One of the biggest differences between Mitt Romney’s and Barack Obama’s health policies is who is responsible for making available health insurance coverage. Mitt Romney would place primary reliance on state governments and the private sector. Barack Obama would rely more on the federal government.
Romney’s plan, according to his website, "will begin by returning states to their proper place in charge of regulating local insurance markets and caring for the poor, uninsured and chronically ill." He says on his first day in office, he will issue an executive order issuing waivers to all 50 states allowing them to develop their own health plans (including Medicaid) without most of the regulations that are currently set by the Obama administration. Romney also would ask Congress to repeal the Patient Protection and Affordable Care Act.
Under the Romney approach, there would be fewer federal regulations regarding how state Medicaid programs and private health insurance plans would operate. States would receive block grants with reduced restrictions on how money is spent. For covering persons who are difficult to insure, Romney favors high-risk pools and reinsurance. In addition, small businesses and individuals would be encouraged to form purchasing pools.
Medicare also would change under Romney as he seeks to have seniors obtain more of their health insurance coverage from the private market rather than from government-run Medicare. Under his plan, seniors would receive a "defined contribution or premium support" from which they could buy health care coverage from Medicare or from the private sector. Although Romney favors less regulation of insurance, he would require private insurance plans that offer alternatives to Medicare to provide coverage comparable to Medicare.
The amount of the contribution or support for health coverage for seniors has not been announced. According to the Romney campaign, "Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support."
Perhaps to avoid scaring current Medicare beneficiaries or those soon to be eligible for Medicare, the campaign says: "This plan has no effect on current seniors or those nearing retirement. It will go into effect for younger Americans when they reach retirement in the future."
Romney maintains that "a competitive, market-oriented system" is the best way to deliver health care and that private insurers competing with each other will promote quality and hold down costs. To that end, Romney would allow insurance plans to be purchased across state lines.
President Obama is quite willing to stand on his record. The "health care" portion of the Obama-Biden website leads off with a statement that the Affordable Care Act will "restore health care as a basic cornerstone of middle-class security in America."
The Obama campaign cites the changes that are taking place, including: providing coverage for 34 million Americans without insurance; ending discrimination based on preexisting conditions; allowing young adults to stay on their parents’ insurance policies until they turn age 26; providing more preventive services to Medicare beneficiaries and persons covered by private insurance; closing the Medicare "doughnut hole" on payments for prescription drugs; and ending lifetime limits on insurance coverage.
Obama says the Affordable Care Act will reduce the federal deficit by $127 billion between 2012 and 2021. He also noted that the Affordable Care Act requires insurance companies to spend 80 percent of premiums on health care (instead of overhead, marketing and profits). Insurance companies that do not meet that criteria will have to pay rebates to consumers.
When President Obama seeks to provide more uniform health care rights for Americans, the vehicle for that is federal law and regulation.
Although Mitt Romney and President Obama differ significantly on their methods of achieving health care reform, they do share some approaches.
Prevention of discrimination on the basis of preexisting conditions
Both candidates favor laws that would prevent insurance companies from discriminating against individuals seeking health insurance on the basis of preexisting conditions. Romney emphasizes that the protection should apply to persons who have maintained continuous coverage.
If a person changes jobs, they should be able to maintain their insurance.
To help promote quality and informed choice, both Romney and Obama favor obtaining and disseminating information about the quality of service by health care providers and insurance companies.
Both candidates also support increased use of information technology to promote efficiency in the health care system.
Alternatives to fee-for-service
Both candidates recognize the need to control costs and promote quality by developing alternatives to fee-for-service. Such options would include bundling payments to a group of providers for a single episode of care and higher payments to providers for better
Medical malpractice reform
Obama and Romney favor medical malpractice reform, including using non-litigation alternatives to dispute resolution. In addition, Romney emphasizes placing caps on non-economic damages. Obama places more emphasis on providing immunity to providers if they follow recognized guidelines.
The presidential election will set the path for future health care reforms - with the alternative paths being continuation and expansion of the federal government’s involvement in health care versus curtailment of the federal government’s involvement and more reliance on states and private insurance. In either case, the makeup of Congress also will affect the pace of future reforms.
For more information about the health care policies of the candidates from their websites, see:
• Barack Obama
• Mitt Romney
mittromney.com/issues/health-care (Health care)
Jeff Atkinson ([email protected]) teaches health care law at DePaul University College of Law in Chicago.