Healthcare was again the leading topic of discussion at the most recent debate among the 2020 Democratic presidential candidates – but it didn't stick around as the moderators and candidates chose to focus on other pressing issues for the remainder of the evening.

Ten candidates gathered at Texas Southern University in Houston on Thursday night, with many facing off for the first time on the same stage.

As in the two previous debates, the moderators led with a question about healthcare, specifically, Medicare for all, the plan to replace the Affordable Care Act (ACA) that has been embraced by Senators Bernie Sanders (VT) and Elizabeth Warren (MA).

But the moderators did not touch on any other health-related topics — with the exception of some points about gun violence — during the 3-hour debate, even though Democratic voters have expressed concern about drug prices, reproductive rights, abortion, and the rising cost of healthcare.

The moderators chose instead to focus on immigration, racism, education, and trade, among other issues.

An Issue of Cost and Who Pays

According to the most recent Kaiser Family Foundation Health Tracking poll, Medicare for all is still open for debate among Democratic voters. Most Democrats and Democratic-leaning independents (55%) said they would prefer to vote for a candidate who wants to build on the existing ACA than replace the ACA with a Medicare for all plan (40%).

Former Vice President Joe Biden — who continues to lead in the polls — has proposed building on the ACA. During the debate, he said, "I think the way we add to it, replace everything that has been cut, add a public option, guarantee that everyone will be able to have affordable insurance."

Biden challenged Sanders and Warren on how they would pay for Medicare for all, which he said would cost $30 trillion over a decade.

"We pay for it, those at the very top, the richest individuals and the biggest corporations are going to pay more," said Warren, who promised that "middle class families are going to pay less."

Sanders said that without doing anything to the healthcare system, "status quo over 10 years will be $50 trillion." He claimed that "every study done shows that Medicare for all is the most cost-effective approach to providing healthcare to every man, woman, and child in this country."

The program would eliminate all out-of-pocket expenses, including deductibles and copayments, said Sanders, adding, "Nobody in America will pay more than $200 a year for prescription drugs, because we're going to stand up to the greed and corruption and price-fixing of the pharmaceutical industry."

Biden was quick to point out that his plan would also cut costs for consumers. "The largest out-of-pocket payment you'll pay is $1000," he said. The former vice president also said that people who like their private insurance would be able to keep it.

That brought a retort from Warren. "I've actually never met anybody who likes their health insurance company," she said. "I've met people who like their doctors. I've met people who like their nurses. I've met people who like their pharmacists. I've met people who like their physical therapists. What they want is access to healthcare."

With Medicare for all, said Warren, individuals will keep their doctors and hospitals. And, she added, "Doctors won't have to hire people to fill out crazy forms. They won't have to spend time on the phone arguing with insurance companies."

Variations of Medicare for All

South Bend, Indiana Mayor Pete Buttigieg, California Senator Kamala Harris, and New Jersey Senator Cory Booker have all pushed for a variation on Medicare for all.

Buttigieg said his plan would offer Americans more freedom of choice, with both a public option and private plans ― what he calls Medicare for All Who Want It. "I trust the American people to make the right choice for them," he said.

Harris said that under her plan, which she calls Medicare for all, "people have the choice of a private plan or a public plan, because that's what people want."

She warned that instead of just debating their own proposals, Democrats also need to focus on what President Donald J. Trump is doing. The "Department of Justice is trying to get rid of the Affordable Care Act," said Harris, referring to a case making its way through the courts that is seeking to overturn the ACA and that the administration has backed.

"I think this discussion has given the American public a headache," she said. "What they want to know is that they're going to have healthcare and cost will not be a barrier to getting it.... But let's focus on the end goal. If we don't get Donald Trump out of office, he's going to get rid of all of it."

Booker said he believed that Medicare for all is "the best way to rationalize the system," but that putting such a program in place would likely take too long.

"There is an urgency right now in this nation," he said. "People in my community, they need help right now. They have high blood pressure right now. They have unaffordable insulin right now."

Entrepreneur Andrew Yang has repeatedly made a point that he also made at this debate: that the current system "makes it harder to hire people, makes it harder to give them benefits and treat them as full-time employees," and that it's harder to start a business.

Clinicians have also been hit by the burdensome system, said Yang. "They tell me that they spend a lot of time on paperwork, avoiding being sued, and navigating the insurance bureaucracy," he said. "We have to change the incentives so instead of revenue and activity, people are focused on our health in the healthcare system."

Gun Violence

With the recent shootings in nearby El Paso, Odessa, and Midland, Texas, gun violence was close to home for the Houston audience and for some of the candidates, most notably Beto O'Rourke, the former Texas congressman who lives in and represented El Paso.

O'Rourke has advocated a mandatory buyback of assault weapons by the government. When moderator David Muir asked if he was proposing to take away guns, O'Rourke said, "I am, if it's a weapon that was designed to kill people on a battlefield, if the high-impact, high-velocity round, when it hits your body, shreds everything inside of your body, because it was designed to do that, so that you would bleed to death on a battlefield and not be able to get up and kill one of our soldiers."

He said that in Odessa, he'd met a mother who watched her 15-year-old girl bleed to death after being shot by an AR-15. "Hell, yes, we're going to take your AR-15, your *****," said O'Rourke. "We're not going to allow it to be used against our fellow Americans anymore."

Senator Amy Klobuchar (MN) said that all the candidates supported an assault weapons ban and limitations on high-capacity magazines. But she said she would only favor a voluntary gun buyback.

Klobuchar also noted that Senate Majority Leader Mitch McConnell (R-KY) had three bills on his desk that would create universal background checks, close "the Charleston loophole," and ensure that perpetrators of domestic violence didn't get assault weapons. "We can't wait until one of us gets in the White House," she said. "We have to pass those bills right now to get this done."

In May, Booker issued a broad gun control plan that included a call for a national gun license. He, too, said that the time for waiting was over. "We have a mass shooting every single day in communities like mine," he said.

"We must awaken a more courageous empathy in this country so that we stand together and fight together and overwhelm those Republicans who are not even representing their constituency," said Booker.

"Children die every day on streets, in neighborhoods, on playgrounds," agreed Warren. She added that people also die from gun violence through suicide and domestic abuse.

The majority — 90% of Americans, said Warren — want to implement background checks and an assault weapons ban. "Why doesn't it happen?" asked Warren.

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