In health-care platform, Democrats focus on the past

September 4, 2012

Obama signs his health-care reform bill into law, as promised. (Marvin Joseph/The Washington Post)

The 2008 Democratic party platform was a laundry list of very big, very specific health policy goals. Back then, the party aimed to prohibit insurers from "charging different prices based on pre-existing conditions" and to make insurance affordable by giving "Americans ... subsidies provided through tax credits." The section clocked in at a lengthy 1,600 words.

None of that language exists in the 2012 platform. Much of it became unnecessary when the Affordable Care Act accomplished the goals laid out four years ago. This year, the party's health-care platform focuses on all the things Democrats have done, with little vision for what happens next.

The 2012 platform takes no short notice of the Affordable Care Act's accomplishments. It boasts about the "landmark reforms that are already helping millions of Americans, and more benefits will come soon." The lion's share of the 600-word health-care section runs through the law's most most popular benefits, such as extending insurance for young adults up to age 26, and eliminating co-pays for contraceptives.

Obamacare's passage largely explains the big platform changes. The Democratic party no longer needs to advocate for ending discrimination based on preexisting conditions; it has checked that box. The 2008 platform called for a greater focus on preventive care; the Affordable Care Act eliminated co-pays for annual wellness visits. Health insurance tax subsidies will become available in 2014, just as the party advocated four years ago.

That's what the Democrats have already done. But as this platform acknowledges, Obamacare is not the final act — it does not represent the "end of all efforts" to improve American health care. There's not much in the platform in explaining what, exactly, the next effort ought to look like.

The party offers support for more preventive care and greater funding for the fight against HIV/AIDS. It aims to "strengthen Medicaid" but offers no details on how it gets there, aside from noting it would not implement the Republican's block grant plan. The same goes for Medicare, where there's a promise to "build on those reforms, not eliminate Medicare’s guarantees." What, exactly, that means, is never laid out in any further detail.

There's certainly no lack of policy options to choose from. The Republican platform lays out a very clear vision of the future. It's one where Medicare and Medicaid move toward  defined-contribution models, meaning that each one gets a set amount of money rather than a standardized set of benefits.

On the private insurance side, Republicans would "equalize the tax treatment of group and individual health insurance plans," meaning that employer-sponsored insurance would lose its tax-free status — or that individual plans would gain that same exemption.

States offer up other ideas. Massachusetts, for example, recently became the first to pass a global budget for health care. It now has a cap on how much can be spent annually on medical treatments, meant to bring down health spending.

Those health-care futures may not be crowd-pleasers; capping health spending in Massachusetts engendered no shortage of legislative fighting. Republican plans for Medicare have become a central issue in the presidential campaign, drawing ire from Democrats. But they are plans, nonetheless, and more specific than anything the Democrats outline.

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Dylan Matthews · September 4, 2012