Republican presidential candidate Mitt Romney would dismantle most of the federal Affordable Care Act and make sweeping changes to Medicare and Medicaid, according to a study released Wednesday by UCLA's Center for Health Policy Research.
The side-by-side analysis of health care proposals in the 2012 presidential contest found stark policy differences between the former Massachusetts governor and President Barack Obama, said Shana Alex Lavarreda, the report's co-author and director of UCLA's Health Insurance Studies Program.
"I think the choice is very clear," she said. "It wasn't hard to find major distinctions."
The analysis is based on candidates' statements, position papers, government documents and news coverage. "All this information was out there, but it wasn't together in one place," Lavarreda said.
Obama has promised to fully implement ACA if he's returned to office, encouraging private employers to offer health insurance and providing subsidies to middle-income families for coverage through new health insurance exchanges. Most low-income Americans will be covered through state Medicaid programs.
Romney has vowed to repeal the ACA and replace it with his own plan, which includes budget policies authored by his running mate, Rep. Paul Ryan of Wisconsin. Romney would provide a fixed dollar benefit for Medicare or a premium support voucher, allowing recipients to buy private insurance. States would get block grants for Medicaid.
Romney has said he would keep the ACA's private dependent coverage for young adults up to age 26, despite his call to repeal the law. But his plan would end other provisions of ACA, including elimination of annual and lifetime limits on covered benefits, and the requirement that all families have insurance by 2014.
He would repeal the ACA's state-based health insurance exchanges and establish "public-private partnerships, exchanges and subsidies," but it's unclear how his policy would differ from ACA, according to UCLA's analysis.
Romney would end the law's requirement that private insurers spend at least 80 or 85 percent of premiums on medical costs or issue rebates to policyholders, as well as guarantees of coverage for pre-existing conditions for adults without health insurance for at least six months.
He'd also drop the ACA's provision for free preventive care, stop federal funding for Planned Parenthood and establish other restrictions on abortion, the report said.
The two candidates differ sharply on Medicare, the analysis found. Romney endorsed Ryan's voucher plan, which would let beneficiaries choose between Medicare and private insurance.
Where Obama seeks to reduce Medicare costs by cutting provider or insurer fees, Romney would abolish the Independent Payment Advisory Board and return cost-cutting authority to Congress.
Higher- income seniors would face increased Medicare premiums under both candidates, but Romney's plan has few details, the study found.
Romney has endorsed Ryan's proposal to convert Medicare Part A and B's guaranteed coverage to vouchers indexed for inflation.
On Medicaid, Romney favors Ryan's plan for fixed block grants to states, capping federal spending at 2011 levels with an inflation rate tied to population growth and other factors. The Republican candidate wants to repeal the expansion of Medicaid under ACA and let states determine Medicaid fees to providers.