The latest Romney campaign commercial , titled “Nothing’s Free,” returns to his favorite whipping post, “Obamacare.” It seems to have finally occurred to Romney that quite a few voters might think extending health insurance to more than 40 million Americans is a good thing. But Romney does not want to focus on the ugly side of his promise to repeal the Affordable Care Act (ACA)—that he would leave these citizens uninsured and potentially allow them die for lack of medical treatment. So instead he argues that the cost of insuring them is too high.
“Some think Obamacare is the same as free healthcare,” says the voiceover. “But nothing is free. Obama is raiding $716 billion from Medicare, changing the program forever. Taxing wheelchairs and pacemakers.” On the other hand, “The Romney/Ryan plan will restore Medicare funding, and protect and strengthen the program for the next generation.”
Each of these complaints is false. As the New York Times explains , the ACA did not actually take $716 billion out of what goes into Medicare, it took the money out of what Medicare pays to insurers and hospitals. Therefore, it actually improves Medicare’s fiscal health, which Romney would undermine by repealing the ACA. “The 2010 health care law cut Medicare reimbursements to hospitals and insurers, not benefits for older Americans, by that amount over the coming decade,” writes the Times’s Jackie Calmes. “But repealing the savings, policy analysts say, would hasten the insolvency of Medicare by eight years—to 2016, the final year of the next presidential term, from 2024.”
The ad also gives you the incorrect impression that the ACA is detrimental for people with disabilities. Nothing could be further from the truth. Disability rights advocates have vociferously supported  its passage and implementation.
As for taxing wheelchairs and pacemakers, that claim is misleading. The ACA will impose a 2.3 percent excise tax on medical devices. But remember, thanks to the ACA, everyone will have health insurance, so necessary devices such as wheelchairs and pacemakers will be covered. That means the tax will not directly be paid by consumers, but rather—to the extent the manufacturers can pass the cost on rather than accepting lower profit margins—by the insurance companies. Some of that in turn finds its way into higher premiums, but very little. The Center on Budget and Policy Priorities found , “The effect of the excise tax on consumers’ costs for health care and health insurance will be minimal and will be swamped by other factors. Spending on taxable medical devices represents less than 1 percent of total personal health expenditures, so a small increase in their price would have an almost imperceptible effect on health insurance premiums. Device manufacturers generally do not hold enough market power to pass on the entire excise tax to consumers through higher prices.”
If you are worried about making sure that people with disabilities get adequate and affordable care, then you should cheer a bill that expands health insurance coverage of the currently or potentially disabled. It is especially important that the ACA bans insurers from excluding people with prior conditions, which is basically another way of saying no to people with disabilities. It also outlaws lifetime caps on insurance usage, which are a way that insurers avoid adequately covering the long-term needs of the disabled. Mark Periello, president of the American Association of People with Disabilities (AAPD), says, “AAPD unequivocally supports the Affordable Care Act. The law will result in better health outcomes, increased access to healthcare for millions of Americans, and at a lower cost to taxpayers.”
Repealing the ACA is not the only way that Romney proposes to harm the disabled. He and his running mate, Paul Ryan, want to turn Medicare into vouchers for buying private insurance and make Medicaid block grants to states instead of a federal entitlement. These are the two main programs that people with disabilities depend upon to provide them with health insurance, since most people with disabilities are old enough or poor enough to qualify for one or both of the programs.
Both of these changes would have dire consequences. Under the Romney/Ryan plan, the elderly would get vouchers that they use to buy insurance. But if the cost of insurance exceeds the increase in the cost of vouchers, they are on their own. So some may not be able to afford insurance. Meanwhile, the insurance plans they purchase may not meet their needs. Romney and Ryan would “strengthen” Medicare for the next generation only if by “strengthen” they mean “eliminate.”
If Medicaid is a block grant, then states will get the same amount of money, without regard to economic circumstances. During recessions they will therefore have to cut what is covered or bump people off the rolls. (For a full explanation of the impact of Romney/Ryan’s Medicaid plan on people with disabilities, read this piece by Harold Pollack  in the Daily Beast.)
The crowning irony is that as governor of Massachusetts, Romney actually did want to impose taxes on the disabled. He proposed  a $10 fee for a state certificate of blindness and a $15 for a photo ID card, a $100 fee for an intake session for the developmentally disabled and a $400 fee for anyone with tuberculosis. Clearly, Romney lacks the standing to criticize President Obama’s record on disability issues.