The declared candidates for the Republican presidential nomination have already been campaigning in Iowa, New Hampshire and South Carolina. They've held several debates and competed in the Iowa straw poll. But they're still developing their platform positions and honing their stump speeches.
KHN has assembled this chart to show where five of the candidates currently stand on major health care issues. The candidates are Rep. Michele Bachmann of Minnesota, former Utah Gov. John Huntsman, Rep. Ron Paul and Gov. Rick Perry, both from Texas and former Mass. Gov. Mitt Romney. We will be adding issues - and candidates - in the days ahead.
We have sorted the positions by issue. To compare the beliefs and statements, you can scroll down the page or jump to [their positions by issue] from these links:
Medicare & Aging | Marketplace | Health Reform Philosophy | Medicaid
Medicare & Aging
Michele Bachmann
- Voted for the Ryan budget plan, but later qualified her support, saying she thought it could hurt senior citizens.
- Supports reducing future Medicare benefits for people who are now 55 or younger.
- Claimed during the health overhaul debate that the law would create death panels and lead to rationing.
- Opposes creation of the 15-member Independent Payment Advisory Board, saying the panel, charged with making binding recommendations to reduce Medicare spending, will cause seniors to lose control over their care.
- Voted against allowing the government to bargain with pharmaceutical companies to get lower drug prices for Medicare Part D, arguing it would lead to draconian price controls.
- Voted to override President Bush's veto of the Medicare Improvements for Patients and Providers Act of 2008, which temporarily blocked a Medicare pay cut for physicians, prohibited some Medicare Advantage marketing practices, expanded coverage of mental health services and authorized Medicare to cover new preventive services.
"Senior citizens will lose control over what they actually get in Medicare, because a politically appointed 15-member board that's unelected and unresponsive to the will of the people called IPAB will make the decisions about what care we get and what care we don't." -- Bachmann to conservative bloggers, June 2011
Jon Huntsman
- Backed the Ryan budget plan, which proposed turning Medicare into a "premium support" program to curb spending.
- Supported the August 2011 debt-ceiling deal, which leaves entitlement programs untouched in its first phase; the only GOP presidential hopeful to take this position.
"I admire Congressman Paul Ryan's honest attempt to save Medicare. Those who disagree with his approach incur a moral responsibility to propose reforms that would ensure Medicare's ability to meet its responsibilities to retirees without imposing an unaffordable tax burden on future generations of Americans." -- Wall Street Journal, May 31, 2011
Ron Paul
- Argues that Medicare and other entitlement programs create undesirable dependence on the government, worsening the nation’s financial woes.
- Views the Medicare’s Part D prescription drug program as an unwarranted expansion of the government’s role in health care and a "reminder that the GOP sometimes can't resist the temptation of big government."
- Didn’t take part in Medicare when he practiced medicine; offered low-cost or free care to those who couldn’t afford his services.
- Proposes redirecting resources from defense spending and foreign aid to fund Medicare for those already enrolled, while weaning younger people away from such assistance programs in favor of free market approaches.
"Why exactly should Americans be required, by force of taxation, to fund retirement or medical care for senior citizens, especially senior citizens who are comfortable financially? And if taxpayers provide retirement and health care benefits to some older Americans who are less well off, can’t we just call it welfare instead of maintaining the charade about 'insurance' and 'trust funds'?" -- Texas Straight Talk weekly address, Nov. 2010
Rick Perry
- Argues that, based on the 10th Amendment, states should be able to opt out of Medicare and develop their own means of providing health care.
- Led the charge in 2005 against a provision of the Medicare Part D program, which was designed to relieve states of prescription drug costs for low-income elderly people. The policy required states to pay a portion – known as "clawback payments" – of their savings back to the federal government. Perry argued this was unfair to states that had already reduced their Medicaid drug spending. His administration filed a lawsuit in 2006 charging that the policy was unconstitutional.
"I think every program needs to stand the sunshine of righteous scrutiny. Whether it’s Social Security, whether it’s Medicaid, whether it’s Medicare. You’ve got $115 trillion worth of unfunded liability in those three. They’re bankrupt. They’re a Ponzi scheme." -- Newsweek interview, Aug. 12, 2011
Mitt Romney
- Said, as president, he would sign the Ryan proposal, but also pledged to put out his own plan for reforming Medicare and Social Security.
- Wants to publish federal yearly balance sheet to help people understand the impact of entitlement spending on the budget and economy.
- Promises he won't slice benefits for current seniors or jeopardize their retirement security.
Marketplace
Michele Bachmann
- Cites her experience as co-owner with her husband of Bachmann and Associates, a Christian-based mental health care counseling center that employs nearly 50 people.
- Sponsored a bill in 2009 that she says would make medical expenses, including insurance premiums, tax deductible for everyone.
- Supports the expansion of high-deductible health savings accounts.
- Seeks to allow small businesses to band together through trade associations to purchase health insurance for their employees at a lower cost than they can get individually.
- Backs tort reform to curb medical malpractice awards.
Jon Huntsman
- Pushed as governor for the completion of Utah's all-payer claims database.
- Campaigned for reelection in Utah promising to overhaul the state's health system and trim the number of uninsured residents.
- Signed Utah laws that established a task force to consider comprehensive health system changes, created a tax credit for individuals purchasing a health insurance policy on their own and began setting up an electronic medical records system.
"It is unacceptable that a young father in Clarkston, Utah who works for a small business and wants to buy insurance for his family is denied coverage because of minor ailments. Should eczema or post-partum depression preclude a family from getting affordable health insurance?" State of the State speech, 2008
Ron Paul
- Introduced legislation in 2009 to allow patients and physicians to opt out of the electronic medical records system set up by the federal government, to refuse to have those records shared with a third party and to repeal a federal program establishing a "unique health identifier" for each patient.
- Supports creating tax credits and deductions for all medical expenses, exempting terminally ill people from paying the employee portion of payroll taxes, providing a payroll deduction to workers who are caring for a spouse, parent or child with a terminal illness.
- Opposes caps on awards in medical liability cases.
- Endorses a new tax credit for "negative outcomes" insurance bought by patients before medical treatment so they can be compensated for medical mistakes. Says it would reduce “the burden of costly malpractice litigation."
- Supports allowing insurers to sell across state lines, as well as association health plans.
- Wants to expand high-deductible health savings accounts.
Rick Perry
- Believes policymakers can best improve access to health care by working to improve the economy and increase jobs so that more people are covered under employer-sponsored health plans.
- Opposes any federal action that would undermine states’ ability to regulate the health insurance and protect consumers.
- Supports medical liability reform/tort reform to reduce frivolous lawsuits and reduce health care costs; cites a Texas measure that became law in 2003 as evidence of effectiveness.
- Promoted investments in adult stem cell infusion and helped pass a health care measure that authorized creation of a state adult stem cell bank. He also personally received lab-grown stem cells during a spinal fusion to help with a back injury.
- Supports allowing insurance companies to sell across state lines and efforts to help small businesses get better rates on health care plans.
Mitt Romney
- Wants to "strengthen" high-deductible health savings accounts by allowing consumers to use them to pay insurance premiums.
- Seeks to cap non-economic damage awards in medical malpractices law suits and favors giving states grants to fund other ways to deal with the liability issue, such as health care courts.
- Urges restricting federal regulation of health care insurance, although he supports limited rules to bar insurers from denying coverage to those with preexisting conditions when they have had coverage for a specified period of time.
- Says insurers should be allowed to sell their products across state lines.
- Supports creating a tax deduction for people who obtain health insurance on their own.
- Favors allowing individuals and small businesses to join together to buy insurance.
Health Reform Philosophy
Michele Bachmann
- Founded the House tea party caucus and is a vociferous critic of the health law.
- Co-sponsored legislation in the House to defund the health law.
- Introduced in Jan. 2009 the "Health Care Freedom of Choice Act" to allow individuals to deduct all medical expenses.
"The American people spoke soundly and clearly at the ballot box in November and they said to us, 'Mr. Speaker, in no uncertain terms, repeal this bill.'" -- Remarks to the House of Representatives, Jan. 19, 2011
Jon Huntsman
- Supports repealing the health law, which he says is "top-heavy" and "government-centric."
- Signed in 2008, while governor of Utah, a law to overhaul health care and set up an insurance exchange –- one of only two in the United States.
- Opposes a federal mandate to require individuals to have health insurance.
Ron Paul
- Outspoken opponent of the health law on policy, procedural and constitutional grounds.
- Believes the individual mandate is unconstitutional; introduced legislation to end the mandate
- Cites his experience as a physician to oppose the implementation of managed care: "We don’t have a right to medical care."
- Introduced legislation to create a market-based system "that reflects consumer choices while rationally pricing services."
"If medical care is provided by government, this can only be achieved by an authoritarian government unconcerned about the rights of the individual." -- Statement, Sept. 23, 2009
Rick Perry
- Called the health law unconstitutional and a "train wreck of a plan" and supports its repeal.
- Opposes the creation of a state-based health insurance exchange, as called for in the health law; his veto threat derailed a GOP effort to create a state exchange.
- Did not commit to the health law’s high-risk insurance pool program, which was created by the health law, citing lack of program rules and reliable federal funding.
- Believes states should develop state-specific health care reforms instead of "Washington's one-size-fits-all solutions"
- Texas is one of the 26 states involved in a multi-state lawsuit challenging the health law.
- Signed legislation in July 2011 to clear the path for Texas to join multi-state health care compacts. The compact would, if approved by Congress, enable the state to opt out of federal health care programs and receive federal funds to fulfill those responsibilities.
"The federal government’s attempt to force every American to buy government-approved health insurance is an egregious violation of our Constitutional rights. The 10th Amendment and individual liberties must be protected, and I am committed to fighting the overreach of Obamacare and challenging these unconstitutional mandates, which have gone far beyond both the letter and spirit of the Constitution." -- Statement about district court ruling in Florida vs. HHS, Dec. 13, 2010
Mitt Romney
- Known for working with Massachusetts Democrats to enact the precedent-setting 2006 state law requiring most residents to have insurance.
- Supported - as part of this law - the creation of an online marketplace called the Health Connector, through which individuals and businesses can purchase insurance.
- Argues that the federal law didn’t grow out of the Massachusetts law, saying the state reforms were tailored specifically to meet the needs of the state.
- Says, if elected, he’d allow states to opt out of the federal health law and encourage Congress to repeal it.
“Mr. President, if, in fact, you did look at what we did in Massachusetts, why didn't you give me a call and ask what worked and what didn't? ... I would have told you, Mr. President, that what you're doing will not work. It's a huge power grab by the federal government. It's going to be massively expensive, raising taxes, cutting Medicare.” -- GOP candidate debate, June 13, 2011
Medicaid
Michele Bachmann
- Strongly opposes the expansion of Medicaid and other low-income health programs such as CHIP; repeatedly has criticized the expansion of Medicaid under the health care law.
- Voted against the 2009 stimulus package, which included a temporary enhanced federal matching rate for the Medicaid program, as well as short-term COBRA continuation assistance.
- Voted against expanding CHIP in 2009 and 2007.
- Denounced last year’s decision by Minnesota Gov. Mark Dayton to expand Medicaid coverage to nearly 100,000 state residents.
- Came under scrutiny after media outlets reported that the Christian counseling business she and her husband own received federal and state government funding, including Medicaid payments.
Jon Huntsman
- Supports reducing federal funding for Medicaid and turning the program into a block grant to the states.
- As governor, implemented a preferred drug list to steer doctors and patients toward lower-cost medications, curb rising costs of Medicaid.
- Restored “optional” dental and vision benefits by raising funds through private donations.
- Expanded coverage by instituting a year-round open enrollment period for the Children’s Health Insurance Program.
"Let states determine what the percentage of poverty levels are, and let public officials rise or fall on how local citizens feel about those decisions. They're in a much better position to understand their vulnerable populations than at the federal level." -- Wall Street Journal, June 25, 2011
Ron Paul
- Voted against expanding CHIP in 2009 and 2007.
- Opposed stimulus package, which included a temporary enhanced federal Medicaid contribution and short-term extension of COBRA coverage.
Rick Perry
- Wants states to have more flexibility in administering Medicaid.
- Joined with 32 other governors to oppose the health law’s maintenance-of-effort provisions, which prevent states from tightening Medicaid eligibility through 2014.
- Opposes the health law’s expansion of Medicaid, arguing it will cost Texas taxpayers more than $27 billion over 10 years starting in 2014. Supports turning Medicaid into a block-grant program, which he says would "improve health care delivery, with innovation, flexibility and local input."
- Pushed a plan late in 2010 to opt out of Medicaid, a proposal that drew resistance from health care and nursing home advocates.
- The 2010-2011 state budget signed by Perry included $12 billion in federal stimulus funds.
- Outlined a Medicaid vision in 2007 to reduce the number of uninsured Texans by restructuring federal Medicaid funding; unsuccessfully sought a waiver from the HHS to pursue the changes.
- Facing budget pressures, the state during Perry’s tenure as governor has relied on cuts to provider payments and controls on pharmacy expenses to rein in the program’s costs.
- Texas has the largest percentage of any state's population that is uninsured, ranks 49th in Medicaid coverage of low-income people and ranks 49th in per capita state spending on Medicaid.
Mitt Romney
- Opposes the health law’s expansion of Medicaid coverage to more than 30 million people.
- Backs block grants for Medicaid to allow states to use capped federal contributions to run Medicaid as they see fit.
http://www.kaiserhealthnews.org/Stories/2011/August/26/GOP-candidate-health-care-platforms.aspx