Health care is a big campaign issue in this election, Obama hails health care legislation as one of his biggest achievements, and Romney wants to repeal it. (Photo/Getty Images )

Decision 2012: On health care, a big gulf between Romney and Obama

Perhaps no issue is as fundamental a difference between the two candidates, as well as the party platforms, than the issue of health care policy.  “The two candidates’ plans are as different as night and day,” says Jennifer Ng’andu, Deputy Director of Health Policy for the National Council of La Raza (NCLR).  A recent Pew Hispanic poll finds 50 percent of Latinos put health care as one of the “extremely important” election-year issues.  About one-in-three Latinos in the U.S. do not have health insurance, almost three times more than non-Hispanic whites.

President Obama spent a good part of his first few years in office ensuring Congress would pass the Affordable Care Act, the landmark health legislation whose goal is to vastly expand overall access to health insurance. The law passed, but it was not bipartisan.  Republicans opposed it, and in fact the Tea Party was largely created in opposition to it. The law’s main aim is to allow individuals and families to obtain insurance even if they do not have it through work.  Affordable insurance has long been almost impossible for people who are unemployed, or self-employed, and who do not qualify for Medicaid and Medicare.

The most contested part of President Obama’s health insurance legislation is the “individual mandate.”  The Obama administration insists everyone at one time or another will require medical treatment, so everyone should pay into a system.  The individual mandate requires Americans who do not get insurance at work and are above a certain income level to buy insurance (fee will be based on their income, and there are hardship clauses),  and it requires employers to either offer coverage to employees or pay into the system.   Uninsured individuals will be able to buy into health care exchanges in 2014.  To be able to insure low-income and disabled families, the ACA initially mandated states to increase their Medicaid rolls, and guarantees federal funding for a number of years, but the Supreme Court ruled states may opt out of doing this.

The Affordable Care Act also puts an emphasis on preventive care, so well-visits are free, as well as mammograms and contraceptives.  It also prevents insurance companies from charging women more, as has been the practice in the past.  Some of the ACA provisions are already in place, and have proven popular.  One allows young adults under 26 to stay on their parents’ health insurance, but perhaps the most important is that insurance companies will not be able to deny coverage due to pre-existing conditions.

Though NCLR is non-partisan, the Latino organization strongly supports the Affordable Care Act. “There is a saying in Spanish, ‘sin salud no hay nada,’ – without health there is nothing,” says NCLR’s Ng’andu.  “Health is fundamental to the ability to get a job and take care of your family.  Health is a basic need, and therefore healthcare should be a basic guarantee,” says Ng’andu.

Leticia Mederos, vice president of the non-partisan National Partnership for Women and Families, also supports the healthcare legislation.  “With the ACA’s Medicaid expansion, insurance exchanges, and the expansion of community health centers, whose patients are about a third Hispanic, this is one of the greatest advances for women’ s health in a generation,” says Mederos.

Republican presidential candidate Mitt Romney opposes the Affordable Care Act, and has repeatedly vowed to repeal it “on Day One.”  Governor Romney and Republicans say the health care legislation gives government too much control over what should be a free market system, and they vigorously oppose the individual mandate requiring Americans to purchase insurance.  They also oppose requiring companies to either provide insurance or pay into a pool. Governor Romney says it should be up to the states to come up with ways to expand the ways in which individuals can buy affordable insurance, and this should not be the purview of the federal government.

“I think the intent was great, but I don’t think they thought it through,” says Michael Barrera, of the Libre Initiative, which advocates for less government and less business regulations, and opposes what is now being called Obamacare.  ‘”We’ve got 2,700 pages of law, and businesses are worried they will not be able to afford it, says Barrera.  “The ACA is interfering with businesses’ ability to reinvest in their businesses and in their employees,” he adds.

Israel Ortega, of the conservative group Heritage Libertad, also opposes the Affordable Care Act, saying “the best way to increase coverage is to provide tax relief to individuals and allow them to buy insurance across state lines; I have more faith in the free market,” says Ortega.  Supporters of the ACA say that insurance companies will not by themselves take people with pre-existing conditions, but Ortega says “I think competition would fix that, since insurance companies would be losing to competitors who offer it,” he says.

Mederos disagrees.  “Repealing the legislation and offering tax credits is not going to get you to insure millions more Americans,” Mederos adds. “It’s the ACA which makes that a reality, and repealing it would be a step backward.”

How do Latinos poll on health insurance?  Several Latino Decisions polls found  the majority of Latinos support the idea of an increased role of government in ensuring access to health care.  A January 2012 Latino Decisions poll found 57 percent of Hispanics agreed the Affordable Care Act should be left standing, and an earlier poll found 60 percent of Latinos said it is the role of government to ensure access to healthcare for everyone; only 25 percent thought people should be left to get their own.  On the individual mandate,  59 percent of Latinos were opposed to being required to buy it or pay a fine, yet 85 percent supported tax credits to small businesses to cover their employees, and 80 percent agreed with the provision of the law which provides financial help to low and moderate income families with no employer coverage to obtain insurance.

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