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.”