Obamacare or Romneycare?

Of all the issues in the 2012 presidential election, none defines the candidates quite as specifically as health-care reform.

President Barack Obama’s policy stands forth in the Patient Protection and Affordable Care Act of 2010—known as the ACA, or “Obamacare,” a label of derision that the president now uses with pride. It took more than a year to pass, as Obama attempted to build support, and the final product produced detractors on the far left (who prefer a single-payer solution) and on the right (who object to the individual mandate). In the end, it took a 5-4 vote in the Supreme Court to keep the law alive, so onward goes the implementation timeline.

Once upon a time, when he was governor of Massachusetts, Mitt Romney signed a law similar to the ACA. It’s become known as Romneycare. Now he wants to repeal Obamacare, or at least the parts he finds objectionable, even if the ACA would then implode under its own weight.

The moderate Democrat and the pendulum-swing Republican may provide only nuanced differentiation on some issues, but not on health care. Here, in comparison, they contrast. The CN&R assesses their differences:

Obama

What his campaign says:

• “President Obama believes that quality, affordable health insurance you can rely on is a key part of middle-class security.”

• “Obamacare is making health care work better for all of us, even if you already have insurance. It puts the health of your family first—ensuring access to free preventive care and protecting consumers from insurance company abuses.”

• “The Affordable Care Act is holding insurance companies accountable, putting an end to the worst abuses, such as capping or dropping your coverage when you get sick.”

• “The Affordable Care Act is helping people with Medicare save on the care they need to stay healthy—from free preventive services to lower costs on prescription drugs and monthly premiums.”

• “President Obama is putting an end to the health insurance company practice of charging women more than men for the same coverage.”

Analysis:

Many aspects of the Affordable Care Act already have taken effect. Among them: Hospitals and physicians have begun the transition to electronic medical records, supported by the federal government; insurance companies have issued rebates to customers under the “medical loss ratio,” limiting the percentage of premium dollars spent on non-treatment expenses; the government has invested $15 billion to bolster preventative care; and hospital payments from Medicare have been linked to patients’ outcomes.

In Obama’s second term, Medicare would remain a public insurance program with renewed emphasis on reining in costs. Medicaid would expand, reducing the ranks of the uninsured.

The “individual mandate” would require working individuals to purchase insurance, but the government would subsidize premiums for those whose incomes are up to four times the federal poverty level ($92,200 for a family of four). Middle-class workers whose employers don’t provide health insurance would be able to buy coverage through a national exchange, rather than choose from the more limited offerings available state by state.

The ACA timetable (viewable online at www.healthcare.gov/law/timeline) could change. Paul B. Ginsburg, president of the Center for Studying Health System Change, told the New York Times that Obama and congressional Democrats might sway Republican support for the legislation by delaying implementation of the more costly and administrative-intensive provisions. That prediction makes sense given Obama’s track record of compromise.

Romney

What his campaign says:

• “On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all 50 states. He will then work with Congress to repeal the full legislation as quickly as possible.”

• “In place of Obamacare, Mitt will pursue policies that give each state the power to craft a health-care reform plan that is best for its own citizens. The federal government’s role will be to help markets work by creating a level playing field for competition.”

• “Mitt 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. States will have both the incentive and the flexibility to experiment, learn from one another, and craft the approaches best suited to their own citizens.”

• “Competition drives improvements in efficiency and effectiveness, offering consumers higher quality goods and services at lower cost. It can have the same effect in the health-care system, if given the chance to work.”

• “For markets to work, consumers must have the information and the power to make decisions about their own care. Placing the patient at the center of the process will drive quality up and cost down while ensuring that services are designed to provide what Americans actually want.”

Analysis:

Romney the governor and Romney the nominee have decidedly different positions on health coverage for all citizens. What Massachusetts Romneycare made a requirement via universal insurance, U.S. Romneycare would attempt to patch together by ramping up the status quo. That is, spur free-market competition in the hope of driving down costs, let states pursue individual reform policies, and accept the fact that ill people without insurance will flock to emergency rooms for “free” treatment.

The Republican nominee favors block grants from the federal government to help states subsidize their Medicaid programs. States then would take those lump-sum grants and control their expenses by limiting benefits and enrollment—again, as each state sees fit.

Rather than working within a national insurance exchange, insurance companies would continue to operate state by state. Medicare would become a program that supports the purchase of private insurance instead of serving as a public insurance plan; thus, the discussion of “vouchers” has arisen in health care, not just education.

Tax breaks for those who purchase private insurance would replace the individual mandate. Romney says this would inspire competition and lower costs.

Romney plans to preserve the ACA protection for people with pre-existing conditions, but with a major proviso: It would only guarantee Americans who have maintained continuous, uninterrupted insurance coverage. Moreover, because those individuals would not be offset in the “risk pool” by healthy adults purchasing insurance, those with pre-existing conditions could find themselves faced with hefty premiums as part of a special high-risk pool.