Poll sponsors said Mitt Romney won the first of the three 2012 presidential debates Wednesday.
CBS News, for example, reported that 46 percent of the 500 uncommitted voters it polled after the debate said Romney won. Only 22 percent said Barack Obama won.
CNN said 67 percent of the likely voters it polled thought Romney won.
Obama and Romney, a former Massachusetts governor, spent much of their time talking about health insurance policy.
Romney said he wants to repeal the Patient Protection and Affordable Care Act of 2010 (PPACA) but believes that society does have a role to play in providing health care for people who cannot afford to pay for care themselves.
"We're a nation that believes that we're all children of the same god and we care for those that have difficulties, those that are elderly and have problems and challenges, those that are disabled," Romney said. "We care for them."
The solution is for Congress to repeal PPACA and for states to come up with alternatives that meet their own needs, Romney said.
“I think something this big has to be done on a bipartisan basis,” Romney said.
Romney also said he wants to replace the current Medicaid funding system, which gives the Centers for Medicare & Medicaid Services (CMS) a considerable amount of control over states’ Medicaid programs, with a block grant program. The program would provide each state with an amount equal to what the state received from the federal government last year, plus an inflation adjustment, plus an additional 1 percent increase, he said.
Medicaid pays for nursing home care for many middle-income families as well as acute medical care for poor people.
"Don't have the federal government tell everybody what kind of training programs they have to have and what kind of Medicaid they have to have," Romney said. "Let states do this. And, if a state gets in trouble, we can step in and see if we can find a way to help them."
Obama said he began working on PPACA when he took office rather than on jobs programs because health care spending is the biggest contributor to the federal budget deficit, and because rising health care costs are hurting small businesses and threatening families with the fear of medical bankruptcy.
PPACA has eliminated "arbitrary" caps on benefits, lets families keep kids on their insurance up until age 26, and provides rebates for enrollees in health plans that spend too much on administrative costs, Obama said.
Obama also referred indirectly to the exchanges, saying the PPACA exchanges will, essentially, set up a group plan for individuals who have to buy their own coverage.
"The irony is we've seen this model work really well, in Massachusetts." Obama said, alluding to the health system change proposals Romney signed into law while he was governor of Massachusetts.
Romney’s Medicaid block grant proposal "means a 30 percent cut in the primary program we use to help seniors who are in nursing homes, for kids who are with disabilities.... Governors are creative. There's no doubt about it. But they're not creative enough to make up for 30 percent of revenue on something like Medicaid. What ends up happening is some people end up not getting help."
Obama accused Romney of implying that he’d keep the most popular parts of PPACA without actually describing his proposals.
Romney has said, for example, that he wants to provide some kind of help for people with pre-existing conditions, but it’s still not clear whether Romney means he would keep the kinds of protections for those people that are available in PPACA or if he means he would simply preserve the consumer protection provisions already in effect in the Health Insurance Portability and Accountability Act of 1996, Obama said.
Romney said he is not giving detailed proposals because he plans to use general principles to work with Congress, not come in with detailed proposals already developed.
When the candidates where debating Medicare, Romney accused Obama of wanting to cut $716 billion from the Medicare program budget.
Medicare provider reimbursement cuts are driving hospitals and nursing homes away from participating in Medicare, Romney said.
"We also have 50 percent of doctors who say they won't take more Medicare patients," Romney said.
Obama argued that Romney’s proposal to create a Medicare voucher program for future retirees, and give seniors the option of choosing between government-run Medicare plans and privately run Medicare plan, would saddle the government-run plans with the sickest seniors, push the government plans out of business, and force the seniors in the traditional plans to find new coverage just when they needed stable coverage the most.
"When you move to a voucher system, you're putting seniors at the mercy of those insurance companies," Obama said.
The primary beneficiaries of PPACA repeal, and efforts to cut Medicare Advantage funding, "are insurance companies that are estimated to gain billions of dollars back when they aren't making seniors any healthier," Obama said.
Financial services policy
When the candidates were discussing the Dodd-Frank Wall Street Reform and Consumer Protection Act, Romney said that he believes the federal government does have a role to play in regulating the financial services industry.
“Regulation is essential," Romney said. “You can't make a free market work without regulation.”
Some parts of Dodd-Frank, such as provisions dealing with transparency and leverage limits, may have some merit, but other parts, such as provisions regulating mortgage lending, have had harmful, unintended consequences, Romney said.
Getting a mortgage loan is difficult today partly because banks are not sure what kind of mortgage loan fits the Dodd-Frank definition of a “qualified mortgage loan,” and those parts and other parts of Dodd-Frank have been killing off community banks, Romney said.
Dodd-Frank “is the biggest kiss that's been given to the New York banks than I've ever seen," Romney said.
Obama said Dodd-Frank is supposed to regulate the kinds of reckless behavior at banks and on Wall Street that caused the recent financial crisis.
“Does anyone out there think that the big problem we had is that there was too much oversight and regulation of Wall Street?” Obama asked. “If you do, then Governor Romney is your candidate. But that's not what I believe.”
Also during the debate:
- Romney said that he would not increase families’ taxes but also would not lower taxes for high-income families.
- Romney said, "My number-one principle is that there will be no tax cut that adds to the deficit."
- Romney said the country should focus on using growth, not tax increases, to reduce the deficit. “You never balance the budget by raising taxes," Romney said Elsewhere, he said, "It's not just Donald Trump you're taxing. It's all those businesses that employ one-quarter of the workers in America; these small businesses are taxed as individuals. You raise taxes and kill jobs."
- Obama said he'd like to lower the corporate tax rate, especially for manufacturing, to 25 percent.
- Obama argued that Romney's proposal to cut the tax rate for middle-income families 20 percent would cost about $5 trillion and that Romney ought to describe the "loopholes and deductibles" he wants to eliminate if he wants to pay for the tax rate cut, an extension of the Economic Growth and Tax Reconciliation Act of 2001 (EGTRRA) tax cuts, and $2 trillion in additional military spending without increasing the deficit.
- Obama said Romney's refusal to consider raising $1 in additional tax reveue in exchange for every $10 in spending cuts shows he's taking an "unbalanced approach" to government finance.