Decision 2012: The Candidates and Health Care

Each election cycle, the candidates and political pundits tell us “this is the most important election in a generation, maybe even in our lifetime.” We are told “your children and your grandchildren’s futures depend on how you vote.” This year’s Presidential election is no different. When we go to the polls next month, we will be casting a vote not just for president but for one of two profoundly different visions for the future of health care.

Most of the rhetoric has been about the health care overhaul that became law in 2010. President Obama and most Democrats support it; candidate Mitt Romney and most Republicans oppose it. At stake is how you will receive care and how that will be paid for.

Let’s look at two key components – The Patient Protection and Affordable Care Act (Obamacare) and Medicare/Medicaid.

The Patient Protection and Affordable Care Act

With an Obama win, the President will step up efforts to carry out his landmark health care law, the Affordable Care Act.

Parts of the bill have already kicked in — a provision that allows young adults to stay on their parents’ insurance plans until age 26; prohibiting insurers from denying coverage to children with a pre-existing condition; and phasing out the gap in Medicare prescription drug coverage. Many Americans are in favor of these pieces of the legislation. On January 1, 2014, the less favorable requirement takes effect, requiring most Americans to obtain health insurance or face a penalty. Also slated for 2014 is the expansion of Medicaid eligibility and setting up state-based exchanges to allow individuals and small businesses to purchase insurance.

The Congressional Budget Office projects that 30 million uninsured people will eventually gain coverage. Given the controversy over the law and the logistical challenge of setting up state insurance exchanges where people can shop for coverage, the transition will probably be rocky. But many doctors, hospitals and insurance companies are determined to make it work.

Mitt Romney has pledged to “repeal and replace Obamacare.” He will issue an executive order on his first day in office to grant waivers to states that didn’t want to participate in Obamacare and then work to repeal the legislation completely. Even though he helped develop the 2006 law requiring most Massachusetts residents to have health insurance – generally seen as a model for the Obama law – Mr. Romney says that this requirement as a national policy is the wrong approach. His advisors say the focus should be on controlling health care costs by fixing the dysfunctional insurance market, not on increasing the number of insured Americans. Mentioned among the alternatives to the legislation are the long-standing Republican initiatives of expanding health savings accounts, limiting medical malpractice awards, and giving tax credits to the self-insured.

Medicare and Medicaid

There is agreement that the current Medicare and Medicaid programs are financially unstable, unsustainable and need to be addressed; however, the candidates have sharply different views on how to do that. In 2011, more than 100 million low-income, disabled and older Americans were covered by these two government health programs.

Mr. Romney looks to make fundamental changes to the structure of the programs that would include privatization and much less government regulation. He proposes giving each state a fixed amount of federal funding to cover its disadvantaged population with more control for the states over eligibility and benefits. He also proposes giving each Medicare beneficiary a fixed amount of federal money to pay for either a traditional Medicare program or private insurance.

Mr. Obama’s health care law expands Medicaid to nearly all individuals under age 65 with incomes up to 133 percent of the federal poverty line – projected to be as many as 17 million previously uninsured added to the Medicaid rolls. However, the ultimate reach of the program will depend on states’ decisions to “opt in” to the expansion. As of July, more than a dozen states –including Florida, Texas and South Carolina – have indicated they will not participate in the expansion. Mr. Obama would also preserve the current Medicare system of guaranteed benefits and close the prescription drug “doughnut hole” coverage gap of Medicare part D. He would attempt to rein in costs, largely by reducing payments to health care providers.

Neither candidate has addressed the unpopular choices on the way health care is delivered – physician compensation, over-treating of patients, and the share of health care consumed by beneficiaries in their final year of life. No doubt the sting of the”death panels” accusation is still felt.

Many health care providers and consumers alike are taking a “wait and see” attitude until the morning of November 7. Most agree the outcome of this election will have a significant impact on the future of health care. Regardless of where you stand, please vote on November 6.