Friday, May 11, 2012

Mitt Romney on Health Policy

This is the fourth in a series of entries revisiting Mitt Romney's policies as stated in the debates. The first covered foreign policy; the second covered economic policy. The third covered the social issues of religion, gay marriage, contraception, abortion, and guns. This entry covers health care, including Obamacare, Romneycare, Medicare, Medicaid and other health reform ideas.

Obamacare vs Romneycare:

Romney often highlighted differences between the Massachusetts health care reform commonly called "Romneycare" and the national Patient Protection and Affordable Care Act, commonly called "Obamacare." While he supported and throughout the debates continued to defend Romneycare, he opposed Obamacare to the extent that he promised to grant waivers to all 50 states on his first day in office and to press Congress for full repeal. Claimed differences include:
  • Obamacare raises taxes; Romneycare didn't
  • Obamacare takes money from Medicare; Romneycare didn't
  • Obamacare is a national program; Romneycare is a state program
  • Similarly, Obamacare is unconstitutional for the national government; Romneycare is constitutional because it's at the state level
  • Obamacare includes "a panel that ultimately is going to tell people what kind of care they can have," referring to the Independent Payment Advisory Board; Romneycare does not include such a panel
  • Obamacare applies to 100% of the citizenry; Romneycare supposedly only addressed the 8-9% who were uninsured (he said 9% in the 5th debate, 8% in the 6th, 7th and 17th debates)
  • Obamacare leads to regulations like the contraception mandate; Romneycare had a provision that people did not have to buy coverage for treatments or medical devices which violated their religious beliefs
  • Obamacare was 2,700 pages long; Romneycare was 70 pages long
Note that these are differences claimed by Romney; whether or not you find them believable is up to you. Also, some of these were repeated (a lot) more than others. Throughout the debates, Romney often returned to Obamacare's cuts to Medicare and to the federalism defense that states can adopt individual mandates but the national government cannot. On the other hand, the IPAB point was, to my knowledge, only mentioned once.

Medicare and Medicaid

As mentioned above, Romney often criticized Obamacare for cutting Medicare. In fact, almost every time Romney mentioned Medicare, it was either to criticize Obamacare for cutting it, or defending Romneycare for not cutting it.

Regarding actual reforms to Medicare, he wants a shift to a premium support model like the Ryan plan. He also favors means testing for Medicare, where the rich would receive lower benefits and everyone else would receive higher benefits. Finally, he would not repeal Medicare Part D.

He would send Medicaid to the states as a block grant and only allow it to grow at either 1-2% per year (in the 8th debate) or inflation-plus-one-percent (in the 10th debate). He never mentioned any other reform to Medicaid, but repeated this block grant plan in several debates. 

Other Health Reforms 

Individual Mandates: While Romney opposes Obamacare, including its national individual mandate, he often defended the individual mandate itself as a good policy to carry out on the state level. In the 3rd debate, he compared it to states' ability to require children to attend school. He sees individual mandates as ways to provide the uninsured with what he called in the 6th debate "market-based, private" insurance. In the 8th debate, he said about the individual mandate in Massachusetts, "A lot of people were expecting government to pay their way. And we said, you know what? If people have the capacity to care for themselves and pay their own way, they should." Romney disagrees with Obama on what level of government should impose the individual mandate, but he agrees that it's a good policy in the first place.

Health Savings Accounts: In the 5th debate, Romney said health care "isn't working like a market," but rather is "working like a government utility" because consumers are separated from the cost of health care. He advocated health savings accounts to fix this problem, mentioning HSAs in the 5th and 9th debates.

Employer-based Insurance: In the 9th debate, Romney said we should treat individually-purchased insurance the same as employer-purchased insurance in regards to the tax code. He also mentioned this in the 19th debate.

Tort Reform: In the 9th debate, he advocated tort reform as part of the package of reforms he would replace Obamacare with. 

Health Issues Covered Elsewhere

Romney's positions on contraception and abortion were covered in the third entry in this series, on social issues. In addition to the section above, Obamacare was also covered in the second entry in the context of regulations and fiscal responsibility.

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