IGPA: Tale of 2 health care plans ... Why this election matters
By NICOLE KAZEE
The outcome of the 2012 presidential election will have major implications for the future of health care. This year's candidates have laid out extraordinarily different policy visions. How can you know which party best represents your views?
While the health care policy options are complicated, the principles behind them are actually quite simple.
Do you believe that addressing escalating health care costs should be our first priority? Should states be able to determine what kind of care they provide for the poor? Will the free market bring down health care costs and make Medicare more stable over the long term? If you answered "yes" to these questions, you agree with the Republican Romney-Ryan ticket.
Alternatively, do you believe that providing coverage for more than 48 million uninsured Americans should be our first priority? Should coverage for the poor be expanded and unified nationwide? Should the insurance industry be better regulated? Should Medicare continue to function as a public program? If you answered "yes" to these questions, you agree with President Obama and the Democrats.
What would each vision of future health care policies mean for you?
The future of health care under a re-elected President Obama is somewhat clear, as embodied in the Affordable Care Act (ACA). If you are currently uninsured, you will have new coverage options: access to Medicaid or subsidized commercial insurance through a new state marketplace.
If you have a pre-existing condition, insurance companies won't be allowed to deny you coverage. Preventive care like mammograms and immunizations will be free. If you already have insurance that you like, you will probably be able to keep it, although premiums may increase because insurers might pass new costs onto customers. In an attempt to save money and improve patient outcomes, the ACA will also affect how health care is delivered, how doctors and hospitals are paid, and how insurers operate.
If Mitt Romney is elected, many of these changes may never be implemented. Romney supports the health care proposals of his vice presidential nominee, Paul Ryan, who proposes a modified voucher system for Medicare that would go into effect as those currently under age 55 become eligible for retirement.
He also proposes giving states a fixed block grant and almost complete freedom to design health care programs for the poor, elderly, and disabled.
Yet unanswered questions remain about both plans. State officials will have a say in certain key parts of the ACA's implementation.
Will the state expand Medicaid coverage? State Democrats largely see long-term benefits to wider insurance coverage, while Republicans are concerned about additional costs expansion would incur for the state. Will the state run its own insurance exchange, rely on the federal government, or create a partnership exchange? Illinois policymakers would have to answer these important questions in the near future under a re-elected Obama.
Romney's plan, on the other hand, has yet to undergo the lawmaking process, which (as exemplified by the ACA) sometimes requires substantial compromise to satisfy the demands of stakeholders. As a result, we don't know how a premium support system in Medicare would operate or how much money it might save the government (or cost patients).
In addition, Romney's commitment to increasing state control over health care policy decisions would give Illinois lawmakers a great deal of leeway in Medicaid, but it is difficult to predict whether they would cut benefits and eligibility under a block grant system.
The presidential candidates represent significantly different health care visions. Despite uncertainties, it is clear that this election will set the health care system in our country on a course that will have a dramatic impact all citizens.
Any opinions expressed are those of the author. Nicole Kazee is director of Health Policy and Programs for the University of Illinois Hospital & Health Sciences System.
About "On the Issues": For more than 65 years, the University of Illinois Institute of Government and Public Affairs (IGPA) has conducted nonpartisan research on our nation's toughest policy challenges. IGPA experts have devoted their careers to studying the complicated issues behind the questions that are often on voters' minds. What are the most important things citizens should know as the step into the voting booth this fall? We asked our IGPA experts: What does the research show? Here, find the nonpartisan, evidence-based answers ON THE ISSUES. Learn more at http://igpa.uillinois.edu/ontheissues.