Dr. Eli Y. Adashi of Brown University in Providence, R.I., and John E. McDonough of the Harvard School of Public Health in Boston reviewed the Republican nominee's campaign website, public addresses, debates, interviews and other statements and found five essential elements of his health policy intentions.
The article, published in The New England Journal of Medicine, said Romney would seek repeal of large portions of the Affordable Care Act, especially the provisions that expand health coverage for the uninsured through private plans and Medicaid. However, the researchers said many Affordable Care Act sections would be untouchable even if the Senate changes to a Republican majority. However, the elements that would have the greatest impact and cost the most -- Medicaid expansion and health insurance subsidies -- could be repealed if the GOP had 51 votes.
Also uncertain is whether a Romney administration would seek repeal of the $716 billion in Medicare savings -- from reducing the Medicare Advantage taxpayer subsidy so it costs the same as traditional Medicare and -- would be used to finance about half the Affordable Care Acts' cost, the researchers said.
Though Romney has committed to repealing these savings, his running mate, Rep. Paul Ryan, incorporated them into his House budget resolutions in 2011 and 2012, with overwhelming support from the House Republican Caucus. Rescinding these savings would speed up the insolvency of the Medicare Part A Hospital Insurance Trust Fund from 2024 to 2016 and trigger an average increase of $323 in the premiums paid by most Medicare beneficiaries from 2013 to 2022, the researchers said.
Romney said he would also attempt to move Medicare toward a defined-contribution -- or premium-assistance, or voucher -- model beginning in 2023. Romney said he would turn Medicaid into a block-grant program, capping the federal funds provided to state governments to cut costs, the researchers said.
The former governor of Massachusetts said he would seek to make individually purchased health insurance tax-deductible -- like employer-based coverage -- and pre-empt much state regulation of the private health insurance market.
He would oversee massive reductions in federal spending on all health programs as a by-product of his budget and tax proposals.
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