Despite the fact that the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA) last June, health care reform remains an important subtext in the Presidential race.
Most Republicans opposed PPACA and led the legal actions against it. After first saying he would repeal the law, Republican presidential nominee Mitt Romney now says he would keep parts and roll back others if he wins the Presidency and his party takes control of Congress. In contrast, President Barack Obama touts PPACA as the signature accomplishment of his first term, evidence of his ability to get things done for the American people despite an array of powerful, competing interests.
Polls show that voters remain divided on PPACA, and it is unlikely that antipathy toward the law will be enough to fuel a Republican electoral sweep. After the elections, PPACA most likely will remain the law of the land.
Perhaps anticipating the controversy that the law might arouse, lawmakers have delayed implementation of many of its provisions until after this election. Beginning January 1, 2013, PPACA will begin to assume its full shape, but its ultimate impact on the way union members receive health care benefits remains unclear. LIUNA and the LHSFNA continue to monitor and assess the law’s evolving regulatory scheme and what it means for LIUNA health & welfare funds.
Meanwhile, Romney opened another front of struggle over health care reform when he selected House Budget Committee Chairman Paul Ryan as his running mate, endorsing Ryan’s budget proposal and his plan to reform Medicare. An immensely popular government program, Medicare provides health care coverage to 39 million Americans over age 65. Because the cost of health care keeps rising, analysts are divided about Medicare’s long-term financial viability. In general, Democrats believe stability can be maintained through PPACA’s reforms and, if necessary, raising the cap on income subject to Medicare tax. In contrast, many Republicans support Ryan’s plan that would attempt to limit Medicare payments through a voluntary voucher program, beginning with citizens who are now 55 or younger. Under this plan, eventual Medicare recipients could opt for a voucher to purchase private health care insurance rather than accept the designated list of benefits from Medicare. Support of this plan say the private market will be an attractive option, more efficient and better at containing costs than the government. Critics counter that government vouchers almost certainly will not keep up with health care cost inflation, forcing retirees who choose that option to accept declining levels of coverage as they age.
Romney and Ryan also propose an overhaul of Medicaid, the government’s health care program for the nation’s poor while Democrats generally disagree. As all the debates over health care reform indicate, the most fundamental issue in this election may be the role of government, itself, which is deeply involved in America’s health care system. For those who favor a smaller role for government, the expansive PPACA, Medicare and Medicaid programs seem a good place to draw the line and cut back. For those who want government to aggressively tackle social problems, these programs represent the basic foundation of government services and the cutting edge for further advance.