The future of America’s healthcare is at the hands of two men—President Barack Obama and Governor Mitt Romney. It is up to the voter to decide which future they wish to inherit. Forty eight million Americans are currently on Medicare—the federal regulated health care system; fifty eight million households are dependent on the state regulated Medicaid services. According to the Census Bureau data 46 million Americans are uninsured and 10 million of those are non US-citizens.
In 2010, the majority of the House passed legislation on the healthcare bill proposed by President Obama. The key areas include an increased coverage of Medicaid for individuals, up to 133 percent of the federal poverty level, insurance exchange benefits for individuals and tax benefits for small businesses, eligibility for preventive services and coverage by insurance agents for people with pre-existing conditions. It will also reimburse Medicare part D- prescription drug services, by closing the “doughnut hole” enabling seniors to get reimbursements. Under Medicaid, children also qualify for the children’s health insurance program (CHIP). Children under 26 years will be eligible to remain on their parent’s insurance plan.
In 2010, President Obama enacted legislation for the Patient Protection and Affordable Care Act (PPACA). This act ensures every American gets the care they need. It included the preexisting condition insurance plan (PCIP).
While voters are at crossroads, one of the issues they feel unfair is the compulsion to purchase health insurance or be fined. Another issue is the cut in Medicare expenses. According to the Congressional Budget Office, Obamacare Medicare payment cuts will decrease the Medicare expenditure by $716 billion from 2013 to 2022. Health services will suffer most with a $260 billion cut. According to Forbes health policy expert Avik Roy, the ratio of cuts to increased benefits is 15:1. These cuts will affect seniors and their accessibility to healthcare benefits and services which will be reduced.
Dr Norman Edelman is a well-seasoned professional in the medical field, a professor and policy expert who says the presidential election will determine whether the above mentioned mandates come into form or get replaced by alternatives, which are not necessarily the best.
Should Mitt Romney come into office, Obamacare will be repealed. Romney has no definitive plans that he has highlighted for healthcare. However, he has also indicated in his campaigns and presidential debates that he will encourage inter-state insurance purchasing for those who wish to buy private insurance. Purchase of Individual insurance will be eligible for tax deductions. Medicaid will be turned into block-grant programs where federal funds will be capped by the state governments. By 2030, Medicare will have moved to a voucher system, where each person will have defined premium assistance and ability to purchase insurance from private or public (Medicare). The idea a premium-support system has been largely criticized by voters and senior citizens with opinion polls showing a 2:1 ratio on it. Romney also plans to increase the eligibility age of Medicare from 65 to 67 years.
Repealing Obamacare won’t be as easy as said, because Romney will need to retain power in the House of Representatives and win the Senate by a super majority vote of 60 or more, to have filibuster power to overturn the legislation. In that case, he will be able to repeal Medicaid and financial subsidies. There is uncertainty on whether the $716 billion Medicare cut will be repealed. If that happens, there will be two consequences: advancing of the insolvency in the Medicare part A- Hospital Insurance Trust fund and an annual increase of $323 in premiums which beneficiaries will pay from 2013 to 2022.
Romney believes that purchasing of insurance should be a competitive inter-state process. He has proposed to increase health benefits for the middle class and provide fewer benefits to rich seniors. According to Kaiser Commission on Medicaid and the Uninsured, Romney’s proposed alternatives would increase the uninsured from 14 million to 17 million.
In the recent presidential debate Romney was under fire for his proposed action on Planned Parenthood and abortion. He does not support abortion and for companies to cover health benefits including contraceptives. Obama’s contention is to have coverage so women can afford cancer screening and mammograms. Romney’s plan to repeal Obamacare will deny 30 million Americans insurance.
Additionally, the doctors’ future in Medicare and Medicaid is bleak. Reimbursements are often lower than the actual medical care. Dr Edelman says the future of doctors and private practice may get replaced by vertical integration, where hospitals own doctors. That means doctors will be employed by hospitals, thereby accelerating the number of hospitals as opposed to private practices.
Romney’s term as the governor of Massachusetts had put in place systems similar to Obamacare, however, the tried and tested model does not appear to be the model for the country.