Health Care Policy under President Romney — NEJM

Health Care Policy under President Romney — NEJM

Also uncertain is whether a Romney administration would seek repeal of the $716 billion in Medicare savings that would be used to finance about half the ACA's cost. Though Romney has committed to repealing these savings, his running mate, Congressman Paul Ryan (R-WI), incorporated them into his House budget resolutions in 2011 and 2012, with overwhelming support from the House Republican Caucus.4 Rescinding these savings would advance 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 between 2013 and 2022. Romney has pledged not to change Medicare for current enrollees.2 However, premium increases for future enrollees, plus the elimination of ACA-created Medicare benefits such as no-cost preventive services, will test that pledge.

Romney and the Republican National Platform also endorse Ryan's proposal to convert Medicare from a defined-benefit to a defined-contribution program.2,4 Under this plan, new senior and disabled Medicare enrollees (beginning in 2023) would receive a capped subsidy (“premium support”) to purchase individual coverage from competing private and public (traditional Medicare) health plans.2,4 Romney also proposes to increase Medicare's eligibility age from 65 to 67 and to provide less premium support to wealthier seniors.2 These changes would reduce future federal Medicare spending beginning in 2023 and would shift growing costs to beneficiaries.

Romney also endorses Ryan's proposal to modify the federal–state Medicaid partnership by turning the program into block grants and capping the federal contribution.2,4 The corresponding budget resolution calls for cuts (beyond those effected by ACA repeal) of $810 billion over 10 years (2013 through 2022).4 These cuts would mean curtailing benefits, reducing provider payments, tightening eligibility, shrinking enrollee rolls, and swelling the ranks of the uninsured by 14 million to 27 million people, according to the Kaiser Commission on Medicaid and the Uninsured.5 Though Romney outlines countermeasures such as state-sponsored high-risk pools and insurance subsidies, both options are costly and contingent on flush state coffers.

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