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October 24/31, 2012

The Health Policy Election

Author Affiliations

Author Affiliations: Indiana University School of Medicine, Children's Health Services Research, Indianapolis (Dr Carroll); and VA Boston Healthcare System, Department of Veterans Affairs, and Boston University, Boston, Massachusetts (Dr Frakt).

JAMA. 2012;308(16):1633-1634. doi:10.1001/jama.2012.13667

Much is at stake in the 2012 presidential election. President Barack Obama's vision and former Governor Mitt Romney's vision differ across many domains, but perhaps most starkly in the area of health policy. Fundamentally, the candidates disagree on the role of government as the guarantor of affordable access to health insurance, as evidenced by their plans for private insurance markets, Medicare, and Medicaid.

Obama's vision is reflected in the Affordable Care Act (ACA); Romney wants to repeal it. The ACA makes significant changes to private insurance regulation. The individual market will be remade, with subsidies available to families with incomes up to 400% of the federal poverty level. Insurance companies will no longer be permitted to deny coverage due to preexisting conditions or be able to charge more to those with preexisting conditions. Other changes include elimination of lifetime and annual limits, a floor on coverage generosity, and a requirement for family policies to cover dependent children until age 26 years. These changes are expected to increase the number of privately insured by 16 million.1