Presidential Election Offers Voters ‘Stark Choice’ on Health Care

When voters on Nov. 6 select the U.S. president for the next four years, they also will decide the foreseeable future of the U.S. health care system and the fate of the Affordable Care Act, the New York Times reports.

President Obama and Republican presidential nominee Mitt Romney are offering voters a "stark choice" on health care policy, according to the Times. Obama's plan -- outlined in the ACA -- focuses on expanding coverage and requiring most U.S. residents to obtain insurance or pay a tax penalty.

Meanwhile, if Romney is elected and Republicans gain control of the Senate, a large portion of the law could be repealed or many of its funding mechanisms could be cut back. Romney frequently has said that controlling medical costs will be a top priority.

Health Care Under a Romney Administration

Romney has said that his administration would put more emphasis on private-sector solutions to address health care costs and coverage issues, according to the Times. He has frequently said that he wants to repeal the ACA, but he has not offered specifics about the plan with which he would replace it.

Romney also has repeatedly argued that the individual mandate in the ACA is the wrong approach for national policy, even though it is modeled on a coverage requirement in the 2006 Massachusetts health care law that he signed while governor. Romney favors providing tax breaks to individuals who purchase their own insurance coverage, which he says would force insurers to compete for business and result in lower costs.

Under a Romney administration:

• States would be given a fixed amount of federal funding to offset the costs for providing care to Medicaid beneficiaries, along with greater control over benefits and eligibility, which would "effectively shrink" the program, the Times reports;
• Medicare would be transformed into a premium support program, in which beneficiaries would receive subsidies to help purchase either private coverage or traditional Medicare; and
• Individuals with pre-existing conditions would be guaranteed access to coverage, but only if they have maintained coverage without a significant gap; those individuals would be allowed to obtain coverage through high-risk pools, but the coverage could be "prohibitively expensive" for some, the Times reports.

Health Care in a Second Term of the Obama Administration

If Obama wins re-election, the ACA would "almost certainly come into full force," the Times reports. In 2014, the individual mandate would take effect with the goal of extending health coverage to at least 30 million more U.S. residents.

Under the Obama administration:

• Medicaid would be expanded in 2014 to cover millions more individuals;
• Medicare would be preserved in its current state, with an increased emphasis on reining in costs; and
• Insurance premiums would be subsidized for people with incomes up to four times the federal poverty level.

Marc Goldwein -- senior policy director at the bipartisan Committee for a Responsible Federal Budget -- noted that some of the ACA's provisions could help rein in costs, such as the excise tax on high-priced health plans that is scheduled to take effect in 2018.

Experts say that if Obama and other Democrats are willing to make compromises in a second term, they might be able to discourage the GOP from seeking to block the implementation of the ACA and encourage more Republicans to accept it.

For example, Obama and Democratic lawmakers could agree to delay the implementation of some of the law's largest and most expensive provisions by one year, which would give all stakeholders more time to prepare and save money, according to Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change (Goodnough/Pear, New York Times, 10/10).