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Where the Presidential Candidates Stand on Key Healthcare Issues
by Michael O'Neal
Healthcare—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 healthcare issues affecting rheumatologists and the medical profession as a whole? The Rheumatologist looked at the candidates’ 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.
President Barack Obama
Sustainable Growth Rate (SGR)
On February 14, 2011, President Obama proposed a $3.7-trillion budget that would postpone until September 2013 the scheduled 25% cut in Medicare payments to physicians based on the SGR. This proposal made other cuts to what he called “wasteful” medical spending in order to keep Medicare payment rates to doctors steady. This included cuts to state Medicaid grants, healthcare and COBRA tax credits, and the public health and social services emergency fund. President Obama called the two-year SGR-fix “a downpayment toward a permanent fix.” While the President and members of Congress nearly universally agree that the SGR must be replaced, a permanent fix the SGR has eluded decision makers, and physicians face a 27% cut scheduled for January 1, 2013.
Affordable Care Act
Reaching the two-year mark in March 2012, the ACA has seen some parts enacted, such as the new heightened age limit on dependent insurance coverage and subsidies for Medicare recipients. The law includes provisions that will expand access for patients with rheumatic disease, such as eliminating barriers for those with preexisting conditions. It includes programs to broaden access to coverage and treatment, such as its eventual elimination of the coverage gap in Medicare Part D—the doughnut hole—and its cap on out-of-pocket expenses. The ACA’s Pediatric Subspecialty Loan Repayment Program, if funded, will help reduce the shortage of pediatric rheumatologists in the U.S. Now that the U.S. Supreme Court upheld most parts of the law via their June 28, 2012 ruling, we can expect more of the ACA’s provisions to be enacted, and some provisions will 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 Congress and the President have already repealed an unpopular 1099 tax-reporting provision of the original ACA, and a bipartisan group in Congress supports repeal of the Independent Payment Advisory Board. Republicans consider the ACA to be an overreach of the federal government and vow to repeal it, saying it costs too much and forces American citizens to participate in a government-mandated program.
The Obama administration’s FY13 budget keeps NIH funding flat at $30.7 billion. According to the NIH budget allocation, in FY13, arthritis would receive $225 million in funding and lupus $105 million.
In 2009, President Obama signed an executive order eliminating certain restrictions on stem-cell research that were put in place by President George W. Bush.
In a proclamation released on September 12, 2011, President Obama declared September 11th through the 17th, 2011, as National Health Information Technology Week. He encouraged getting more information about IT in healthcare, citing benefits in improving patient care and safety and reducing costs. The press release also mentioned the provisions listed in the American Recovery and Reinvestment Act of 2009, which “promotes the use of health IT while significantly strengthening Federal laws protecting patient privacy,” and “provides landmark financial incentives to eligible professionals and hospitals that adopt and meaningfully use electronic health records while protecting the privacy and security of health information.” The president’s words served to embolden his stance that health information technology is essential for providing high-quality, efficient patient care.
Mitt Romney, former Governor of Massachusetts
Sustainable Growth Rate
Because he voiced his support of Congressman Paul Ryan’s budget plan, political and economic experts agree that Romney is likely to push for a debt-ceiling plan that will cut Medicare spending along with other nondefense discretionary budget categories. Romney has not outlined his own specific plan to either postpone or eliminate the looming 25% cut to Medicare payments, so it is unclear what Romney plans to do with the SGR. It is likely that, like Republican leaders in the House and Senate, Romney will support eliminating the SGR.
Affordable Care Act
Calling it Obamacare, a pejorative term that President Obama now says he accepts, Romney has called ACA a failure and a “federal takeover of healthcare” that is a disaster for the country. Romney himself was the architect of his own healthcare overhaul in Massachusetts that many say was a precursor to the ACA because it mandated coverage for all Massachusetts residents, among other provisions. However, it is this focus on state-level policy that Romney is now promoting. According to Romney’s campaign website, he would issue an executive order that paves the way for the federal government to issue ACA waivers to all fifty states and would pursue policies that give each state the power to craft healthcare reform at the state level. The federal government’s role would be to help markets work by creating a level playing field for competition. A recent study by the National Bureau of Economic Research says Romney’s reforms in Massachusetts worked, and led to more people being insured without skyrocketing costs.
Because Romney has not widely discussed specific allocations of research monies, it is unclear where he stands on research funding, outside of his projected plans to cut federal spending and cap the debt ceiling.
Romney takes a specific stance on stem-cell research and therapy, citing that, although he believes stem-cell therapy can benefit patients (his wife, for example, who has multiple sclerosis), only preexisting embryos that are left over from in vitro fertilizations should be used to develop stem-cell treatments. Romney believes that no new embryos should be fertilized for the sole purpose of harvesting stem cells for treating patients.
At this point, Romney’s views on health information technology are vague. A report by the American College of Physicians (ACP) published on May 3, 2012, that examined the presidential candidates’ views, states that, “Romney supports efforts to facilitate information technology interoperability.” This statement is at odds with Romney’s promise to repeal ACA in its entirety because the law contains specific provisions for increasing use of health information systems and implementation incentives for practices. While most political experts agree that a full “repeal and replace” of the ACA is unlikely, it remains to be seen which pieces of the ACA Romney might reinstall after the repeal he has promised if he is elected president and if he has a Republican-controlled Congress to support him.
Tier IV Co-pays
On March 19, the bipartisan Patients’ Access to Treatments Act of 2012 was introduced by Rep. David McKinley (R-WV) and Rep. Lois Capps (D-CA), along with other cosponsors. The Act would increase the ability of patients to access medically necessary specialty drugs, like biologics used to treat RA. It would do this by limiting commercial insurance plans’ cost-sharing requirements for specialty drugs (usually placed in Tier IV) to the dollar amount of cost sharing the plans require for preferred-brand drugs (typically placed in Tier III). The ACR is working with the Arthritis Foundation on companion legislation in the Senate and garnering cosponsors for the House version. They are also bringing other physician and patient organizations into a broad coalition in support of these initiatives. There have been no formal comments from either candidate about the introduction of this Act.
Michael O’Neal is a writer based in New Jersey.