Barack Obama made reforming the U.S. health insurance system one of the main themes of his 2008 presidential campaign and the highest-profile focus of his first term in office.
He worked with House and Senate leaders to maneuver the bill that created the Patient Protection and Affordable Care Act of 2010 (PPACA) through Congress, and, since then, his administration has posted implementing regulation after implementing regulation.
Gov. Mitt Romney, meanwhile, comes from a party that has made fighting PPACA a sacred duty.
Here, then, is LifeHealthPro’s comparison of the candidates’ views in six key health policy categories, drawn mainly from the candidates’ websites and, in some cases, from party platforms.
1. Commercial health insurance system change
President Obama focuses on his site mainly on what he believes PPACA already has accomplished or is set to accomplish as the law takes effect.
Obama says PPACA already is improving health care access for millions of Americans and “ending insurance abuses” by letting young adults stay on their parents’ coverage up till age 26; forbidding health insurers from imposing lifetime benefits caps; limiting insurers’ ability to impose annual benefits caps; requiring insurers to pay for checkups, vaccinations and other preventive care without imposing out-of-pocket costs on the patients; and requiring that plans that spend more than a certain percentage of revenue on administrative costs send their customers rebates.
PPACA already prohibits health insurers from denying coverage to children with preexisting conditions, and it will prohibit PPACA from denying coverage to anyone with preexisting conditions starting in 2014, Obama says.
In the section on “access and affordability,” Obama does not mention the health insurance “exchanges” — the Web-based insurance supermarkets that PPACA is supposed to create in 2014.
Mitt Romney would “roll back all the benefits of health reform,” Obama says.
“The bill, itself more than 2,400 pages long, relies on a dense web of regulations, fees, subsidies, excise taxes, exchanges, and rule-setting boards to give the federal government extraordinary control over every corner of the health care system,” Romney says. “The costs are commensurate: Obamacare added a trillion dollars in new health care spending. To pay for it, the law raised taxes by $500 billion on everyone from middle-class families to innovative medical device makers, and then slashed $500 billion from Medicare. Obamacare was unpopular when passed, and remains unpopular today, because the American people recognize that a government takeover is the wrong approach.”
Romney says he would return responsibility for regulating local insurance markets and providing care for the poor, the uninsured and the chronically ill to the states.
A Romney administration would limit moves to apply federal standards and requirements to private insurers, he says.
Romney says he would encourage use of health insurance exchanges, and that he would promote the use of high-risk pools, reinsurance and risk adjustment mechanisms to help people with chronic health problems who cannot qualify to buy conventional health insurance.
He also says he would work to “prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage” and “facilitate [health information technology] interoperability.”
Image, above left: Supporters and opponents of health care reform rally in front of the Supreme Court in Washington, Tuesday, March 27, 2012, as the court continued arguments on the health care law signed by President Barack Obama. (AP Photo/Charles Dharapak)
2. Women’s health and abortion
The Obama team has worked to link the fate of PPACA to the fate of PPACA provisions that require most health plans to include benefits for contraceptive services in the package of basic preventive services that must be covered without imposing out-of-pocket costs on the patients.
“Thanks to Obamacare, many insurance plans are beginning to fully cover birth control without co-pays or deductibles as part of women’s preventive care — potentially saving women hundreds of dollars every year,” Obama says in a section on women’s health and birth control. “Mitt Romney would repeal Obamacare, and give employers the authority to limit women’s access to common forms of birth control.”
The Romney campaign website does not mention abortion or birth control in its discussion of health issues.
The Republican Party, in its platform, says the following about federal health care policy and abortion: “Through Obamacare, the current administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and wellbeing of women, and we stand firmly against it.”
Obama says PPACA already has made important changes in Medicare, such as requiring basic Medicare to impose a package of basic preventive services without imposing out-of-pocket costs on the patients, and reducing the size of the Medicare Part D prescription drug plan “doughnut hole” — the gap between the point at which routine prescription coverage ends and catastrophic coverage begins.
“Mitt Romney would end Medicare as we know it,” Obama says in a section on “security for seniors.” “Instead of their guaranteed benefits, new retirees would get a voucher that they would have to use to buy coverage, which could increase costs by more than $6,000 per year.”
Romney says in his own discussion of his Medicare plan that he wants to modernize entitlement programs and guarantee their vitality for future generations.
“Instead of paying providers directly for medical services, the government’s role will be to help future seniors pay for an insurance option that provides coverage at least as good as today’s Medicare, and to offer traditional Medicare as one of the insurance options that seniors can choose,” Romney says. “With insurers competing against each other to provide the best value to customers, efficiency and quality will improve and costs will decline. Seniors will be allowed to keep the savings from less expensive options or choose to pay more for costlier plans.”
Medicare would stay the same for retirees and near retirees, Romney says.
Younger workers would get a fixed amount that they could use to buy either traditional Medicare coverage or private plan coverage, and they would have to make up the difference out of their own pockets if they wanted to buy more expensive coverage, Romney says.
“Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support,” Romney says. “Competition among plans to provide high quality service while charging low premiums will hold costs down while also improving the quality of coverage enjoyed by seniors.”
Image, above left: In this photo taken Aug. 21, 2012, Mike O'Malley, 55, left, and Sharon O'Malley, 53, pose for a photo in Chicago. Mitt Romney's Medicare plan would have very different effects on couples and siblings just a few years apart in age. (AP Photo/Sitthixay Ditthavong)
Obama says of Medicaid — the program for poor people and for eligible nursing home patients — mainly that he believes Romney would cut federal Medicaid funding.
Romney says he would replace the current Medicaid funding formula with a “block grant” program that would provide each state with a set amount of cash that it could use as it wished. He says he would “limit federal standards and requirements” for Medicaid as well as for private insurance.
The Republican Party platform includes an extensive section on long-term care finance.
The party says in the platform that it wants to ensure that America’s aging population has access to safe and affordable care.
“Because seniors overwhelmingly desire to age at home, we will make home care a priority in public policy,” the party says. “We will champion the right of individual choice in senior care. We will aggressively implement programs to protect against elder abuse, and we will work to ensure that quality care is provided across the care continuum from home to nursing home to hospice.”
Next: Tort reform
Image, above left: Dr. Steve Auerbach, a pediatrician, participates in a rally in support of Medicaid funding outside the Waldorf Astoria hotel, Thursday, Oct. 18, 2012 in New York. (AP Photo/Mary Altaffer)
5. Tort reform
Obama says nothing in his comments aimed at voters about “tort reform” — the idea of controlling health care costs by reducing what doctors and other providers spend to protect themselves against lawsuits.
The Obama for America (OFA) campaign does talk about torts on the “terms of service” page for the site.
“In no event shall the aggregate liability of OFA, whether in contract, warranty, tort (including negligence, whether active, passive or imputed), product liability, strict liability or other theory, arising out of or relating to the use of or inability to use the sites or the site materials exceed any compensation you pay, if any, to OFA for access to or use of the sites,” the campaign says in the terms of service.
Romney says he would promote free health insurance markets by capping non-economic damages in medical malpractice lawsuits.
Next: Health accounts
Image, above left: nuttakit/FreeDigitalPhotos.net
6. Health accounts
Obama says nothing on his campaign website about health savings accounts or health reimbursement arrangements on his websites.
Romney says he would “unshackle HSAs by allowing funds to be used for insurance premiums.” Although he has vowed to streamline the tax code, he also says he would “end tax discrimination against the individual purchase of insurance” and encourage independent entities to rate health plans.
Romney also talks about wanting to let health insurers sell coverage across state lines.
A provision of PPACA, the multi-state plan provision, apparently would let some carriers sell coverage across state lines through exchanges starting in 2014. Neither Obama nor Romney has mentioned the PPACA multi-state plan provision.
Image: As part of his health policy, Romney has mentioned a desire to let health insurers sell coverage across state lines.
Visit LifeHealthPro.com/election for more on the presidential race, including: