Debate Guide: Candidates’ Positions on Health Care

BY Kaiser Health News and PBS NewsHour  October 16, 2012 at 9:43 AM EST

Throughout the presidential campaign, health care has been one of the top issues on voters’ minds. The presidential and vice-presidential nominees of the two parties have starkly different visions for how to control costs, improve access to care and preserve Medicare benefits for future seniors.

Use the chart below to compare and contrast the views of the candidates. Click an issue or candidate name to show or hide the details.


  • Medicare

    • Mitt Romney

      Favors Medicare reforms that would give future beneficiaries a “defined contribution” or “premium support” and allow them to choose between private and traditional plans. All plans would offer coverage comparable to what Medicare provides today.

      Current beneficiaries would not be affected by this plan, which would apply to new beneficiaries in 10 years — people now 55 and younger. Also supports gradually increasing Medicare’s eligibility age from 65 to 67.

      Supports proposals for wealthier seniors to pay more toward their health coverage and lower-income seniors to receive a higher subsidy.

      Romney endorsed the budget plan advanced by Rep. Paul Ryan, R-Wis., now his running mate, when Ryan was chairman of the House Budget Committee.

    • Rep. Paul Ryan

      Ryan’s budget plan, which was passed by the GOP-controlled House, would change Medicare from a defined benefit to a premium-support program, by giving seniors beginning in 2023 a set amount — a voucher — to purchase either a private health plan or the traditional government-administered program. His proposal also would increase the eligibility age from 65 to 67.

      His plan included many of the Medicare trims included in the 2010 health law. Ryan has said that those Medicare cuts, totaling $716 billion, are included in his budget because they are part of the budgetary baseline.

      In 2011, Ryan teamed up with Sen. Ron Wyden, D-Ore., for a Medicare overhaul plan: Guaranteed Choices To Strengthen Medicare And Health Security For All.

    • President Barack Obama and Vice President Joe Biden

      Obama touts provisions in the 2010 health law that aim to bring down costs in entitlement programs, including the creation of the Independent Payment Advisory Board, accountable care organizations, and other payment pilots and demonstration projects designed to reward providers for delivering quality — rather than quantity — of care.

      The health law also closes the “doughnut hole” in Medicare prescription drug coverage, and adds new preventive services coverage, such as an annual wellness visit with a physician.

      Obama has strongly opposed Republican proposals to change Medicare for future beneficiaries into a defined-contribution program, in which they would receive a set amount of money each year to buy health coverage, rather than the program’s current defined-benefit design.

      Has supported increasing premiums based on income for Medicare Part B and Part D.

      The health law includes an estimated $716 billion in reductions to Medicare spending in the next decade, which add to the solvency of the Medicare trust fund. Romney characterizes this as program funding “cuts” to pay for “Obamacare.” But Medicare spending will continue to increase, just at a slower rate. The spending reductions will come in the form of reduced provider payments and cuts to Medicare Advantage.

  • Medicaid

    • Romney

      Supports Medicaid block grants to allow states to use capped federal contributions to run the program with more flexibility.

      Favors reducing the amount of money the federal government spends on Medicaid. The Romney campaign estimates the block-grant approach will save an estimated $100 billion per year by 2016.

      Opposes the health law’s Medicaid expansion to provide insurance to as many as 17 million more people.

    • Ryan

      Supports replacing the current Medicaid program with a block grant to states.

    • Obama and Biden

      The 2010 health law includes an expansion of Medicaid that would extend access to health coverage to as many as 17 million people. It does this by setting national eligibility standards to cover populations such as childless adults, which have been considered optional by states. The expansion is paid for almost entirely with federal funds.

      The administration has opposed Republican proposals to turn Medicaid into a block grant for states.

  • Health Care Marketplace And Reform Philosophy

    • Romney

      As Massachusetts governor, Romney signed the 2006 state health reform law that is now often considered a prototype for the federal Affordable Care Act, but he now urges the repeal of the federal law.

      Believes that “each state should be able to fashion their own program for the specific needs of their distinct citizens,” and that states are the “laboratories of democracy.”

      Supports high-deductible health savings accounts(http://www.kaiserhealthnews.org/stories/2011/august/26/gop-candidate-health-care-platforms.aspx); allowing health insurance to be sold across state lines; and allowing individuals and small businesses to join together to buy insurance.

      Backs tort reforms that include caps on non-economic damage awards in medical malpractice lawsuits.

      Urges restricting federal regulation of health care insurance, although he supports limited rules to bar insurers from denying coverage to those with preexisting conditions when they have had coverage for a specified period of time.

      Endorses ending “tax discrimination against the individual purchase of insurance” and has suggested allowing tax deductions for people who obtain health insurance on their own.

    • Ryan

      Supports repeal of much of the 2010 health law; has supported market-based reforms such as interstate insurance purchasing and the creation of association health plans, as well as efforts to decouple health coverage from the workplace, including removing tax incentives for employer-sponsored insurance and providing tax credits to individuals to purchase their own insurance. (see Roadmap for America’s Future).

    • Obama and Biden

      The 2010 health law, which is considered to be the Obama administration’s signature legislative achievement, has the dual objectives of expanding health coverage and containing costs. Among its key provisions is a requirement that nearly all Americans obtain health coverage, an expansion of the Medicaid program, the creation of health insurance exchanges and an array of consumer protections including bans on pre-existing condition exclusions.

      Has opposed medical liability tort reforms that impose federal caps on jury awards in malpractice cases. His administration also launched a Patient Safety and Medical Liability Reform Demonstration program to help states test new ways to improve patient safety, reduce the incidence of frivolous lawsuits and bring down the cost of liability insurance premiums.

      The administration has consistently supported proposals to increase transparency related to health care costs and quality, such as the health law’s medical-loss ratio requirement and requirements to collect and report on health care quality measures such as preventable medical errors, hospital-acquired infections, and others.

      Has advocated for comparative effectiveness research to help physicians and patients make health care decisions.

Interactive chart by Justin Myers of the PBS NewsHour. This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.