Health Care Reform

Ann Arbor, Michigan | May 12, 2011

 The AMERICAN
EXPERIMENT
Government or People?

•  The people are sovereign

•  Freedom to choose representatives
•  Freedom to choose occupation,
enterprises

“Free Enterprise” propels America

to world leadership

2 of 25
The AMERICAN
EXPERIMENT !"#"$%&'()*+*(,%,"*!"#$%&

Federal or State?

!"#"$%&* (,%,"*

•  The 10th Amendment limits •  States retain other rights

the Federal Government
and responsibilities
—Laboratories of Democracy
—Competition between them
—Responsive to the people
—Solutions fit the people
—More efficient, effective,
and productive

3 of 25
The AMERICAN
EXPERIMENT

The Obama Administration fundamentally does not

believe in the American Experiment.

•  Distrusts free enterprise

•  Distrusts the states

—NLRB Boeing decision

—Obamacare

4 of 25
MASS - CARE &
OBAMACARE #'!!"$"-,*'"()*&

./%)%0%$"* )%((10%$"*

A government takeover Help people get and keep

of health care their health insurance

5 of 25
MASS - CARE &
OBAMACARE ,2"*+,--$%$./$*&

./%)%0%$"* )%((10%$"*

~$500 Billion in New No New Taxes

or Increased Taxes

~$500 Billion in No Cuts for Seniors

Medicare Cuts

6 of 25
MASS - CARE &
OBAMACARE 32%,*%/.4,*012$&3(.+(1$40&

•  Massachusetts citizens without insurance could

get care for free

•  Many citizens who could afford insurance chose

to forego coverage—free riders

Deny Taxpayers pay Personal

them care for their care responsibility

10TH AMENDMENT: A STATE DECISION

7 of 25
MASS - CARE &
OBAMACARE 5(/6'%"7.+&

•  About 94% insured before reform—no change for them

•  Almost 500,000 uninsured before reform in 2004
•  400,000 of which now insured because of reform
•  No fear of losing insurance if you get sick or change jobs
•  Private insurance, premium support
•  “Relatively modest” program cost

ALL WITHOUT A TAX INCREASE

Source: Massachusetts Division of Health Care Finance and Policy; Massachusetts Taxpayers Foundation

8 of 25
The UNITED STATES
HEALTH CARE SYSTEM .5"$5'"3&

8$.(*.!*46(6* *0.-(*.!*46(6*
2"%&,2*0%$"*(7(,")* 2"%&,2*0%$"*(7(,")*

•  High quality health care •  High cost

•  Choice for consumers •  Non-portable insurance

•  Attracts the best and brightest •  50 million uninsured

•  Most innovation in the world •  Tax discrimination

9 of 25
The UNITED STATES
HEALTH CARE SYSTEM 5(*"5(3(/(%$&

*
8$.(*.!*46(6*
./%)%0%$"*
2"%&,2*0%$"*(7(,")* *

•  High quality health care •  Hurts health care quality

•  Choice for consumers •  Reduces consumer choice

•  Attracts the best and brightest •  Repels the best and brightest

•  Most innovation in the world •  Discourages innovation

10 of 25
The UNITED STATES
HEALTH CARE SYSTEM 5(*"5(3(/(%$&

./%)%0%$"*
*

$/"."3,/&.,'213(%$& 5,'&'"8$%.3$.1&

•  Doesn’t lower costs •  Massive federal spending

•  Raises taxes •  Unconstitutional power

grab from the states
•  Diverts Medicare funds
•  Massive new federal
•  Kills jobs bureaucracy

A radical plan for vastly increasing federal power

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INAUGURATION DAY
PRIORITIES $"8"%&*"5(3(/(%$&

— No. 1 —
Issue Executive Order paving way for
Obamacare waivers for all 50 states

— No. 2 —
Work with Congress to repeal Obamacare

13 of 25
ROMNEY U.S.
HEALTH CARE REFORM ./9"0,'5"(*

—First—
#.*-.*2%$)*

(:;<=>:?<=*2<@A:?*0@;<* "BC@=D*2<@A:?*0@;<*

•  Lower health care costs •  Care for those with pre-existing

conditions
•  Provide portability
•  Provide access to care for the
•  Enhance consumer choice low-income uninsured

14 of 25
 1 RESTORE STATE LEADERSHIP
ROMNEY U.S.
HEALTH CARE REFORM 2 EMPOWER INDIVIDUAL OWNERSHIP

3 FOCUS FEDERAL REGULATION

4 REFORM MEDICAL LIABILITY

5 INTRODUCE MARKET FORCES

15 of 25
ROMNEY U.S.
HEALTH CARE REFORM
1 RESTORE STATE LEADERSHIP
2 EMPOWER INDIVIDUAL OWNERSHIP
3 FOCUS FEDERAL REGULATION
4 REFORM MEDICAL LIABILITY
5 INTRODUCE MARKET FORCES
%$*1"%$*(,%,"*&"%#"$(2'8*
Restore to the states the responsibility
and resources to care for their poor,
uninsured, and chronically ill
•  Block grant Medicaid and other payments
to states
•  Limit federal standards
•  States will experiment and learn from one
another
•  Flexibility to deal with uninsured
e.g., Charity, exchanges, subsidy for
private coverage
•  Flexibility to deal with chronically ill
e.g., High-risk pools, reinsurance, risk
adjustment
16 of 25
ROMNEY U.S.
HEALTH CARE REFORM $3!"#$%&'-#'5'#4%&*.3-"$(2'8*

1 RESTORE STATE LEADERSHIP Give a tax deduction to those who buy

2 EMPOWER INDIVIDUAL OWNERSHIP
their own health insurance, just like those
who buy it through their employers
3 FOCUS FEDERAL REGULATION
•  End tax discrimination
4 REFORM MEDICAL LIABILITY
•  Greater consumer choice—can buy what
5 INTRODUCE MARKET FORCES you want, not only what your employer
wants
•  Promote portability
•  Help control health care costs

17 of 25
ROMNEY U.S.
HEALTH CARE REFORM -"/7*&!"#"$%&*$"E4&%,'.-*

1 RESTORE STATE LEADERSHIP Focus federal regulation of health care

2 EMPOWER INDIVIDUAL OWNERSHIP
on making markets work
•  Correct common failures in the insurance
3 FOCUS FEDERAL REGULATION
market
4 REFORM MEDICAL LIABILITY –  Ensure that individuals with pre-
existing conditions who are
5 INTRODUCE MARKET FORCES
continuously covered for a specified
period may not be denied coverage
–  Empower individuals and small
businesses to form purchasing pools
•  Eliminate counterproductive federal
constraints
–  Remove barriers to the sale of
insurance across state lines
–  Allow providers to design plans that
meet consumer needs

18 of 25
ROMNEY U.S.
HEALTH CARE REFORM %$-"%3&)"#'0%&*&'%/'&',7*

1 RESTORE STATE LEADERSHIP Reduce the influence of lawsuits on medical

2 EMPOWER INDIVIDUAL OWNERSHIP
practice and costs
•  Cap non-economic damages in medical
3 FOCUS FEDERAL REGULATION
malpractice lawsuits
4 REFORM MEDICAL LIABILITY
•  Innovation grants for state reforms:
5 INTRODUCE MARKET FORCES health courts, alternative dispute
resolution, etc.

19 of 25
ROMNEY U.S.
HEALTH CARE REFORM
1 RESTORE STATE LEADERSHIP
2 EMPOWER INDIVIDUAL OWNERSHIP
3 FOCUS FEDERAL REGULATION
4 REFORM MEDICAL LIABILITY
5 INTRODUCE MARKET FORCES
,.1%"+7/$&)%$F",*!.$0"(*
Make health care more like a consumer market
and less like a government program
•  Unshackle HSAs—e.g., permit HSA funds
to be used to pay insurance premiums
•  Promote “co-insurance” products
•  Encourage “Consumer Reports”-type
rating of alternative insurance plans
•  Facilitate IT interoperability
•  Establish cost and quality transparency
•  Promote alternatives to “fee for service”
20 of 25
ROMNEY U.S.
HEALTH CARE REFORM /"-"!',(*

—First—
#.*-.*2%$)*

(:;<=>:?<=G*2<@A:?*0@;<* "BC@=DG*2<@A:?*0@;<*

•  Lowers health care costs •  Cares for those with pre-existing

conditions
•  Provides portability
•  Provides access to care for the
•  Enhances consumer choice low-income uninsured

21 of 25
ROMNEY U.S.
HEALTH CARE REFORM
(:;<=>:?<=G*2<@A:?*0@;<*
•  Lowers health care costs
•  Provides portability
•  Enhances consumer choice
/"-"!',(*
Individuals can acquire health insurance
without a tax penalty
Market dynamics—consumers care what a
procedure costs
Malpractice reforms reduce
defensive medicine
Providers have incentive for quality,
not quantity
Medicaid no longer an “open checkbook” on
the federal treasury
Greater competition with cross-state purchase
of insurance, purchasing alliances
22 of 25
 More to Come!
ROMNEY U.S.
HEALTH CARE REFORM •  Additional specifics

•  Medicare reforms
–  Ryan plan keeps Medicare
solvent, adds choice and
market dynamics
–  My plan will not be identical,
but shares objectives

23 of 25
HEALTH CARE RX

OBAMACARE ROMNEY U.S. Reforms

Taxes Raises taxes No new taxes

Medicare Diverts Medicare for Obamacare No Medicare diversions
Bureaucracies New federal bureaucracies No new bureaucracies
Consumer Choice Reduces consumer choice Increases consumer choice
Health Care Costs May raise health care costs Lowers health care costs
Government Spending More government spending Less government spending
Mandates Mandates (individual, corporate, state) No mandates
Responsibility Federal responsibility for uninsured State responsibility for uninsured
Tax Treatment Tax discrimination Tax fairness
Pre-existing Conditions Overbroad pre-existing condition rules Fair pre-existing condition rules

24 of 25
Health Care Reform
Ann Arbor, Michigan | May 12, 2011

25 of 25