I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.
Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options.
We need independent review of our federal healthcare spending. We have to find ways to eliminate waste and reward providers who are maximizing patient outcomes while minimizing costs. We need innovation and fresh ideas and solid oversight. A board that is tasked with cutting Medicare spending (but not coming between doctors and their patients in terms of treatment options) should be encourage – not vilified. Granted, it needs to be transparent, non-partisan, and free of any special interest ties. But the idea of a board that works to limit Medicare spending is a good one. Remember the fear mongering talk about “death panels” a few years ago when the PPACA legislation fights were underway? Telling people that the IPAB is going to “decide what kind of treatment you ought to have” seems very akin to using words like “death panels” – both are designed to stir fear and anger in people who may not know anything else about the board’s actual mission and tasks. I can understand that there are certainly people who are put off by the true nature of the IPAB (it’s not a perfect solution). But the grievances with it should be focused on the actual mission and scope of the IPAB rather than fabricated falsehoods that are meant to scare people.
It’s no secret that Republican lawmakers have generally been opposed to the PPACA while Democrats have mostly been supportive. Romney has long said that he would repeal the PPACA right off the bat, and Republicans have said that they would replace it with something else: a less far-reaching plan (ie, smaller government) that relies more on market solutions rather than government mandates. Tort reform, enhanced HSA options, allowing the purchase of health insurance across state lines, and more state-based solutions (as opposed to federal ones) are all key aspects of most of the Republican-championed healthcare reform ideas. The individual mandate is not part of the plan, and that generally means that the provision that allows health insurance to be guaranteed issue would also not be part of the plan, as those two parts of the reform law are very intertwined. And yet, last night Romney claimed that “pre-existing conditions are covered under my plan.” If you look at point number 4 on this article from last summer, it does appear that Romney supports having guaranteed issue coverage for people with continuous coverage, even if they’re moving from a group plan to an individual plan (current law already provides pre-existing condition coverage for people who move from one group plan to another, but individual health insurance in most states – including health insurance in Colorado – is medically underwritten regardless of the applicant’s health insurance history). It’s very unclear, however, how Romney’s plan would accomplish this rather monumental task. If we eliminate the individual mandate (and the PPACA in general), it would be a very tough sell to create a federal mandate to force health insurance carriers to cover all pre-existing conditions, even if the provision were limited just to those with a history of continuous coverage. And without a mandate, it’s highly unlikely that it would happen given that insuring people with pre-existing conditions tends to be a money-loser. Romney might be hoping that other states will adopt regulations similar to those in Mass (health insurance there is guaranteed issue), but without federal reform, it could be a long, slow process; indeed, many states might never get there. What’s more likely is that people with pre-existing conditions would simply continue to be unable to purchase health insurance in the individual market. We currently have high risk pools in all 50 states thanks to the PPACA, but if the law were repealed we would presumably go back to having just the state-run high risk pools that were in existence prior to the PPACA’s passage. That means that in some states, there would be no option at all for people with pre-existing conditions if they don’t have access to group health insurance.
The PPACA is not perfect, and the individual mandate has proven to be one of its less popular provisions. Guaranteed issue health insurance, on the other hand, is definitely one of the more popular aspects of the law. Unfortunately, there aren’t a lot of feasible ways to offer affordable health insurance to everyone with pre-existing conditions without also requiring everyone to be part of the pool of insureds. Romney’s desire to make sure people with pre-existing conditions are able to obtain coverage is laudable, but it may not be realistic if the overall goal is to repeal the PPACA.
