It's the Obamacare, stupid: Why Election 2012 is about health care, not the economy
ANALYSIS - On no issue are the candidates further apart, as Obama pledges to implement his massive health care reform while Romney plans to gut it...
Much of the implementation of the law requires heavy government intervention. Under the law, state governments are supposed to be set up “exchanges” that would create new rules and a market that would make it easy for people to shop for health plans and purchase them. Some state governors, many of whom are Republicans, are threatening not to set up the exchanges.
Under the law, the federal government can set up an exchange for a state. Obama would certainly use federal power to create these exchanges; Romney would be under enormous pressure from conservatives not to. This is an important distinction, as the Congressional Budget Office estimates as many as 25 million Americans would get coverage through these exchanges by 2016.
Similarly, the Supreme Court’s ruling on Obamacare said states can, but don’t have to accept new federal funds for Medicaid, which was originally projected to provided coverage for more than 15 million new people under the new law. By not accepting the money, these states would be denying themselves billions to cover the uninsured, but many GOP governors face political pressure not to accept the money or are ideologically opposed to Medicaid. Obama would of course look for ways to convince the governors, perhaps by giving states flexibility or waivers in how they create their Medicaid programs.
Romney, having pledged to dump the entire law, would face conservative pressure either to limit the expansion of Medicaid or give Republican governors almost complete control in how they implement the program.
““If President Obama is re-elected, Leavitt Partners believes the administration will do everything in its power to incentivize states to opt in to the full Medicaid expansion, offering program flexibility as needed. Under this scenario, most states will ultimately choose to expand their Medicaid programs, although some Republican states will be slow to move,” according to a report written by a consulting firm operated by Michael Leavitt, who was Secretary of Health and Human Services under George. Bush and is now a top Romney adviser. The report was obtained by the New York Times.
The report, according to the Times, adds, “If Republicans take both the White House and Congress, Leavitt Partners believes the administration and Congress will effectively repeal the Medicaid expansion” or reduce the amount of federal money available, so “the expansion will no longer be an attractive option for most states.”
President Obama is not defining this choice on health care that starkly on the campaign trail. He is largely not talking at all about Obamacare, which remains very controversial, opposed by many Republicans and independents. Romney constantly notes he would repeal the health law, but also spends most of his time talking about the economy.
But this issue is perhaps the most stark difference between the candidates, particularly on an issue on which the next president will have huge influence. (It’s unlikely Romney can dramatically shift laws on abortion or gay marriage, where the two also differ sharply.) The future of the American health care system will be defined on Nov. 6.
Follow Perry Bacon Jr. on Twitter at @perrybaconjr
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