Amid all the discussion of the economy, foreign policy, and social issues this election season, the role of the federal government in shaping the country’s health-care system is not getting the attention many people thought it would — especially since opposition to the Affordable Care Act (“Obamacare”) played a large role in the Republican takeover of the House of Representatives two years ago. But just because health care isn’t always in the spotlight doesn’t mean the stakes are any lower, or the controversies any less heated, than they were in 2010. The actions of Congress and the president over the next few years could greatly shape the course of health care for people with diabetes.
The area in which federal health-care policy is perhaps most uncertain is still the Affordable Care Act itself. President Obama, of course, supports the law and would oppose any attempt by Congress to repeal it, just as most Democrats in Congress support the core elements of the law (which are set to go into effect in 2014). These core elements include establishing state-based insurance exchanges through which people without employer-provided or other group health insurance plans can buy private health insurance; requiring that insurance plans on these exchanges accept all applicants, regardless of preexisting medical conditions; providing subsidies, based on income level, to make health insurance purchased on exchanges more affordable; and requiring that nearly all Americans have comprehensive health insurance of some kind. In principle, at least, requiring nearly everyone to have health insurance will lead to lower premiums, since more healthy people will be part of insurance pools.
Mitt Romney, the Republican nominee for president, has vowed to work to repeal the Affordable Care Act, as have most Republican candidates for Congress. In explaining his opposition to the law, Romney often notes that it requires certain businesses to pay a penalty if they do not provide health-insurance plans to employees; this is one way the law pays for subsidies to individuals buying insurance on state exchanges. Romney favors giving states more control over health-care regulation, meaning that some states might enact plans similar to the Affordable Care Act (as Romney did as governor of Massachusetts) but that many would not. Rather than supporting subsidies for lower-income families and individuals to buy health insurance, Romney supports a federal tax credit that would reduce some of the cost of health insurance. For those with truly low incomes, however, such a credit would most likely still leave insurance unaffordable. Romney also only favors requiring insurers to accept applicants with preexisting conditions if they have continuous insurance coverage, which leaves out many who currently lack health insurance as well as anyone who might be unable to pay for continuous coverage because of financial hardship caused by a job loss or similar event.
The candidates also disagree on the direction of Medicaid, the joint federal-state public insurance program for the poor (which also covers nursing-home coverage for the elderly who lack sufficient finances). Obama supported the expansion of Medicaid to anyone earning up to 133% of the federal poverty line, which is a provision in the Affordable Care Act that states can opt out of, thanks to a US Supreme Court ruling. Romney opposes this Medicaid expansion and would furthermore drastically change the existing program, ending federal rules governing eligibility and coverage and instead giving states complete flexibility to cover their poor residents as they choose.
Medicare, the federal public insurance program that covers all senior citizens, has seen some changes in its structure under the Affordable Care Act, with the support of President Obama. The prescription-drug coverage gap in Medicare Part D (often called the “doughnut hole”), under which many seniors have had to pay the full cost for all drugs out-of-pocket, was eliminated in the law. The law also, however, cut approximately $700 billion in hospital reimbursements and private-insurance subsidies from the Medicare program. While these cuts did not affect the benefits of people enrolled in Medicare, many Republicans claim that the cuts could lead to health-care providers becoming less accepting of Medicare patients. Romney promises to restore this funding to Medicare. He also supports changing the program so that future enrollees (those currently under 55 years old) can either choose the current Medicare system or receive a voucher from the government with which they could buy private insurance.
Will your views on federal health-care programs be a major factor in how you vote next week? Do you see either Obama’s or Romney’s plans changing your diabetes care for the better, or for the worse? Do you rely on either Medicare or Medicaid, or do you anticipate gaining coverage through the Affordable Care Act? Do you support any of the proposed changes to these programs? Leave a comment below, and don’t forget to vote on Tuesday, November 6!