The Center Policy Snapshot 2012 Presidential Candidates: for Health Affairs February 2012 Health Policy Platforms the Leading Advocate for Northeast Ohio Hospitals

The election season is in full swing and unless you’ve joined the bears medical liability awards because he believes tort law is a state matter. He is, in hibernation you’ve probably caught some coverage of the Republican however, supportive of a new tax credit for “negative outcomes” candidates vying for their party’s nomination. Teasing out how the Republican bought by patients prior to medical treatment that would compensate them candidates’ health policy platforms differ can be a bit tricky given the common for medical errors.5 themes of “repeal Obamacare” and “less government” heard frequently on the campaign trail. Yet a candidate’s health policy positions encompass much In the past, Paul has been a vocal opponent of entitlement programs including more than the issue of federal healthcare reform and upon digging deeper, Medicare and Medicaid, which he views as being unconstitutional. Recently distinctions on key issues including Medicare, Medicaid and medical liability he has supported allowing younger generations to opt out of Medicare and reform come into focus. instead build up medical savings accounts. For current Medicare enrollees, he has proposed redirecting resources from defense and foreign aid to pay for the program.6 He is also supportive of block-granting the Medicaid program.7 Newt Gingrich Paul has been an outspoken critic of the federal healthcare Former House Speaker and political consultant Newt Gingrich reform law and supports its repeal. has a long history of speaking out on key policy issues, healthcare in particular. In 2003 he founded the Center for Health Transformation, a conservative think tank that seeks to develop healthcare solutions. The former governor of Massachusetts and successful Despite his party’s opposition to the federal health reform law, businessman was initially the front-runner for the Republican particularly the , Gingrich once supported nomination. Having virtually tied for first in the Iowa caucus the idea of a mandate, an idea which and then winning the New Hampshire primary he appeared at sprang from the conservative Heritage Foundation. He is also the outset to be pulling away from his Republican contenders. reported to have made comments in the past in favor of the Recent losses to Newt Gingrich and Rick Santorum have Massachusetts healthcare plan, which includes an individual slowed his momentum and ensured that what initially looked mandate, that Mitt Romney supported and helped guide to to be an easy path to the nomination was suddenly not passage.1 However, he now views the individual mandate as guaranteed. Romney is considered by many to be more unconstitutional and has vowed to work toward the repeal of moderate in his policy positions compared to Rick Santorum health reform. or Newt Gingrich, but where does he stand on healthcare?

Unlike Rick Santorum who favored the initial “Ryan plan,” which would have A conversation about Romney’s health policy positions has to begin by created a Medicare premium support model in which recipients purchase talking about the universal healthcare law he supported and helped see private policies, Gingrich spoke out early in opposition to the plan calling to passage while governor of Massachusetts. Despite similarities between it “too big a jump.”2 Later he spoke positively about a revised plan which the Massachusetts plan and the federal healthcare reform law (which many would allow seniors to stay in traditional fee-for-service Medicare or choose claim was modeled after the Massachusetts plan), Romney and the other a private plan. He supports creating more choices in Medicare, such as Republican candidates unanimously support a repeal of the federal law. allowing seniors to choose health savings accounts, and restructuring In explaining his reasons for wanting to repeal health reform, Romney Medicare reimbursement.3 has stated that he is against a one-size-fits-all government program that Gingrich supports turning Medicaid into a block grant program in which states would raise taxes. While he has gone to great lengths to explain why the get a set amount of money to customize the program to meet the needs of Massachusetts plan is different from the federal law, many in his own party their residents. He also favors changing Medicaid reimbursement to take remain skeptical of the differences, particularly given that both plans include into account the quality of care being provided.4 an individual mandate. Persuading the public of where he stands on health reform remains a big hurdle, particularly as his Republican opponents have Gingrich has long supported tort reforms, including capping non-economic gone on the attack. damages. Romney has stated he is in favor of reforming Medicare and has put out his own plan, which calls for repackaging existing funding in order to provide a Ron Paul fixed amount to each recipient to purchase an insurance plan. Traditional fee-for-service Medicare would continue to be offered alongside private As a physician and U.S. Representative from , Ron Paul, MD, plans. This plan would not affect current Medicare recipients or those nearing draws from his experience working in the healthcare system to shape his retirement age, but would go into effect for younger Americans. Furthermore, health policy views. Of the remaining Republican candidates vying for the he supports block-granting the Medicaid program to allow states to use nomination, Paul’s positions on healthcare are arguably most different from capped spending as they choose.8 those of the other candidates, which is no surprise given his libertarian leanings. Romney supports tort reform legislation that would cap non-economic damage awards. He also favors giving states innovation grants to fund other For example, while the other candidates for the Republican nomination have ways of handling the medical liability issue, such as healthcare courts or spoken in favor of federal tort reform, Paul is opposed to federal caps on alternative dispute resolution.9

Visit our website at For more information, contact Like The Center & Follow us on Twitter www.chanet.org [email protected] NEONI on Facebook @NEOHospitals Rick Santorum Comparing the Republican Candidates’ Health Policy Positions Rick Santorum, former U.S. Senator from Candidate Health Reform Medicare Medicaid Medical Liability Reform Pennsylvania, has arguably been garnering Supports creating more choices more media attention for his conservative in Medicare, such as allowing Supports tort reforms includ- Supports social values than his health policy positions, Newt Gingrich Supports repeal seniors to choose health savings ing capping non-economic block-granting particularly as he battles Newt Gingrich to accounts; Supports restructuring damage awards become the conservative alternative to Mitt Medicare reimbursement Romney. Yet a bit of research reveals some Has proposed redirecting Opposed to federal caps interesting distinctions between his health resources from defense and for- on medical liability awards; policy positions and those of his opponents eign aid to pay for Medicare for Supportive of a new tax credit those currently enrolled; In favor Supports for “negative outcomes” insur- for the nomination. Ron Paul Supports repeal of allowing younger genera- block-granting ance bought by patients prior Santorum has said repeatedly that tions to opt out of Medicare and to medical treatment which healthcare costs are high because instead built up medical savings would compensate them for medical errors consumers are insulated from the cost accounts of care by third parties. He believes Supports capping non- consumers need to get more involved economic damage awards; Supports his own plan to reform Supports giving states innova- in the cost of their care and take partial Medicare by creating a premium Supports 10 Mitt Romney Supports repeal tion grants to fund additional responsibility for their healthcare choices. support model to purchase tradi- block-granting medical liability reforms, such tional or private policies. Rick Santorum is also supportive of private as healthcare courts or alter- insurance. He doesn’t believe that insurance native dispute resolution companies should have to cover everybody, Supports replacing current Supports tort reform; In past program with a premium sup- Supports has supported a $250,000 either those with pre-existing conditions or Rick Santorum Supports repeal those without, because he believes this port model to purchase private block-granting cap on non-economic dam- makes it more likely that people will wait policies age awards until they’re sick to purchase insurance.11 While health reform supporters argue that the individual mandate is designed to cure the healthcare system of the problem of people waiting until they get Conclusion sick to purchase insurance, Santorum is staunchly opposed to the individual As we inch closer to Ohio’s March 6 primary on Super Tuesday, the race to mandate and favors a repeal of the law. secure the Republican nomination will intensify. The Republican candidates Santorum has talked about wanting to overhaul entitlement programs. continue to jockey for the lead; and the outcome of the presidential election Similar to the other candidates, Santorum supports block-granting Medicaid in the fall is anyone’s guess. What is certain is that this year’s highly to provide states with more choices in how they run the program. In terms of anticipated Supreme Court ruling on the legality of the federal healthcare Medicare, he has spoken in support of replacing Medicare with a premium reform law will keep the issue of healthcare in the spotlight for the duration support model in which recipients could purchase private policies.12 of the election season.

Rick Santorum is supportive of medical liability reforms to ensure access to care is safeguarded and to protect against the practice of defensive medicine. In the past he has supported a $250,000 cap on medical liability awards.13 Endnotes

President Obama 1. Hicks, J. “Newt Gingrich’s Changing Stance on Health-Care Mandates.” The Washington Post. December 12, 2011. http://www.washingtonpost.com/blogs/fact-checker/post/newt-gingrichs-changing- A discussion of the 2012 Presidential candidates wouldn’t be complete stance-on-health-care-mandates-fact-checker-biography/2011/12/09/gIQAVl0lkO_blog.html without exploring President ’s health policy positions. Certainly 2. NBC: Meet the Press. May 15, 2011. http://www.msnbc.msn.com/id/21134540/vp/43038275#43038275 the most glaring difference between President Obama’s health policy 3. Kaiser Health News. “GOP Presidential Hopefuls: Where They Stand on Health Care.” January 27, positions and those of the Republican candidates is the federal healthcare 2012. http://www.kaiserhealthnews.org/stories/2011/august/26/gop-candidate-health-care-platforms. aspx reform bill that he signed into law and continues to support. 4. “Newt’s Plan to Save Lives and Save Money.” http://www.newt.org/solutions/healthcare In terms of reforming entitlement programs, President Obama spoke out 5. “Ron Paul: Health Care.” http://www.ronpaul2012.com/the-issues/health-care/ against a plan that was advanced in early 2011 that would have turned 6. Kaiser Health News. “GOP Presidential Hopefuls: Where They Stand on Health Care.” Medicare into a voucher program. Instead, he has said his Medicare reform 7. “Ron Paul: Plan to Restore America.” http://www.ronpaul2012.com/the-issues/ron-paul-plan-to-restore- america/ efforts will focus on eliminating waste and making prescriptions more 14 8. “Fact Sheet: Mitt Romney and Medicare.” December 8, 2011. http://www.mittromney.com/news/ affordable. A deficit reduction plan he proposed in September would cut press/2011/12/fact-sheet-mitt-romney-and-medicare; Kaiser Health News. “GOP Presidential Hopefuls: $248 billion from Medicare over the next decade with 90 percent of the Where They Stand on Health Care.” January 27, 2012. http://www.kaiserhealthnews.org/stories/2011/ savings coming from reducing payments to drug companies and healthcare august/26/gop-candidate-health-care-platforms.aspx providers.15 9. “Health Care: Policy.” https://mittromney.com/issues/health-care 10. Fox 4 Dallas Fort-Worth. “Santorum Priority: Big Spending Cuts.” January 5, 2012. http://www. As part of his deficit reduction plan, President Obama has proposed $66 myfoxdfw.com/dpps/news/santorum-priority-big-spending-cuts-dpgonc-20120105-sv_16833816 billion in cuts coming from the Medicaid program over the next decade. The 11. Ibid. most significant savings to the Medicaid program would come from limiting 12. Glenn, B. “Why Nearly All of Rick Santorum’s Ideas on Healthcare are Bad Policy.” January 9, 2012. http://www.medcitynews.com/2012/01/why-nearly-all-of-rick-santorums-ideas-on-healthcare-are-bad- state financing practices that increase federal spending and replacing the policy/ complicated federal matching rate formulas with a single matching rate 13. Kaiser Health News. “GOP Presidential Hopefuls: Where They Stand on Health Care.” specific to each state.16 14. Cillizza, C. “President Obama’s Delicate Dance on Medicare.” September 19, 2011. http://www. washingtonpost.com/blogs/the-fix/post/president-obamas-delicate-dance-on-medicare/2011/09/19/ While President Obama signaled in his 2011 State of the Union address that gIQAiVcpfK_blog.html he would be open to medical liability reforms to rein in frivolous lawsuits, he 15. . “President’s Obama’s Medicare Proposals.” September 24, 2011. http://www. nytimes.com/2011/09/25/opinion/sunday/president-obamas-medicare-proposals.html remains opposed to caps on medical liability awards. 16. Office of Management and Budget. “Living Within Our Means and Investing in the Future.” September 2011. http://www.whitehouse.gov/sites/default/files/omb/budget/fy2012/assets/jointcommitteereport.pdf