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US - What is 'Obamacare' and what is the Republican alternative

  Although the issue of health care is a very controversial topic that stands out in the US Presidential campaign, very few people know the main points of the debate.  Therefore, we offer below the main points of the Republican proposal (including Paul Ryan's legislative initiative) as an alternative to the Health Care Reform known as "Obamacare", and then we copy the main elements of the law that is already in force, taken from an official website of the White House.  Finally, we copy from an independent source a perspective of the PROS and CONS of the Health Care reform already in force. What is your opinion on this issue?  Open the full text of this report (click on "leer más") and let the World know your views in the space at the foot of the text.

Republican Party Health Care proposals ("A Pledge to America")Obamacare vs Ryan's health care plan

Enact Medical Liability Reform

Skyrocketing medical liability insurance rates have distorted the practice of medicine, routinely forcing doctors to order costly and often unnecessary tests to protect themselves from lawsuits, often referred to as "defensive medicine." We will enact common-sense medical liability reforms to lower costs, rein in junk lawsuits and curb defensive medicine.

Purchase Health Insurance across State Lines

Americans residing in a state with expensive health insurance plans are locked into those plans and do not currently have an opportunity to choose a lower cost option that best meets their needs. We will allow individuals to buy health care coverage outside of the state in which they live.

Expand Health Savings Accounts

Health Savings Accounts (HSAs) are popular savings accounts that provide costeffective health insurance to those who might otherwise go uninsured. We will improve HSAs by making it easier for patients with high-deductible health plans to use them to obtain access to quality care. We will repeal the new health care law, which prevents the use of these savings accounts to purchase over-the-counter medicine.

Ensure Access for Patients with Pre-Existing Conditions

Health care should be accessible for all, regardless of pre-existing conditions or past illnesses. We will expand state high-risk pools, reinsurance programs and reduce the cost of coverage.

We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick. We will incentivize states to develop innovative programs that lower premiums and reduce the number of uninsured Americans.

Permanently Prohibit Taxpayer Funding of Abortion


We will establish a government-wide prohibition on taxpayer funding of abortion and subsidies for insurance coverage that includes abortion. This prohibition would go further and enact into law what is known as the Hyde Amendment as well as ban other instances of federal subsidies for abortion services. We will also enact into law conscience protections for health care providers, including doctors, nurses, and hospitals.

[ Source & additional information ]

Paul Ryan's House Budget Proposal

  • Strengthens health and retirement security by taking power away from government bureaucrats and empowering patients with control over their care.
  • Repeals the new health care law's unaccountable board of bureaucrats empowered to cut Medicare in ways that would jeopardize seniors' access to care.
  • Saves Medicare for current and future generations, with no disruptions for those in and near retirement.
  • For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.
  • Program growth would be determined by a competitive-bidding process – with choice and competition forcing providers to reduce costs and improve quality for seniors.
  • Premium support, competitive bidding, and more assistance for those with lower incomes or greater health care needs will ensure guaranteed affordability for all seniors.

The Congressional Budget Office estimates that federal spending on Medicaid, a program which provides medical care for the poor, will grow from $276 billion in 2013 to $622 billion by 2022. This translates into an annual growth rate of 9 percent. Should this problem continue to be ignored, Medicaid will continue to overwhelm state and federal budgets and fail the vulnerable people who need it most.

Specifically, the Path to Prosperity:

  • Secures the Medicaid benefit by converting the federal share of Medicaid spending into a block grant tailored to meet each state's needs, indexed for inflation and population growth. This reform ends the misguided one-size-fits-all approach that has tied the hands of so many state governments. States will no longer be shackled by federally determined program requirements and enrollment criteria. Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations.
  • Improves the health-care safety net for low-income Americans by giving states the ability to offer their Medicaid populations more options and better access to care. Medicaid recipients, like all Americans, deserve to choose their own doctors and make their own health care decisions, instead of having Washington dictate those decisions for them.
  • Saves $810 billion over ten years, contributing to the long-term stabilization of the federal government's fiscal path and encouraging fiscal responsibility at the state level.
  • All Americans will pay more because of this broken Medicaid system – and not just in higher taxes. Because Medicaid's reimbursement rates have been ratcheted down to below-market levels, the care that Medicaid patients receive is often substandard. Offering states more flexibility for their Medicaid beneficiaries will remove the stigma Medicaid recipients face, and allow them to take advantage of a range of options available. Several of the nation's governors have made innovative proposals to fix Medicaid. This budget encourages further efforts in this direction.

[ Source & additional information ]

The Obama-Biden Plan (already in force)

  • Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
  • Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
  • Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
  • Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
  • Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
  • Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
  • Ensure everyone who needs it will receive a tax credit for their premiums.

[ Source & additional information ]

Perceived Pros and Cons of the Health Care legislation already in force:


1. Mandate to Purchase

A mandate that All Americans purchase Health Insurance. It will be a misdemeanor offense for a live legal resident person to be found uninsured.

2. Fines and Collection (IRS)

Misdemeanor Penalties (Fines). The Internal Revenue Service (IRS) is the designated Collection Agent (Collector). The fines will be automatically imposed upon annual Federal Tax filing and added to your Tax bill if no Health insurance plan has been acquired for any person on the tax return including listed dependents.

3. Guarantee for Pr-existing conditions

A requirement that Insurance companies not deny coverage to person for an existing medical condition.

4. State Exchange Mandate

A requirement that the States each set up an insurance Exchange to facilitate the placement of Insurance for those who can not obtain coverage on the open market.

5. Minimum Coverage Requirement

The establishment of a national minimum standard for coverage allowed on a Medical Insurance Policy.

6. Employer Mandate

A mandate that commercial entities who employ over 50 persons as employees provide an avenue to purchase coverage through the employer.

7. Quality of Care

The only gleaned mechanism for the improvement in the quality of health care services rendered is contained in a subsection that stiffens penalties for Health care workers who have certain past offenses including drug possession on their record. These health care workers license to practice will be revoked.

8. Price

There is no price control mechanism found.


1. Mandate to Purchase

The mandate does not require undocumented residents to purchase coverage. The undocumented (illegal) resident must still receive care under current regulations but the act offers no mechanism to enforce payment as it does on a legal resident or citizen. So these costs will continue to be passed to others.

2. Fines and Collection (IRS)

a. Fines will be collected regardless of whether a person has ever received care from a medical professional or even if that tax payer has never failed to pay a health care bill.

b. There is no exemption for people who pay there own bills, Self insure or use a medical savings account or other avenues to cover their own heath care costs.

c. There is no exception or defense for the poor, the indigent or the unemployed.

3. Employer Mandate

There is debate over the definition of a Small Business, Whether an small company that employees only 50 to 100 people can actually be expected to provide an affordable, effective health care plan.

Also there is debate over the effect on jobs and small business ability to hire new workers or to stay in business. Small businesses traditionally generate more than 70 percent annually of all new jobs created in the United states. It is argued that such a mandate could be a job killer that may cause an already high unemployment rate to get even worse.

4. Quality of Care

There would seem to be no address of quality of care beyond a crack down on health care workers. Some argue that such a crackdown could remove hundreds of thousands of workers from the industry resulting in an overall decrease in quality of care and a further shortage of available health care workers.

5. Price

There is no guarantee of lower premiums because there is no proven relationship showing that the price of health insurance is related to costs associated with the uninsured patient.

Many Americans have been erroneously informed that the cost of the uninsured patient is somehow passed on to them through increased premiums to the insured.

In reality, costs related to care for the uninsured patient are simply not payable by an insurance company because they are uninsured. These costs are actually covered by local hospital district taxes of the tax paying residents of the associated tax district along with state and federal tax funding and is not reflected in the cost of an insureds health insurance policy.

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