Health care—particularly the Patient Protection and Affordable Care Act (ACA)—has been a hot topic this presidential election season. Where do the Democratic and Republican presidential candidates stand on health care issues affecting otolaryngologists and the medical profession as a whole? ENT Today looked at President Barack Obama’s and former Governor Mitt Romney’s positions on a few key issues, summarized briefly below. Information on the candidates’ views is taken from campaign websites, public campaign appearances and news interviews.
Affordable Care Act (ACA)
President Obama: As of the two-year mark in March 2012, parts of the ACA have been enacted, such as the new heightened age limit on dependent insurance coverage and subsidies for Medicare recipients. The ACA includes programs to broaden access to coverage and treatment, such as eventual elimination of the coverage gap in Medicare Part D—the doughnut hole—and a cap on out-of-pocket expenses.
Now that the U.S. Supreme Court has upheld most parts of the law with its June 28 ruling, we can expect more of the ACA’s provisions to be enacted, while some continue to be modified. Congress and the President have already repealed an unpopular 1099 tax-reporting provision of the original ACA, and a bipartisan group in Congress supports repeal of the Independent Payment Advisory Board.
Romney: If elected president, Romney has said he would issue an executive order that paves the way for the federal government to issue ACA waivers to all 50 states and would pursue policies that give each state the power to craft health care reform at the state level. The federal government’s role would be to help markets work by creating a level playing field for competition.
By granting states the power to regulate their own local insurance markets and to care for their poor, uninsured and chronically ill residents, Romney says states would have the flexibility to craft the approaches best suited to their own specific needs. Further, he proposes placing limits on federal standards and requirements on both private insurance and Medicaid coverage, and would offer innovation grants to explore non-litigation alternatives to dispute resolution.
Accountable Care Organizations (ACOs)
President Obama: The ACA contains numerous conditions aimed at improving patient care and reducing costs. Among these are Accountable Care Organizations (ACOs), groups of health care providers who give coordinated care whose payment is tied to achieving quality goals and outcomes that result in cost savings. This model is intended to encourage physicians to examine the most effective, and often the least expensive, routes of patient care by eliminating the traditional fee-for-service reimbursement model.
Romney: Romney hasn’t explicitly outlined his position on ACOs but supports alternatives to the fee for service payment model and promotes ratings systems of insurance plans and hospitals so that patients can compare cost, quality and value, and he says, are ultimately empowered to make informed decisions about their own care.
Health Information Technology
President Obama: President Obama believes the federal government should subsidize the cost of electronic health records (EHRs) for hospitals and physicians to increase adoption of the systems. His administration created the EHR Incentive Program and increased funding for the Office of the National Coordinator for Health Information Technology by signing into law the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
Romney: Romney agrees that hospitals and physicians should implement EHRs to lower costs and improve care coordination. But, he argues that states, and not the federal government, should provide incentives for the adoption of the technology.
President Obama: Currently, e-prescribing requirements are mandated under the Medicare Act and the ACA. In May of this year, the Centers for Medicare and Medicaid Services finalized a rule requiring hospitals and pharmacies to update their e-prescribing technology requirements in order to eliminate unnecessary spending and increase efficiency. The Obama Administration predicts that the new rulings will save the government more than $5 billion over the next five years.
Romney: In late 2003, Romney, then governor of Massachusetts, signed An Act Relative to Electronic Signatures. According to the Massachusetts Medical Society, the act not only enabled many commercial entities to use electronic signatures, but it also allowed doctors to electronically prescribe medications to patients through their pharmacies.
Although Romney has not issued any explicit statements regarding e-prescribing since announcing his candidacy for president, most political experts agree that Romney would not reverse any rulings on e-prescribing that would save the government money.