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Universal healthcare was the most defining policy decision of President Barack Obama’s first term, and Mitt Romney has vowed to repeal it, setting up a clear divide between the candidates’ approach to coverage. Here’s a basic summary of those positions:
Although Mitt Romney has recently responded to questions, allowing that he “likes” some part of Obamacare, he has said he plans to work with congress to repeal the full legislation as quickly as possible if he is elected. He has said that, on day one in office, he would issue an executive order that paves the way for the federal government to issue waivers to all states.
In place of the Affordable Care Act, Romney says he would move the power from the federal government to the states, and claims he would help markets work by creating a fair playing field for competition, what is sometimes referred to as a “voucher system.”
His stated goal is to give individuals the power and information they need to control their own care, for instance by allowing consumers to purchase insurance across state lines, and encouraging vetted ratings of alternative plans. Romney states he would reduce insurance benefits for wealthy Americans and them at the same rate for lower-income citizens.
When Romney selected Paul Ryan as his running mate, he brought the issue of Medicare to the front burner in the campaign because of Ryan’s highly public budget proposals, which include changing Medicare for future recipients into a different system.
Under Ryan’s plan, people who are currently ages 55 and older would continue to purchase Medicare insurance as they do now, but those who have not yet reached age 55 would fall under a different plan when they do reach retirement eligibility age -- one where the government would provide a voucher that the recipient could use to purchase their own insurance coverage from a private (for-profit) company. The Ryan plan asserts that insurance companies would be motivated to offer competitive rates and reduce waste, while Americans would be given the benefit of choice.
The Patient Protection and Affordable Care Act, now commonly known to both parties as “Obamacare,” is the president’s signature effort -- and the one on which he spent a huge chunk of his political capital in his first term.
Broadly, the act intends to cover the vast majority of Americans with health care, keep costs low, promote preventative care and hold insurance companies to a higher standard of accountability. (Under the act, close to 13 million Americans are receiving rebates because their insurance company spent too much on administrative costs or compensation relative to care.) And the law allows adults to stay on their parents’ plans until the age of 26.
For the 30 million Americans who don’t have health insurance, starting in 2014 the law will offer private health insurance plan options from which to choose. And starting in that year, insurance companies will be prohibited from charging more or denying coverage for pre-existing conditions.
People who can’t afford insurance and small businesses that want to provide affordable insurance to their employees will receive tax credits. But starting in 2014, the estimated one percent of those who can afford healthcare but do not choose to buy it will have to pay a penalty. The point of the individual mandate is that all taxpayers have to bear the burden of hospitals having to treat patients who show up sick or injured at emergency rooms.
Starting in 2014, affordable insurance exchanges will allow individuals and small businesses to compare and choose private health plans. Each state will design its own options. States can also implement their own type of reform through “innovation waivers” starting in 2017, meaning the law will allow states to come up with better healthcare ideas if they have them.
Alesandra Dubin is a Los Angeles-based writer and iVillage’s Chief Election News Blogger. Follow her on Twitter: @alicedubin.