The Republican healthcare ticket for Election 2012 profoundly contrasts with its Democratic counterpart on a host of key issues:
Affordable Care Act (ACA)
If elected, Governer Romney has pledged to repeal the Affordable Care Act (ACA), dubbed by many as ‘ObamaCare.’ His opposition stems largely from the Republican view that the latest major healthcare overhaul represents government intrusion in a free-market economy:
“From its start, it (ObamaCare) was about power, the expansion of government control over one-sixth of our economy, and resulted in an attack on our Constitution, by requiring US citizens to purchase health insurance. It was the high-water mark of an outdated liberalism, the latest attempt to impose upon Americans a euro-style bureaucracy to manage all aspects of their lives.”
Reflecting his party’s ideas, Romney has championed instead for states to create their own solutions to healthcare and vie with one another, maintaining a free-market competition. As Massachusetts’ governor, however, the plan he helped craft in mid-2006 shared more of a resemblance to President Obama’s, making it the first state to in fact achieve near universal-coverage. His law required nearly all residents to have healthcare coverage or pay a tax penalty, and mandated employers to offer insurance to their workers. It also established a health insurance exchange where individuals could find affordable coverage that offered certain benefits by the state, as well as subsidies to those in need.
So what explains the discrepancy in positions between his time as Governor and Election 2012? Romney contends that although his plan might have worked well for Massachusetts, he does not believe the government should ever force such plans on the nation as a whole, echoing Republican sentiments. But one of the continuing ironies of his health care position is that it cost Massachusetts hundreds of millions of federal dollars to make its health law possible. Under a Romney administration, other states likely would not get a similar chance.
Medicare & Medicaid
The Romney/Ryan plan seeks to transform Medicare into a “premium support” program applying to those currently younger than 55 years of age. The primary goals of this “premium support” system are to reduce the growth in Medicare spending, and rely more on a competitive marketplace. It would give seniors a voucher (fixed-payment) to purchase either existing, government-run Medicare services, or private insurance coverage. Over time, the amount of the voucher would increase, but it would grow slower than the costs of health-care.
Under this approach, beneficiaries can choose among competing plans, but if they enroll in a more expensive plan, for whatever reason, they would pay the additional premiums themselves. This differs with the current Medicare system, in which beneficiaries pay the same Medicare premium regardless of where they live, whether they choose traditional Medicare or a private plan, or whether they live in a high-cost or low-cost area. Romney has not said how the amount of the fixed payment would be adjusted annually as health-care costs rise. He has however stated that the eligibility age of Medicare would increase from 65 to 67 years under his plan. Although this is estimated to save the federal government $5.7 billion per year, it would result in twice that cost to affected seniors and businesses that would otherwise cover them.
Romney has also proposed a major shift in Medicaid, the government entitlement program providing health insurance to the poor and disabled. Current funding for Medicaid is provided on both the federal and state levels, and anyone who meets either of the given requirements would qualify. Under Romney’s plan, however, states would receive set amounts, or “block grants,” from the federal government to be distributed as they see fit. Many federal restrictions on Medicaid would be lifted, allowing states to save money, if they wished, by covering fewer people or providing fewer benefits.
Conservatives, who have long supported Medicaid “block grants,” say the approach would not only save taxpayers money but also encourage states to innovate and tailor their programs to the specific needs of their populations. Romney has said he would hold Medicaid growth to the rate of inflation plus one percentage point, a spending reduction that he has said would save the country $100 billion a year.
Romney has expressed support for the spending targets in his running mate Representative Paul Ryan’s 2013 federal budget, which held Medicaid growth to that of overall inflation. According to the Congressional Budget Office, by 2022, Medicaid and Children’s Health Insurance Program spending would only be $322 billion, just $4 billion more than was spent in 2009. Yet, the reductions in federal spending for Medicaid would likely lead to increases in the number of Americans without health insurance and strain the safety net, even with added flexibility for states to administer their programs. Federal Medicaid money played a key role in financing Romney’s 2006 Massachusetts healthcare bill, which reduced the amount of uninsured in that state by half, according to the Kaiser Family Foundation, a non-partisan health policy research tank.
Paul Ryan’s proposed cuts to Medicare are only 60 percent as large as the cuts to Medicaid and other health-care programs. Moreover, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation. The CBO believes that $750 billion in Medicaid cuts under Ryan’s plan would “require states to limit payments to providers, curtail eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more out-of-pocket costs than under current law.”
Women’s Health Issues
Governor Romney has stated that he is “pro-life,” that the Roe v. Wade ruling should be overturned, and that abortion policy should be regulated by the states. Although he once backed abortion rights in Massachusetts, he now thinks the procedure should be illegal “except in the causes of rape, incest, or to save a mother’s life.” If he were to repeal the Affordable Care Act (ACA), he would eliminate both the contraceptive coverage and no-cost coverage of preventative services it offers to women in private–insurance and Medicare. He supports legislation that would broaden exemptions to providers and employers who claim religious conflict with certain health care services, namely abortion and contraception. He has criticized the Obama administration’s requirement that certain employers that object to birth control on religious grounds must cover it as part of their health insurance plans.
With respect to family planning, Governor Romney has said that he would eliminate the Title X program, which grants funds to low-income women for contraception as well as maternity care benefits. He also would not permit any federal funds to be given to organizations such as Planned Parenthood that provide abortions with private funds. And like other Republican presidential candidates before him, he supports reinstatement of the Mexico City policy, which would bar the government from providing money to international groups that use non-U.S. funding sources to deliver or promote abortions.
The next president will profoundly influence the future of our health care system. Not since the 1964 election of Lyndon Johnson, whose victory made possible the enactment of Medicare and Medicaid, has a presidential contest carried such significant, immediate, and certain consequences for providers, patients, and all others involved in our health care system. America’s health care system, as it stands, is unsustainable, with high costs, uneven quality of care, and millions being left uninsured. In an aging society, we have no trusted system for long-term care. Healthcare costs have risen faster than the economy, unsustainable for federal and state governments, employers, and the average citizen.
The greatest distinction between the healthcare plans of Romney and Obama lies in each candidate’s respective views on the role of government in financing access to health insurance coverage, as well as restraining growth in healthcare spending. With the economy under the pressure that it is, these financial issues are likely to take precedence in voters’ decisions, especially with respect to Medicare and Medicaid. President Barack Obama’s health care law will extend coverage to 30 million uninsured and keep the basic design of Medicare and Medicaid the same. It is not clear how well his approach will control costs for taxpayers, families and businesses. Mitt Romney would repeal Obama’s healthcare overhaul, the ACA; what parts he would replace have yet to be indicated. Romney would revamp Medicare, pushing future retirees toward private insurance plans, and he would turn Medicaid over to the states.
On women’s health, voters are once again given a stark choice between candidates. Romney has switched his stance from governor to Republican nominee, adopting a pro-life approach in contrast to the Democrat’s pro-choice platform. Romney’s ability as president to enact federal abortion restrictions would be limited unless Republicans gained firm control of Congress. But the next president could have great influence over abortion policy if vacancies arise on the Supreme Court. The prospects of reversal of Roe vs. Wade would increase if even two seats held by liberal justices were granted to Romney-nominated conservatives. The economy has also played its hand on this topic, as reflected in abortion taking precedence over preventative care services as a heated-issue.
The risk of expanding coverage is that health costs consume a growing share of the stressed economy. The risk of not expanding coverage is that millions continue to be uninsured or burdened with heavy costs as the population ages. In a period of economic instability, the Romney/Ryan healthcare plan cautions against the former, while Obama argues for the latter with proposed slashes to federal programs to protect the nation’s poor, disabled, and elderly. It is up to the voter to decide which path to take in 2012.
Shifa Mohiuddin is an MD-MPH candidate at George Washington University. She has participated in lobbying efforts with AMHP on Capital Hill.