Issues in Health Care Reform
President Barack Obama
Governor Mitt Romney
Overall Vision
Full PPACA implementation.
Repeal and replace PPACA.
The Employer-Based System
Individuals could keep their traditional group coverage. A new public insurance program would be made available to small employers who want to provide coverage to their employees.
Individual could buy insurance through purchasing pools: employers, individual purchases, churches or professional associations.
Tax Incentives and Subsidies for the Purchase of Health Insurance
Federal Tax Subsidies for individuals up to 400% of Federal Poverty Line (FPL).
Equalize the way the tax code treats people who buy health insurance for themselves and those who get coverage through their employers.
Employer Mandate to Provide Coverage
In Favor.
Opposed.
Individual Mandate to Obtain Coverage
In Favor.
Opposed.
Health Insurance Market Reforms
Medical loss ratios in place to reduce the amount of money insurers spend on administrative costs.
Guaranteed issue coverage no individual could be turned down for any coverage due to an illness or other preexisting condition.
Rating only allowed on the basis of age, geographic location, and tobacco use. Rating age bands 1 to 3.
No lifetime or annual limits.
Creation of Pre-existing Condition Insurance Plan available to provide coverage option to those individuals who have been denied coverage based on a pre-existing condition and without coverage for over 6 months.
Dependent coverage eligibility expanded to young adults up to age 26
Allow individuals and small businesses to form purchasing pools for the purpose of economies of scale when purchasing coverage.
Limit federal standards and requirements on health insurance plans in the private insurance and Medicaid market.
Prevent discrimination against individuals with pre-existing conditions who maintain continuous health insurance coverage
Allow for flexibility to assist the uninsured with public-private partnerships, exchanges, and subsidies.
Allow flexibility to help the chronically ill, with high-risk pools, reinsurance, and risk adjustment.
Access to Coverage
Guaranteed access to coverage through public health insurance exchanges.
Ensure states the flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies.
Guaranteed access to coverage for those with preexisting conditions who have not gone without coverage for a significant period of time.
Assist the chronically ill through high risk pools, reinsurance, and risk adjustment mechanisms.
Allow for the sale of health plans across state lines.
Health Care Cost Containment
Modernization of the health care system through disease management, health information technology and electronic medical records, and requiring hospitals and providers to collect and publicly report measures of health care costs and quality.
Health plans would also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.
Providers will need to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.
Medicare Accountable Care Organizations incentivized to reach shared savings.
Focus on wellness and preventative care.
Address health care cost containment through competition.
Allow competitive markets to drive improvements in efficiency and effectiveness, offering consumers higher quality care and services at lower cost.
Cap non-economic damages in medical malpractice lawsuits.
Facilitate IT interoperability.
Allow consumers to purchase insurance across state lines.
Allow for HSA funds to be used for insurance premiums.
Promote "co-insurance" products.
Promote alternatives to "fee for service" payment systems.
Encourage "Consumer Reports"-type ratings of alternative insurance plans.
Medicare
PPACA allows for preventative care and wellness checks for seniors.
PPACA closes the doughnut hole for seniors paying out of pocket for prescription drugs and incentivizes providers to achieve shared savings.
Medicare is reformed as a premium support program where existing spending is repackaged as a fixed-amount benefit for each senior to use to purchase an insurance plan.
All insurance plans must offer coverage at least comparable to what Medicare provides today.
?Traditional? fee-for-service Medicare will be offered by the government as an insurance plan option that will compete on cost and benefit design with private plans.
Seniors who choose traditional Medicare could potentially pay the difference to enroll in the option if the price exceeds premium support.
Premium support will be on a tied-system with lower income seniors receiving more generous support and wealthier seniors will receive less support.
Financing Health Care Reform
PPACA is funded by a variety of taxes and offsets.
Major sources of new revenue include a much-broadened Medicare tax on incomes over $200,000 and $250,000, for individual and joint filers respectively, an annual fee on insurance providers, and a 40% excise tax on "Cadillac" insurance policies.
There are also taxes on pharmaceuticals, high-cost diagnostic equipment, and a 10% federal sales tax on indoor tanning services.
Offsets are from intended cost savings such as changes in the Medicare Advantage program relative to traditional Medicare.
Governor Romney mentions no financing mechanism.
Belief that transitioning PPACA into a state-based effort with entitlement caps will reduce federal spending.
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