justice programs;
• Accelerate efforts at the Department of Justice to exercise clemency and Pardon Power to secure release of individuals serving excessively long sentences for non-violent crimes or others who no longer present a danger to the public;
• End the practice of basing sentences upon conduct for which a defendant was acquitted; and
• Make all reforms effective retroactively.

Eliminate the Death Penalty
The Patrick Administration will impose an immediate moratorium on the death penalty, will commute all federal sentences of death to life imprisonment, and will push for legislation repealing the death penalty at the federal level. We will also combat abuses of the death penalty at the state level. Specifically, we will work with Congress to restore meaningful federal review of state death penalty cases, by repealing federal limitations on the writ of habeas corpus. Further, the Patrick Administration will use every tool at its disposal to prevent states from carrying out executions using cruel and experimental means, including by reversing the Trump Administration’s refusal to regulate the importation of death penalty drugs.

Reform Plea Bargaining
The overwhelming majority of criminal cases end not with a trial but with a plea bargain. Too often, defendants feel pressure to plead guilty not because of the merits of their case, but because of structural imbalances in the plea-bargaining, charging, and sentencing process. The Patrick Administration will combat this by imposing meaningful guidelines on federal prosecutors’ use of plea bargaining to make sure defendants are not punished for exercising their right to trial.

End Private Prisons
The Patrick Administration will cancel federal contracts with private prisons and fully end federal reliance on private vendors in incarceration. Since 2000, the number of people housed in private prisons by the Federal Bureau of Prisons has increased seventy-seven percent. It is time to stop allowing for-profit corporations to make money off of our criminal justice system. We will support legislation to ban private prisons throughout the United States, and will also support efforts by states to reduce reliance on private vendors in incarceration, including predatory companies that overcharge prisoners for basic services like phone calls.

End Felon Disenfranchisement and Restore Rights for the Incarcerated
Restore voting rights to citizens who have been convicted of a crime, completed their sentence of incarceration, and returned to society. Further, we should restore Pell Grant access to people who have completed their term of incarceration.

End the School to Prison Pipeline
We must permanently disrupt the pipeline leading students from schools to incarceration. I will direct the Education Department to lead efforts to end zero-tolerance discipline policies in public schools. We will work with states to limit the role of police in school discipline, and reduce the reliance on invasive surveillance systems in schools except where necessary for student security.

Decriminalize Marijuana
Remove marijuana from the list of Schedule I drugs, repeal laws making it a federal offense to possess it, and make those changes retroactive.

• Any change in our marijuana laws must be coupled with (i) equity for those currently incarcerated for marijuana offenses, (ii) additional research into, and awareness about, the effects of using marijuana, and (iii) support for legal marijuana entrepreneurs in communities disproportionately affected by criminal marijuana enforcement.

Support State-level Reform
Through competitive grants and direct funding, support sentencing reform and criminal justice reform at the state level. With 88 percent of all prisoners being held at the state level, no criminal justice reform at the federal level will be near sufficient unless it makes meaningful reform here. The Patrick Administration will expand federal support for alternatives to incarceration programs and efforts to end cash bail. We will:

• Form a Department of Justice initiative to partner with elected and appointed state prosecutors and judges around the country seeking to reform criminal justice and exercise prudent discretion, and share best practices;
• Ensure that criminal justice reforms are evidence-based and effective at both substantially reducing the rate of incarcerated as well as reducing actual crime; and
• End the school-to-prison pipeline by reforming juvenile justice and improving prevention and awareness efforts. Building on my “Raise the Age” work, create incentives for states to address young adult crime in a way that aligns with brain science, and separate young adults from adult prisons.

Fund Mental Health and Addiction Treatment Programs
We must end the legacy and practice of criminalizing mental health and addiction disease. For too long, those struggling with these illnesses have been mistreated and ignored by our criminal justice system. As President, I will end this practice and increase investments in diversion and treatment programs. I will also ensure that those battling addiction and mental health issues have access to the resources they need before they interact with our criminal justice system. We must also expunge the criminal records of those previously convicted of low-level, non-violent drug offenses.

Invest in Early Intervention Programs
We should invest in programs that support people — especially our youth — before they interact with our criminal justice system. We should ensure that schools are able to provide support programs for troubled youth, including social work and counseling services. We should invest in community centers that provide after school programs so that children have an enriching and safe place to go.

Invest in Rehabilitation and Re-Entry Programs
My administration will increase our investments in programs that lift people up and provide them with the support and training necessary to reenter society. These should include job training programs so that individuals have the skills needed to find gainful employment to support themselves, their families, and help grow local economies. We also need to tackle the lack of affordable housing so that everyone can have a safe place to call home. These investments will lower the rates of recidivism and help people get their lives back on track.

• “Ban the box” on employment applications and reduce the time following the completion of a sentence after which criminal records can be expunged.

End the Criminalization of Poverty
We need to end the practice of detaining people because of their inability to pay court fines and fees. Your freedom and the justice you receive should not depend on your financial resources. As part of this, my administration will support nationwide bail reform.

Diversify Our Judiciary
We should have a judiciary that reflects the diversity of our nation. I will appoint judges from diverse backgrounds and experiences so that our criminal justice system reflects talent in every community.

Increase Funding for the Public Defender System
We must guarantee the constitutional promise of a right to counsel in criminal cases by increasing funding for our public defender system. Our public defenders are overworked and underpaid. We must increase our investments in this program to ensure that justice does not depend on your ability to pay for legal counsel.

Create a New Presidential Commission on Criminal Justice Reform
These policies should only be the beginning of the process to purge our system of injustice and prejudice, of broken lives, failed outcomes, and a severe — and, unfortunately, often well-earned — lack of trust. I will create a new Presidential Commission to study what we have been doing wrong for half a century that’s led to the current system, and what must be done at a federal, state and local level beyond the current slate of proposals suggested today to finally do what’s necessary to restore justice to all Americans. I will model the commission off of proposals such as the bipartisan bill introduced by Senator Kamala Harris and others as the National Criminal Justice Commission Act of 2017.

• Importantly, the Commission will be tasked with looking into conditions of confinement, investigating prisons where conditions are deplorable and abusive — becoming counterproductive to the very task of our criminal justice system.

Civil and Human Rights

Protecting and expanding civil and human rights is the means by which America bears allegiance to its defining values of equality, opportunity, and fair play. Accordingly, the Patrick Administration will support vigorous enforcement of existing civil rights laws, through sufficient funding and other resources for all responsible agencies, plus collaboration between federal agencies and state and/or local authorities, and updating, together with the Congress, our entire suite of civil rights laws and regulations to assure they meet modern needs.

As head of the Justice Department’s Civil Rights Division under President Clinton, and a civil rights lawyer for the NAACP Legal Defense Fund, I have been on the frontlines of achieving justice for the poor, for minority communities, and those who have traditionally been marginalized.

At the Justice Department, I co-led the investigation of arsons at black churches across the South — overseeing what was at the time the largest federal criminal investigation in American history. I defended voting rights laws against legal challenges, and prosecuted excessive use of force by police.

I will bring that same perspective and commitment to the Presidency, and will ensure that my administration defends and protects the civic and human rights of all persons.

On Dr. Martin Luther King Jr. Day, Governor Patrick launched his Equity Agenda for Black Americans, proposing specific commitments to address the barriers to opportunity, wealth, justice and equality that Black Americans continue to experience, and that as a result continue to make the American experiment incomplete. Click here to learn more.

Fight Hate Crimes and Domestic Terrorism, and Enforce Civil Rights
In order to stem rise of racist violence against African Americans, Jewish Americans and other minority groups, and the retreat from civil and human rights, my administration will:

• Strengthen hate crime laws and condemn hate speech in all its forms, setting a tone of respect for all and the rejection of white supremacy from the White House throughout the federal government.
• Hold social media platforms accountable for the proliferation of the most provocative hate speech and shut down the dark web where hate groups organize and acquire and distribute illegal contraband is sold.
• Direct the Justice Department to investigate, disrupt and prosecute domestic terrorism with a comprehensive and coordinated strategy across federal agencies, and require federal agencies to collect and report on domestic terrorism.
• Direct the Justice Department, the EEOC and all related agencies and offices to investigate and pursue all violations of civil rights laws prohibiting discrimination in employment, education, housing, etc.

Restore Trust in Law Enforcement
To put an end to police misconduct and the reliance on overly-aggressive tactics in black and brown communities, we will:

• Establish a national standard governing the use of force in policing, and introduce new mandatory training in use of force and de-escalation.
• Direct the Justice Department to impose accountability in local law enforcement and collect richer data on underlying police interactions.
• Update and support community policing models on local police forces, with sufficient numbers of personnel to walk neighborhoods and build relationships with members of community.

Champion the Equal Rights Amendment
As President, I will lead a state-by-state effort to finally ratify the Equal Rights Amendment to ensure equal treatment, regardless of gender identity. My Justice Department will take all necessary steps to lay the groundwork for, and appropriately enforce, the requirements of our newest Constitutional obligations.

Diversify our Judiciary
We should have a judiciary that reflects the diversity and richness of our nation. I will appoint exceptional judges with diverse backgrounds and life experiences to enhance the quality of our judicial system and ensure fairness under the law.

LGBTQ+ Leadership and Equality

Equal Protection from Discrimination
Today, federal law does not expressly prohibit an employer from firing a person, or a landlord from terminating a tenant, because of someone’s gender identity or sexual orientation. And twenty-eight states do not otherwise offer that protection. We will work with Congress to push for immediate passage of the Equality Act, which would amend existing civil rights laws to explicitly ban discrimination on the basis of sexual orientation and gender identity in many areas, including employment, health care, housing, education, public places, and all federally-funded services. My administration will take all appropriate steps to make sure that the rights of LGBTQ+ Americans are fully protected by federal laws.

• We will rescind the Trump Administration’s rules and executive orders stripping LGBTQ+ Americans of legal protections, and replace those rules with new ones that adequately protect the rights, safety, and livelihoods of members of the LGBTQ+ community.
• This will mean, among other things, reinstating and strengthening the Education Department’s guidance to schools on transgender student rights. We must also make it easier for transgender and non-binary people to secure identification (such as passports), use government services, and participate in elections.
• We will step up enforcement of existing discrimination provisions — such as the non-discrimination provisions of the ACA — and ensure that agencies like the EEOC and Department of Justice are fully engaged in protecting LGBTQ+ Americans from discrimination.
• My Department of Justice will resist attempts by some states and private citizens to cloak discrimination against LGBTQ+ Americans in the guise of exercising religious liberty.

Repeal the Transgender Servicemember Ban
I will reverse the Trump Administration spiteful and irrational ban on transgender individuals serving in the military on Day One. My administration will work with the armed forces to ensure that new transgender members of the military are fully integrated into the armed forces and treated with dignity.

Immigration, Citizenship, Asylum
Our administration will assemble a taskforce to ensure that our immigration, naturalization, and asylum processes are attentive to the unique needs of the LGBTQ+ community. We will also expand support for LGBTQ+ refugees fleeing persecution in their home countries, and earn U.S. global leadership on LGBTQ+ human rights.

Ban Conversion Therapy
We will push for a nationwide legislative ban on the harmful and absurd practice of “conversion therapy,” and will take all appropriate executive actions before Congress acts to prevent any federal dollars or support from reaching providers who engage in this discredited practice.

Mental Health
Through enforcement and regulations, we will work to end disparities in mental health care that disproportionately affect members of the LGTBQ+ community.

Stop Violence Against Transgender People
We will establish a new taskforce or unit at the Department of Justice to aggressively combat violent attacks on transgender individuals — and will have more to say about this important area of reform when we launch our comprehensive strategy for combating hate crimes.

HIV/AIDS
We will re-establish the White House Office of National AIDS Policy. That office will take the lead on:

• Expanding access to life-saving preventive drug regimens like pre-exposure prophylaxis (PrEP);
• Working with the health care community and the public, through awareness campaigns, to end the stigma associated with HIV/AIDS;
• Ramp up other preventative strategies and services, including access to condoms; and
• Invest resources, time, and energy in discovering a cure for HIV/AIDS.

Universal Access to Affordable Health Care

Affordable, Universal Care
Governor Patrick is committed to delivering a health plan for every American.

The best way to get there is with a public option that builds on the Affordable Care Act (ACA), one that is free to some and low cost to others, and that could even be modeled on Medicare. And we will engage a broad coalition of stakeholders, from health providers and policymakers to patient advocates and labor to refine and propose improvements as we learn — the very formula that made it possible in Massachusetts to deliver health insurance to nearly 99% of Massachusetts residents.

Under our plan no one will be at risk of receiving a surprise bill or being forced into bankruptcy due to costs associated with a medical need.

We will build on the ACA to deliver real reform to fix a largely broken healthcare system — lowering drug prices, expanding mental health coverage, and reversing the Republican erosion of Medicare and Medicaid. Our guiding focus will be to help American families thrive — not merely to achieve a political slogan or check a box.

Health Care Results
Expand Access to Public Healthcare Plans
Every American deserves access to affordable healthcare. My administration will work with Congress to create a robust and accessible public option to compete with private plans modeled on Medicare. Such an option will be affordable to working families and free for the poor. Just like other options on the health insurance exchanges, the public option will meet the minimum coverage standards, so no American will go without essential health benefits. And we will expand those standards, so families have access to coverage for behavioral health, substance abuse disorder, and dental care.

My administration will roll out a step-by-step administrative plan, supplemented where necessary by legislation, to create a public option based on Medicare. We will:

• Improve and build on Medicare, enhancing dental, mental health, and substance abuse coverage, and capping out-of-pocket costs;
• Merge Medicaid into Medicare, eliminating work requirements and enabling all citizens in all states immediate access to affordable care;
• Increase support for enrollment marketing and mechanisms to make sure that every American is covered by an affordable private plan or a strong public one; and
• Expand the tax credits and subsidies available to low-income individuals to make health plans affordable.

Reduce the Cost of Care
As Governor, I signed groundbreaking legislation in Massachusetts to help crack the code on ever-increasing costs in the health care system. As President, I will continue the fight to manage down the cost of good health care by focusing on the broken features of our system.

• Control High-Cost Drug Prices. We will work with Congress and the private sector to provide the government new leverage in negotiating drug prices, through a combination of increased negotiating flexibility and new standards — without compromising the industry’s ability to innovate. All involved parties need to come to the table with solutions that don’t come at the expense of the consumer. That’s why, as President, I will support legislation that empowers the federal government to negotiate prices for common drugs and high cost new-to-market drugs. Drug companies will need to prove the drug’s value and establish a mechanism for determining return.
• Public vs. Private Competition. The public option will be more cost effective to the government and affordable to consumers. The competitive tension between the private and public systems will force insurers to reduce the cost of insurance, and improve offerings overall. Our administration will push for transparency in hospital pricing and insurer reimbursements, to drive competition and lower overall cost.
• Control Cost Growth. As Governor of Massachusetts, I introduced and signed legislation that successfully slowed the rapid growth of health care costs in Massachusetts. I intend to introduce a similar health care cost growth benchmark to Congress based on health care expenditure data and tied to Gross Domestic Product. These measures will build and expand on the work we did in Massachusetts, where it has yielded results.
• End Surprise Billing. No one receiving needed care should be faced with unexpected, high cost bill when receiving care at a hospital. I support legislative proposals to limit surprise billing while ensuring that providers receive adequate payment for services they provide. We can, and should, learn from providers that have voluntarily adopted such reforms, and include a fair process for resolving disputes between providers and insurers.
• Research and Innovate. Our administration will support evidence-based experimentation in the field to find solutions to drive down costs — exploring innovations like new models for community health centers, innovations in telemedicine, and other strategies to make care more local, personal and timely.

Expand Obamacare’s Successes; Fix its Weaknesses
The Trump Administration’s attempt to de-fund and destroy Obamacare is eroding the path to creating a healthier America. Within hours of assuming the Presidency, I will reverse the government’s legal position in the lawsuits attempting to strip care from millions of Americans. As President, I will simplify access and expand capacity, while driving down system costs.

• Pre-Existing Conditions. Insurance companies should not be able to discriminate against someone who has already been diagnosed with an illness or disorder.
• Young Adults. We will defend provisions of the ACA requiring insurers to permit young adults to claim dependent status until the age of 26.

Improve and Integrate Mental Health Care
There are profound and widespread unmet mental health care needs in our healthcare system and our nation at large. Our administration will prioritize addressing this gap, working with insurers, providers and advocates to improve both access and capacity.

We cannot provide appropriate care without eliminating the stigma that has traditionally accompanied mental health disorder diagnoses. As President, I will lead a nationwide effort to change the way we talk and think about treating mental health disorders, and bring light to where there are currently shadows. We will do the hard work of improving the quality of mental health care coverage, and integrating it with physical care options.

Other mental health care policy priorities include:

• Enforce Parity. We will enforce the mental health parity law, which prohibits most health plans from imposing less favorable benefit limitations on mental health/substance use disorder benefits than on physical care benefits.
• Expand Capacity. Recruiting and supporting a mental health care workforce to provide appropriate care is essential to renewing our system of mental health care. From primary care providers and across the full range of health care professionals, we will redouble efforts to attract, retain, and train the appropriate level of mental health care talent — especially in rural communities. This means, among other things, increasing training options, expanding loan forgiveness programs to health care providers other than doctors, and advancing targeted efforts to recruit health care providers from minority and underrepresented backgrounds.
• Expand Access. As we expand Medicare and stand up the public option, we will ensure that mental health care is among the “essential health benefits” that private and public insurers are required to provide covered individuals.
• Data Integration. We will initiate a regulatory review of the federal policies that govern confidentiality of patient information to ensure data can be shared when appropriate which will vastly improve service delivery.
• Services Integration. We will work with mental health providers and payers in developing legislation that integrates the payment of primary care and behavioral health services, including the breakdown of the physical separation of mental and primary health care providers.
• Eliminating Stigma. Negative association with mental illness or substance abuse disorder are very common among health care providers and employers, which can make it harder to seek help. My administration will work to develop national guidelines and best practices to help employers create work environments that foster wellness and open dialogue about depression, burnout and other issues that are frequently misunderstood or ignored.

Combating the Opioid Crisis
The crisis of substance use disorders in our communities is primarily a public health challenge to be dealt with by health professionals — not by the criminal justice system.

The states need more resources and better, sustained coordination from the federal government, prioritizing access to treatment. We will work with states and Congress to deploy and organize the medicines, social workers, community leaders, mental and emotional health counselors needed to conquer addiction and stabilize lives. At the same time, we need tougher controls on the availability and tracking of prescription opioids, accountability for manufacturers who wrongfully downplayed the risks of prescription drugs, and rigorous oversight of the for-profit recovery industry.

Opioid Crisis Track Record
Well before the opioid crisis became a feature of the national conversation, Governor Patrick’s administration was at the forefront of tackling the epidemic in Massachusetts and across the New England region.

Governor Patrick was among the first governors in the nation to issue a declaration establishing that the opioid crisis was a public health emergency.

Under Governor Patrick’s leadership, Massachusetts approached the challenge as a public health crisis — not a criminal justice one. Governor Patrick took emergency steps to ban dangerous prescription narcotics that were worsening the problem and provide first responders with access to life-saving drugs like Narcan.

The Patrick Administration established a regional New England working group to coordinate efforts to address the epidemic. And Massachusetts’ state health agencies took immediate steps to coordinate with the medical professionals, first responders, and insurers to ensure a continuum of care and comprehensive support.

Support and Enable a Public Health Response. As President, I will work with Congress to establish a new infusion of support for communities, health centers, and nonprofit groups on the frontlines of the epidemic. I will push for and support the expansion of Medicaid and other additional funding sources to the states, and:

• Work with local decision-makers and substance use disorder experts to make sure that resources are being deployed on the ground in the most efficient and comprehensive way;
• Scale up and expand a national Prescription Drug Monitoring Program to track and understand opioid prescription patterns;
• Boost federal opioid awareness efforts, and target resources on early intervention; and
• Introduce new controls on exploitative for-profit recovery centers, support appropriate law enforcement training and efforts to decriminalize substance abuse disorders, and take steps to collect richer data on the epidemic that will improve our ability to respond in real time.

Insurance Mandates. We will vigorously enforce federal parity laws mandating insurance coverage for mental health and substance use, and require insurance providers to remove unnecessary obstacles to getting the appropriate medications to individuals suffering from addiction.

Ensuring Reproductive Freedom
Government should stay out of the most intimate personal health care choices that a person can make — including whether or not to have an abortion. Abortion access is health care. Our administration will push back against efforts by states to make it harder to access abortion and other forms of Constitutionally-protected reproductive health care. We will work to make sure that all Americans, in every part of the country, have access to safe, affordable reproductive care. And we will work to make sure that a person’s right to make intimate health choices is free from government interference.

Reproductive Justice Track Record
Codify Roe v. Wade. Work with Congress to pass a federal law that parallels Roe v. Wade and codifies in law the full range of Roe’s Constitutional protections.

Support and Expand Access to Health Care. Our administration will:

• Restore and expand fully Title X family planning funding to Planned Parenthood and other clinics, which offer a range of critical health care services;
• Repeal, and refuse to re-sign, the Hyde Amendment, which prevents abortion coverage under federally funded health plans;
• Rescind the “Mexico City policy” that limits our ability to support global health efforts overseas;
• Ban federal money from going to so-called “crisis pregnancy centers,”
• Support efforts to expand access to medicated abortion and telehealth options to address the lack of access to services in some states and rural areas;
• Direct the Education and Health and Human Services Departments to coordinate on reproductive justice issues, awareness, and minors’ access to reproductive healthcare; and
• Protect and expand federal laws requiring that insurers cover abortion and contraception access.

Simple, Fair, and Adequate Taxes

Government, as former Congressman Barney Frank used to say, is just the name we give to the things we choose to do together. Government is about how we define the civilization we want; taxes are how we pay for it. But our tax system today is badly broken. It’s out of balance, unnecessarily complicated, inefficient and rife with opportunities for gaming and abuse. We must reform our tax system so that it is simple, fair and adequate to the task. Our guiding principle will be the belief that taxes are not a penalty but just the cost of our civilization.

That’s how we governed in Massachusetts. Through strong fiscal management, Massachusetts secured the highest bond ratings in its history under our administration. During my tenure as Governor, annual budget increases averaged 3.5%, in contrast with the previous Administration’s average of 4.9% — while making historic investments in education, infrastructure and innovation.

My reform plan for personal taxes would tax citizens progressively based on their ability to contribute, eliminate loopholes and unnecessary exclusions and deductions, and increase enforcement to ensure that all citizens contribute their share. It would treat all income as ordinary income, whether from wages, capital gains, dividends or carried interest. It would expand tax credits that aid working Americans like the Earned Income Tax Credit and the Child Tax Credit. We would also increase the estate tax to 55% (in lieu of a wealth tax).

We will require corporations to pay their fair share by raising the corporate tax rate to 25%, eliminating loopholes that allow some of our most successful and profitable corporations pay no federal taxes whatsoever, and imposing new rules to stop corporations from shifting their operations overseas solely for the purpose of evading U.S. taxes.

Altogether, my tax reform reforms would raise the revenue required to invest in our country and our future as efficiently and fairly as possible.

Simple, Fair, and Adequate Income Taxes
Individual income taxes and payroll taxes make up almost 90% of all federal government revenue, of which income taxes are nearly two-thirds. Substantive tax reform starts here.

• Fair Share. Increase the share borne by the wealthiest Americans by expanding the spread between high income and middle income effective tax rates. We will target returning to the rates in effect before the Bush and Trump tax cuts shifted a greater tax burden away from the wealthiest and onto middle class Americans.
• Simplify. If we eliminate the hundreds of deductions, exclusions and credits in our system, we can tax at reasonable rates across the board while assuring fairness and reducing the burden of filing taxes.
• Close Unfair Loopholes. We will bring fairness back to the tax code by closing other old loopholes that the 2017 tax law didn’t close, and closing new ones that the 2017 tax law opened up — such as loopholes that allow multinational companies with foreign operations to avoid customary tax obligations.
• Expand Family Tax Credits. I will push to significantly increase the Child Tax Credit and the Earned Income Tax Credit to offer direct assistant to low and middle-income families. This will radically cut the number of children and working families who live in poverty. To maximize the impact of these credits in the daily lives of families, these tax credits should be fully refundable and paid monthly.
• Streamline Filing. For many filers, the government already has most of the information you need to fill out on your tax forms — it would be far simpler and more efficient if the IRS supplied individuals with a tax form already filled out. I will direct the IRS to study and pilot a program to auto-populate personal tax returns.

Tax All Income as Income. Income is income. People who make most of their money through capital gains should not benefit from a lower tax rate than that which applies to people who earn their way from wages. Therefore, in my plan, capital gains, dividends, interest, carried interest, and other forms of income, would be treated as ordinary income.

Increase the Estate Tax. The wealthy and well-connected have changed the rules to inherit vast fortunes tax free, requiring the rest of us to bear the nation’s generational responsibility. I would return the estate tax thresholds and rates back to the reasonable levels that prevailed in 2001, to 55%, with an exemption for the first ten million dollars, that protects family assets like a farm or a small business. Additionally, we will explore the feasibility of taxing capital gains at death for those above a threshold so that the wealthiest Americans can no longer permanently avoid paying taxes on appreciated assets.

Require Corporations to Pay Their Fair Share
Investing in the future requires corporations to contribute their fair share to the things necessary to build America’s future. Under our plan, we will:

• Increase corporate tax rates to 25%, reflecting the current consensus among the business community for a globally competitive rate;
• Eliminate loopholes and deductions and reform tax provisions for multinational companies that allow some of our most successful and profitable corporations pay no federal taxes whatsoever;
• Impose new rules and steep penalties to make it impossible for corporations to shift their operations overseas solely for the purpose of evading U.S. taxes, or to make other non-business actions purely for the purposes of tax avoidance;
• Create a back-stop for taxing multinational corporations which are too aggressive in exploiting loopholes such as using financial reports or assessing tax receipts by country of operation.
• Aggressively Pursue Tax Evaders. Taxpayers pay 82% of their taxes voluntarily and on time. From 2008 through 2010, that meant $458 billion of tax revenue that was paid late or not at all. We will double the funding the IRS receives to conduct enforcement to assure everyone pays their fair share on time and in full.
• Cut Government Waste, Fraud and Abuse. To deter fraud and help people gain confidence in their government, we will pursue maximum transparency across all agencies, including by opening operating budgets up to greater public scrutiny. We will support efforts to identify waste and fraud, and my administration will consider proposals to unify all watchdog and inspector general functions into one central public integrity bureau that operates across the entire executive branch.

Thriving Veterans, Service Members, and Military Families

As a nation, we have few obligations more vital than our duty to ensure that those who have served in the military have access to appropriate care and the ability to prosper when they return to civilian life.

We will seek out and invest in new strategies to integrate the rich experiences and talents of veterans into our economy and our communities. Our all-volunteer force is rooted in a can-do culture: it is a small, highly-trained, highly-effective force operating in some of the most challenging conditions in the world. Veterans of such a force are a national treasure, and the services we provide in return must reflect our appreciation for what they have done and our understanding of what, through their education, experience, and talent, they can still contribute.

Under my leadership, Massachusetts became a model for supporting veterans of all ages, from all walks of life. We supplied tuition waivers at state colleges and universities in support of a robust and paid for education for service members. We expanded the women veterans’ network, suicide prevention efforts, substance use prevention efforts, and opportunities for housing, and partnered with industry to provide access to jobs for those returning home.

We must do all of that, and much more, at the federal level, while also ensuring appropriate, consistent care and opportunities for servicemembers and their families.

Nation-Leading Results for Veterans
Affordable, Comprehensive Health Care for Veterans. As we expand access to affordable, quality health care to all Americans, we will make special efforts to ensure that every veteran has access to the care of her or his choice, either through the VA, a private plan, or a public option when appropriate.

Reform and Renew the Veterans Affairs System
We should be proud of the care we currently offer. The VA system provides our veterans with access to world-class care, and the service it provides consistently ranks high in patient satisfaction. But the agency is burdened by deteriorating physical infrastructure, was neglected from prior administrations, and has been plagued by consistent management issues. Wait times continue to be a challenge. Response to needs has become characterized by a culture of “no.” As President, I will renew the commitment to mission and focus at the VA, by providing adequate funding, support at the highest level, needed reforms, and a culture of “yes.”

• Right the Balance Between Public and Private. In principle, there is nothing wrong with having private sector options for veterans and their dependents. We will find the right balance of VA and purchased care by conducting a thorough assessment, led by the Secretary of Veterans Affairs in conjunction with a White House official tasked with coordinating the Defense Department and the VA, acknowledging the different needs of veterans across different regions of the country. We will expand private health care options only as appropriate and until such time that wait times, access, and quality through the VA are no longer an issue.
• Streamline Access. As we did in Massachusetts, we will work to accommodate the needs of a new generation of veterans and streamline access to service for veterans, through online tools and mobile apps. We must prioritize the current project to marry VA and Department of Defense records, as well as require the Department to enroll all eligible veterans in the VA system prior to their separation from service.
• Health IT Improvements. We will work to ensure that veterans’ medical records must be shared securely, with permission, and with ease. This is critically important as our veteran populations continue to age. Those in the VA system, nursing homes, or seeing multiple providers need to have peace of mind that the process of sharing their records will occur, so they can focus on their own health.
• Expand Capacity. We must recruit a new generation of care providers, particularly mental health providers. In recent months, the VA has operated with tens of thousands of vacancies, vastly constraining its ability to deliver on its mission. We will partner with providers and teaching hospital to expand the clinical pipeline, greatly increase recruitment efforts, closing the thousands of vacancies and, as necessary, increase salaries for the VA practitioners to recruit more professionals.
• Management and Accountability. Refine and invest in new management and accountability tools at the VA to govern and track every penny, in order to have metrics on successes and areas to improve upon.
• Footprint Review. Undertake a comprehensive capital and facilities review of the VA, to determine which facilities need modernization. We will seek funding to rebuild outdated VA infrastructure and provide decades long fixes to VA facilities whose repairs have been deferred for far too long, particularly in rural areas.

Mental Health and Suicide Prevention
For veterans and current servicemembers, we must dramatically expand access to mental health services. For veterans, this means making it much easier to see a mental health professional at the VA. This, in turn, requires us to fund and recruit many more professionals, and establish a mental health services hotline. For current members of the armed forces, the Department of Defense should offer, and potentially require, annual mental health check-ups.

• We will create a national peer-to-peer outreach effort for veterans modeled on the Massachusetts Statewide Advocacy for Veterans Empowerment (SAVE). The program will offer peer-to-peer support, suicide prevention, and outreach to homeless combat veterans.
• The scope of the challenge is greater than what government alone can solve. We will partner with the private sector and nonprofits like the Home Base program in Massachusetts to leverage best practices in the field, identify new solutions, and extend the umbrella of care to all veterans.
• We must do more to divert veterans with mental health disorders out of the criminal justice system, by supporting innovations like veteran treatment courts.
• There is far too little medical research into the best strategies for preventing suicide among veterans. We will fund and support new investments into suicide prevention, and deploy those solutions as fast as possible.

Support the Transition to Civilian Life
We, as a nation, must take the necessary steps to set servicemembers up for success. Together, we can provide additional tools so they can thrive and continue to serve in new ways.

• Local Veteran Experts. To aid with the transition to civilian life and help veterans access the services, we will establish a national network of local veterans’ services offices to match veterans with resources. Building on a model that succeeded in Massachusetts, we would offer incentives, trainings, and grants to encourage this level of support, so all who wish can receive the benefits they have earned for their service.
• Supplier Diversity. We will support increased federal benefits and procurement set-asides for Service-Disabled Veteran Owned Small Businesses, allowing veterans to gain access to contracts for public projects in the areas of construction, design and goods and services procurement.
• Reintegration Incentives and Transition Programs. Our administration will push for new progressive tax incentives for employers that hire, train, and retain veterans or for veteran-owned businesses, as well as other programs that prioritize hiring for veterans and their spouses. These incentives could be nationwide or targeted at the specific regions, communities, and populations that would benefit most. Our administration will support and build on preexisting and successful transition programs, such as Hiring Our Heroes.
• Higher Education. Our administration will partner with institutions of higher education to strengthen the pipeline for returning military members. We will work with colleges and universities to take steps like accepting military experience as credit to help veterans transition into students.
• Utilize Existing Hubs. We will strengthen the preference veterans receive for services at all of the nation’s federally funded Career Centers. Military installations across the nation are often hubs for the veteran communities. A nationwide program to enhance the offerings at these sites and serve as places for veterans to network and receive care will help.
• End Veteran Homelessness. We will coordinate across the administration offering services such as block grants for transitional housing to ensure no veteran goes homeless.

Supporting Military Families
Military families shoulder a unique burden associated with military service. Our administration will address those needs in a comprehensive, global effort.

• Military Housing. Our military housing stock has not been adequately maintained, and too many families are forced to reside in poorly constructed homes. We will conduct a comprehensive review of all military housing options, and direct new funding to revitalize and improve service member housing.
• Opportunities for Military Spouses. We cannot continue to squander the vast potential of military spouses, who often find it hard to find opportunities to put their talents to use. The federal government can do much more to establish additional guidelines to assist servicemembers, veterans, and their spouses with professional licenses so they can more easily prepare for, transfer from other states to, and apply for jobs.
• Affordable Child Care. The lack of fair and equitable support our nation’s government provides to families seeking affordable child care is a crisis. Many simply cannot afford the childcare they need, whether they are looking to join the workforce, are caring for an aging family member, or have other reasons to require childcare. We will work with Congress to invest in early child education and childcare vouchers for military families in order to address this critical gap.
• Military Child Education. The transition between schools for the children of military families comes with great challenges. Government can and must make it easier. Massachusetts joined the Interstate Compact on Educational Opportunity for Military Children during my administration, which represents an important start. As President, I will bring together the Departments of Defense and Education to accelerate recent progress and commit to incremental funding increases and partnerships to support children.