The Republican candidates starting the long-haul through the primary season have one thing in common — they all want to repeal the health reform law, the Affordable Care Act. It is the lens through which they view healthcare issues.
But most of the candidates have offered few details on their Web sites about what they would replace it with in order to increase the number of those insured, reduce healthcare costs, and improve care quality. Likewise, they also have given little indication about whether they would continue to provide incentives to hospitals and physicians for adopting electronic health records.
[Q&A: In Iowa healthcare is yardstick of federal overreach.]
Mitt Romney and Newt Gingrich have had to back track on health care, since both supported, for at least a time, the individual mandate in 2006 but disavowed that stance as presidential candidates. President Obama’s health reform law was more than inspired by Romney’s healthcare plan when he was governor of Massachusetts. Romney has said the plan may have fit Massachusetts but, like the other candidates, has said that the federal government does not have the constitutional authority to compel all Americans to obtain insurance.
After his years in federal office, Gingrich established the Center for Healthcare Transformation, an organization which sought to develop market solutions for healthcare issues, including the adoption of health IT.
In addition to repealing the Affordable Care Act, the leading candidates all support provisions to:
• Reform medical malpractice laws
• Fund Medicaid block grants to states without federal mandates to enable them to develop the programs that fit their needs
• Increase competition for insurance plans by letting Americans buy insurance across state lines. States currently regulate insurance within their own borders
• Allow all consumers to use health savings accounts to pay for all aspects of health care
Here is a snapshot of other healthcare solutions that the major trending candidates support:
Mitt Romney: Only those who have maintained health insurance would be guaranteed that private insurers could not deny coverage for pre-existing conditions. Give seniors a choice between traditional Medicare or a voucher system to purchase coverage on an insurance exchange. Let small businesses and individuals not part of employer group form purchasing pools to obtain coverage at lower prices and with more choice. Promote ratings system for insurance companies and hospitals so public can compare cost, quality and value. Give states innovation grants to reform their healthcare systems. Change reimbursements away from volume incentives. Implement electronic health records (EHRs) to reduce duplicate testing and coordinate care. Romney's Web site.
Ron Paul, M.D.: Advocates for providing tax credits and deductions for all medical expenses. Supports consumers’ getting educated about alternative treatments and dietary supplements. Supports payroll deduction for employee who is primary caregiver for loved one with terminal illness and payroll tax exemption for employees suffering from and incurring costs related to terminal illness. Paul's Web site.
Rick Santorum: Supports expanding transparency and health literacy and adopting EHRs. Allow those who purchase their own health care coverage to do so with pre-tax dollars, including a refundable tax-credit for the purchase of health coverage to disassociate jobs and health coverage. Replace Medicare program with a voucher system. Santorum's Web site.
Newt Gingrich: Give consumers the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount. Let seniors choose from traditional Medicare or a private option. Expand state high-risk pools for those with pre-existing conditions or who have become too sick to acquire health insurance instead of prohibiting private insurers from denying coverage on those grounds. Change Medicare and Medicaid reimbursement models to take into account the quality of the care delivered and offer incentives to beneficiaries to seek out facilities that deliver the best care at the lowest costs. Give health plans, employers, Medicare, and Medicaid more latitude to design benefits to encourage and reward healthy behaviors. Stop health care fraud by moving from a paper-based system to an electronic one. Gingrich's Web site.
[Related: A word about healthcare in Iowa -- Rural.]
Rick Perry: Expand job growth so more individuals are covered by employer-sponsored health plans. That will relieve safety-net programs. Enable states the flexibility to design their Medicaid program similar to the 1996 welfare reform model. Perry’s Web site.
Michele Bachman: Supports improving health care through a medical innovation and personal choice. Also, make medical expenses tax deductible. Voted to support plan of Rep. Paul Ryan (R-WI), chairman of the House Budget Committee, to transform Medicare to a premium support or voucher program for future seniors while keeping status quo for present seniors. Bachman’s Web site.
Jon Huntsman: Not competing in the Iowa caucuses but is focusing on New Hampshire primary, set for Jan. 10. As governor of Utah, Huntsman developed a state health insurance exchange in 2008 that gave consumers freedom to choose and negotiate their own coverage in a competitive marketplace. Huntsman’s Web site.
