Obama vs. Romney 101: 6 ways they differ on health-care reform

In a different era, President Obama and Mitt Romney might have been completely in sync on health-care reform. Former Governor Romney, after all, championed a reform in Massachusetts, including an individual mandate to purchase insurance, which became the model for Mr. Obama's signature Patient Protection and Affordable Care Act of 2010 (ACA). But times changed, and candidate Romney took a libertarian turn in going against the individual mandate and what he now calls a federal takeover of the health-care system. Now health care is a central point of contention in the presidential race.

Here’s a list of areas where the candidates differ: repeal of health-care reform, how Americans get their health care, controlling health-care costs, Medicare, Medicaid, and medical malpractice reform.

Carolyn Kaster/AP/File
Sherry Hoover (r.) from Carlisle Regional Medical Center and other doctors say the Pledge of Allegiance on the Capitol steps in Harrisburg, Pa., in May 6, 2003, at a rally for tort reform to reduce medical malpractice insurance rates in Pennsylvania. The rally ends a week-long work stoppage.

1. 'Repeal and replace' vs. holding firm

Charles Dharapak/AP/File
In the East Room of the White House, President Obama used 22 pens to sign the health-care reform bill, which became law on March 23, 2010. Multiple pens are used to sign legislation, and then distributed to supporters of the legislation.

Romney has pledged to grant states waivers from Obama's health-care reform law on Day 1 as president, and to work with Congress to try to repeal and replace the law. That’s why keeping a GOP majority in the House and taking over the Senate are critical to repeal. With 50 seats in the Senate, Republicans can use a fast-track budget process known as “reconciliation” to repeal the law, avoiding the need to line up 60 votes to end a filibuster. (Should Romney win, Paul Ryan, as vice president and president of the Senate, would be empowered to break tie votes, thus allowing a unified GOP caucus to repeal the law even in an evenly split Senate.) 

Obama is counting on implementation to help win over skeptics and build public support for the law, but the law does not go into full effect until 2014. Come January, if Republicans control both houses of Congress but Obama is still president, repeal legislation may cross his desk. He would veto it, sending it back to Capitol Hill, where Republicans can attempt to override. Two-thirds majorities of both houses are required – an extreme long shot.

After the US Supreme Court upheld the health-care law in June, the president said he would “work with anybody who wants to work with me” to improve the law, but he offered no suggestions. Obama advisers say the idea of improving the law appeals to independent voters.

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