"Repeal Obamacare" defines Republican health-care plans in 2012

BY SAM LANE | NOVEMBER 28, 2011 7:20 AM

Candidates' Views:

Ron Paul
Paul would allow the purchase of health insurance across state lines. He would also provide tax credits and deductions for all medical expenses.

Mitt Romney
Romney would allow states to expand health-care access to low-income citizens through block grants for Medicaid and the uninsured. Romney believes health savings accounts should be used to pay for health-insurance premiums.

Herman Cain
Cain would require those who lose frivolous lawsuits involving medical professionals to pay the legal expenses of those found not guilty. He would allow the deductibility of health-insurance premiums purchased by employers and employees.

Michele Bachmann
Bachmann put forth legislation that would make medical expenses, including health-care premiums, 100 percent tax-deductible for all individuals. She advocated for the creation of Association Health Plans, which would allow small businesses to come together through trade organizations to purchase health insurance.

Newt Gingrich
Gingrich would create more choices in Medicare, giving seniors the opportunity to choose from private-sector options as well. He proposes states set up a "High Risk Pool" to help cover those who are too sick to buy health insurance. As a U.S. representative in 1993, Gingrich supported something similar to the individual mandate, but he has since backed off.

Gary Johnson
Johnson would give block grants for Medicare and Medicaid to the states. He would also push to legalize marijuana for medicinal and recreational use.

Rick Perry
Perry supports gradually raising the age of Medicare eligibility. He also says Medicare benefits should be paid to recipients on a sliding scale based on income.

Rick Santorum
Santorum has supported health savings accounts — accounts exempt from some taxes that are available to individuals with high-deductible insurance plans. But in 2008, Santorum endorsed Romney, who supported a health-care law similar to Obama's.

Jon Huntsman
Huntsman said he would "roll back" Obama's health-care reform, even though Huffington Post reported he "held a favorable view" of the individual mandate when he was the governor of Utah.

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Repeal Obamacare.

That, at least, is the most common health-care policy proposal from the 2012 Iowa caucus candidates. The slogan dominates candidates' campaign websites and has become common rhetoric throughout debates and speeches.

The Patient Protection and Affordable Care Act — the health-care legislation President Obama signed into law in 2010 — altered the country's previous system, in part by requiring most Americans to obtain some form of health insurance.

Though he said the issue of health care is "not at the top of the agenda" this caucus season, University of Iowa sociology Professor Kevin Leicht said a few main discussions have surrounded the complicated topic.

The first issue, he said, is the controversial individual mandate. Under the new law, all U.S. citizens and legal residents must have health-insurance coverage by 2014 or face a tax penalty.

Advocates have said those who choose to go without health insurance place an undue financial burden on taxpayers. But one reason opponents contest the law is they feel it is unconstitutional to require Americans to purchase a private service. The U.S. Supreme Court recently agreed to rule on the constitutionality of the mandate. That ruling is likely to come out next June.

Another issue is the costs individual states will incur under the bill.

Peter Damiano, the director of the UI Public Policy Center, said the federal government will initially fund the new law's expansion of Medicaid when it is enacted in 2014. But federal funding may later drop to 90 percent, with states picking up the other 10 percent.

Leicht, the director of the Iowa Social Science Research Institute, said many people see the issue as one of the bill's weaknesses.

Another controversial part of the discussion is that caucus contender and former Massachusetts Gov. Mitt Romney supported a similar individual mandate for his state in 2006. That law, Leicht said, has "astonishingly few" differences to the Affordable Care Act and is an issue with which Romney has struggled.

And despite Romney and other candidates' "repeal Obamacare" rhetoric, Damiano and others said Republicans lack specific proposals to replace the 1,000-plus-page legislation. The current candidates have "never come forward with a proposal that would cover a significant portion of the uninsured," Damiano said.

However, Bob Anderson, the head of the Johnson County Republicans, said GOP candidates do have plans.

"What the Obamacare plan was was more of a takeover of health care," Anderson said. "[Several] issues could be addressed … I think every one of the Republican candidates are on board with those."

Further, candidates such as Romney, former House Speaker Newt Gingrich, and Rep. Ron Paul, R-Texas, have laid out some specific proposals.

Gingrich has said he would reform Medicaid with a block-grant system, allowing states to provide funds to low-income families with the federal money.

Romney would also give block grants for Medicaid to states, and he has plans to expand tax deductions to include those who buy their own health insurance.

And Paul has proposed a plan that allows the purchase of insurance across state lines.

Still, supporters of Obama's reform said the plan does address the necessary changes to health care and should continue to be implemented as planned.

Ethan Rome, the executive director of Health Care for American Now, said the Affordable Care Act "stops the worst abuses of insurance companies" and "extends coverage to those who need it and makes it better and more affordable to those who have it."

"The most important thing we can do is to implement the law fully and keep pace of implementation we have," Rome said. "Lots of people will find ways it can be improved over time. But it's a law that provides immediate benefits to people around the country."

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