Call it Mitt's Mantra. As soon as he moves into the White House, Mitt Romney promises, he will demand that Congress repeal the health care reform law that is President Barack Obama's signature achievement. Far less clear is how Romney and Republicans in Congress would replace the Affordable Care Act. That is a critical question for Florida, which has nearly 4 million uninsured residents and has failed to develop its own solution.
Florida's hospitals were on the hook last year for $2.8 billion in uncompensated care. Tampa General Hospital spent more than $60 million on uncompensated care, while St. Petersburg's Bayfront Medical Center spent $34.7 million. Whatever one thinks of the Affordable Care Act, the Congressional Budget Office estimates that it will bring health coverage to 30 million people while reducing the federal deficit by $109 billion over 10 years. That's true even if some states like Florida decline to expand Medicaid to cover all adults under 133 percent of the federal poverty line. Where the law needs more work is in controlling costs, an essential ingredient in health care reform and an opportunity for Republicans to do better.
Right now there isn't a Republican leadership alternative to the health care reform law. Rep. Tom Price of Georgia, an orthopedic surgeon who chairs the House Republican Policy Committee, has introduced a bill that has attracted 42 co-sponsors but little leadership support. House Speaker John Boehner last offered a package of health care reforms in November 2009. At that time, the CBO found it would have reduced health insurance premiums by 5 percent to 10 percent and extended coverage to 3 million people. That is not close to what the Affordable Care Act would achieve.
Romney has offered a rough sketch of how he would reform health care, and some of Boehner's ideas are included. He would allow individuals and small businesses to form purchasing pools and buy insurance across state lines, give individuals tax deductions for health insurance, allow health savings accounts to be used for insurance premiums, and cap noneconomic damages in medical malpractice lawsuits (something Florida already does). Most of those ideas hold promise, but they don't go far enough.
The thrust of Romney's proposal is to hand the regulation of health insurance to the states. He would cut Medicaid costs by sending block grants to the states and "limit federal standards and requirements on both private insurance and Medicaid coverage." States such as Florida could be counted on to cut Medicaid rolls and eliminate coverage requirements for private insurers.
The Affordable Care Act is not perfect, but it will bring health care coverage to millions of Americans. Without more specifics, it is difficult to see how Romney's plan would address the endemic problems of the uninsured and spiraling medical costs. Floridians seeking accessible, affordable health care need help from Washington, and Romney should be clearer about how he would provide it.