Obama vs. Romney: What You Need to Know About their Vision for Health Care

October 09, 2012

The role of government is certainly at the center of many public policy issues in this election, and no issue reflects that debate better than the issue of health care. The debate and enactment of the Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act, the ACA or “Obamacare,” was the centerpiece of the 2010 midterm elections that turned a Democratic-controlled House of Representatives over to the Republicans. Now, it is a key issue in the presidential campaign. 

Regardless of who wins the White House in November, AGA will continue to push for policies that support the science and practice of gastroenterology.

Here’s an overview of where the candidates stand on health-care issues. An in-depth discussion of each position follows.

 

President Obama

Governor Romney

Medicare

  • Added preventive benefits for beneficiaries, including colorectal cancer screening and closing the "donut hole" for prescriptions.
  • Implements and builds upon value-based purchasing and quality improvement programs for providers, such as the Physician Quality and Reporting System (PQRS) and meaningful use.
  • Will restore $700 billion in cuts, largely targeted toward providers.
  • Provides beneficiaries premium support to purchase plan of their choice — either Medicare or private plan.
  • Increases eligibility age to reflect current life expectancy.
  • Requires means testing for wealthier beneficiaries.
  • Builds upon quality improvement and value-based payment systems.
  • Opposes the Independent Payment Advisory Board (IPAB).

Medical Liability

  • Does not support caps on non-economic damages to curb costs.
  • Has expressed support for demonstration projects to address issue.
  • Supports medical liability reform and tort reform to help stabilize costs.

Insurance Reform and Individual Mandate

  • Required under PPACA and found constitutional under Congress’s power to tax.
  • Tied to individual mandate, which will spread risk to wider pool of individuals.
  • Supports states' flexibility to implement their own reform proposal.
  • Supports insurance reform to allow people to be insured.
  • Supports market-driven approach.
  • Would equalize tax treatments of individual and group plans to make more affordable to inviduals.

Health-Care Reform

The Democrats and President Obama have focused on the benefits of PPACA — most notably the popular insurance reforms that most Americans support: eliminating pre-existing conditions, banning lifetime caps, allowing parents to keep their children on their health insurance until they are 26, and increasing access to insurance for those who have been denied coverage. Polls have shown that most Americans believe the law should be given time to work, even if they did not support PPACA initially.

Even Republican candidate Mitt Romney stated that he wouldn’t completely repeal the entire law and supports the insurance reforms that were part of the law. However, the individual mandate is the pin that holds many of these insurance reforms together. Since insurance reform spreads the risk among a wider pool of patients, it is unclear if it would work without the individual mandate, as proposed by Governor Romney. The Supreme Court ruled that the individual mandate was constitutional, but Governor Romney has pledged that he would repeal “Obamacare” on his first day in office. What will he replace it with?

Governor Romney may be walking a thin line on this issue, which was brought up during the Republican debates and was a focal point during the first presidential debate. He was instrumental in pushing through Massachusetts’ health-care reform law. However, Governor Romney omitted the fact that his reform plan in Massachusetts also included an individual mandate to achieve universal coverage. He has stressed that he would like to keep the insurance reforms to allow people to be insured, but would rely on more market-driven approaches to health care to make insurance more affordable for people who cannot currently afford it. Romney would also equalize the tax treatment of individual and group health plans to make insurance more affordable on the individual market.

Medical Liability Reform

Of importance to physicians, Romney supports medical liability reform and tort reform to help stabilize costs. President Obama has not supported caps on non-economic damages to help curb medical liability costs, but has expressed support for demonstration programs to address the issue.

Medicare

President Obama and Governor Romney have differing views when it comes to the Medicare program and how to stabilize and strengthen it. President Obama has pointed to the provisions in PPACA that have added more preventive benefits for beneficiaries, such as colorectal cancer screenings without cost sharing and closing the “donut hole” for prescription drug coverage. The health reform law also implements and builds upon many value-based purchasing programs and quality improvement programs for physicians and providers, such as the PQRS and meaningful use for electronic health records.  The president tried to stress those features during the debate, and pointed to the Cleveland Clinic and the value-based model the organization has implemented that has driven down costs and improved quality. 

Governor Romney’s Medicare proposal is based on a plan developed by his vice presidential nominee, Rep. Paul Ryan, R-WI. This plan would revamp the current Medicare program to one that gives beneficiaries premium support to purchase a plan of their choice. Under this proposal, traditional Medicare would compete with private plans, encouraging seniors to choose between staying in a traditional Medicare plan versus an array of private plans. The proposal, which would not impact current retirees, would not be fully implemented until 2021. The goal of the proposal is to provide seniors with an array of health-care choices, including health savings accounts in which the private market would compete for their business.

Other elements of the Romney proposal include means testing wealthier beneficiaries and increasing the eligibility age of Medicare to reflect changes in life expectancy. Although the proposal does not specifically address the broken Medicare physician payment system and how it should be fixed, the plan builds upon existing quality improvement and value-based payment systems. Infusing more private competition, they theorize, will help stabilize Medicare payments by having physicians compete on quality and value.

Governor Romney has also promised to restore the nearly $700 billion in Medicare cuts that were part of PPACA and were largely targeted at providers. Much has been made of the Medicare cuts contained in PPACA on the campaign trail with Republicans accusing President Obama of raiding Medicare to finance the health reform law. 

Additionally, Governor Romney pointed to his opposition to the IPAB, which he believes will dictate what types of treatments a patient can receive. The IPAB was put in place to control the costs of Medicare spending and consists of a board of unelected officials that will be charged with making global budgetary decisions. AGA has vehemently opposed IPAB and will continue to support legislative measures to abolish it.

Regardless of who wins in November, health care will continue to be at the forefront of the policy agenda. The Medicare program is not sustainable for future beneficiaries in its current form, and AGA will push lawmakers to reform the physician payment system  so future beneficiaries have continued access to providers.

Given the push to a more value-based payment system, many of the quality improvement programs that began before President Obama will continue to move forward since they have support from both parties. Lastly, even though the Supreme Court has ruled on PPACA, its implementation continues. The 2012 presidential election could make or break the implementation of the insurance exchanges depending on who wins.

However, no matter which party wins the White House or the Congress, lawmakers need to address the rising costs of health care and the uninsured. Everyone agrees that the current health-care system is not sustainable. The question continues to remain — what role does government have in implementing these reforms?              

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