By Rebecca Adams, CQ HealthBeat Associate Editor
October 2, 2012 -- Republican presidential candidate Mitt Romney's health care policies might leave 45 million more people without insurance in a decade compared to projections under President Obama's policies, according to a new study by The Commonwealth Fund, a nonpartisan organization whose research often highlights favorable aspects of Obama's health care law.
About 72 million people in 2022 would not have insurance under Romney's plans, according to The Commonwealth study. That compares to 27.1 million if the Democrats' health care law (PL 111-148, PL 111-152) is fully implemented. If the health care law did not exist, the number of uninsured would be 60 million, the study said.
The report comes with lots of caveats, in part because Romney has not released a enough details about his plans to know for sure how coverage would be affected. The Commonwealth Fund assumed that Romney would succeed in overseeing a repeal of the law; provide federal block grants to states for Medicaid; and allow an "above the line" deduction for people who buy insurance on their own so that people could benefit regardless of whether they itemize their taxes.
The organization further assumed that under the block grant plan, federal funding would grow at the rate of growth of the consumer price index plus 1 percent per year; states would match the federal funding with their state shares; states would compensate for lower funding through cuts that would be evenly split between reduced eligibility and lower payments to providers or reduced benefits to patients. The group also presumed that states would not cut eligibility for people who were elderly or had disabilities.
The comparison relies on an analysis by economist Jonathan Gruber, who has served as a consultant for the Obama administration.
"Romney's plan to repeal the Affordable Care Act and replace it with block grants to states for Medicaid and new tax incentives for health plans purchased in the individual market are expected, on balance, to reduce health insurance coverage in every state," said the organization.
Commonwealth Fund president Karen Davis was asked on a conference call with reporters whether she might prefer Democrats to pursue a single-payer approach to health care in the future, considering that the organization has produced reports that shine a positive light on that type of model in other nations.
Davis said that many of the pilot projects allowed under the 2010 health care law could move Medicare toward a system that rewards providers more on value than on volume and experiments with bundled or global payment models. She suggested that these could lead to initiatives that embrace some aspects of a single-payer approach. She said that at some point down the road, more fundamental looks at that will be needed.