Conservatives complain that the ACA does little to address the rising costs of health care. Romney says his plan would introduce more competition into the system, thus driving down costs. He argues for state-driven solutions and the ability to purchase insurance across state lines. Another proposal is to give a tax break to those who buy insurance themselves, thus creating parity with those who get their insurance through their employers as a tax-free benefit.
Democrats express concern that decoupling employment and health insurance would send more people onto the individual market, where those with health conditions might find insurance unaffordable.
Democrats also reject the idea that the ACA does not address health-care inflation. Exhibit A is the new IPAB, or Independent Payment Advisory Board, tasked with instituting cost-saving measures for Medicare if per capita spending rises too quickly. Congress can overrule the board's recommendations by a supermajority vote in the Senate, but if Congress does not come up with a comparable plan to keep Medicare spending within the target growth rate, the board's recommendations become law.
Other cost-cutting innovations in the ACA include the following.
- Accountable care organizations: Another Medicare entity in which doctors and hospitals are given financial incentives to provide Medicare patients quality care while keeping costs down.
- Value-based purchasing: This Medicare program changes the way hospitals are reimbursed for care. Payments will no longer depend just on the amount of care but also on the quality.
- Excise tax on “Cadillac” health plans: By taxing high-end plans, the ACA aims to give employers an incentive to provide less deluxe coverage (and higher pay), which would make employees more mindful of how they use their health benefits.