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By David Morgan



But as he prepares to face Obama in their first presidential debate on Wednesday, Romney is giving a few hints. The former Massachusetts governor's advisers say he would accelerate the use of high-deductible insurance plans that offer lower premiums but require beneficiaries to pay thousands of dollars more in out-of-pocket expenses than they would face under conventional coverage.



"The result," Romney wrote in the New England Journal of Medicine, "will be patients who can confidently choose the coverage that is right for them, who know and care what healthcare costs."

The Romney campaign says its series of changes differ dramatically from Obama's 2010 Patient Protection and Affordable Care Act, which requires most Americans to buy health coverage and seeks to make it easier to do that by creating state-based insurance exchanges. Medicaid, the national program for the poor, would be expanded to accommodate those with low incomes.

Romney's approach is a political departure for him.

In Massachusetts, he oversaw the passage of comprehensive state healthcare changes that later became the model for "Obamacare," the president's federal program.

Romney's role in creating the Massachusetts plan made many conservatives wary of him, and in seeking the Republican nomination for president Romney made a point of rejecting Obama's plan as an illegal overreach by the federal government.

Since winning the Republican nomination, however, Romney has said he would support some Obamacare provisions. More recently, Romney has been criticized for describing emergency rooms as a way to cover the uninsured - the type of expensive treatment that programs such as Obamacare and his Massachusetts plan seek to avoid.


Romney's new incentive-based strategy also could hold pitfalls for consumers.




The idea would be to provide new tax breaks for consumers who now have employer-sponsored plans, which are exempt from federal income tax. But it's unclear whether those breaks would equal the value of the current tax benefits.


"Healthcare is the only service in the United States that you buy and use without knowing what the price is," said Dr. Scott Atlas, a Romney adviser with Stanford University's Hoover Institution. "If you're paying out of a health savings account, you actually see the bill. It really does reduce prices."


"What he's really talking about is shifting more and more of the cost onto the individual," said Christen Linke Young, Obama campaign associate policy director. "That's what he means when he says 'patient centered.' It's really troubling."


Critics also say the patient-centered approach would do little to help the chronically ill, whose needs account for the lion's share of annual medical costs but who often are unable to change providers or forego expenses.








"When you make them easier for people to access, that number gets bigger and bigger. And as that number gets bigger and bigger, the market shifts dramatically," said a Romney campaign official, referring to the higher-deductible plans. "We're on our way. The idea is to continue that trend."



"The current tax treatment of health insurance is the engine that fuels our health inflation costs. There are myriad ways of solving that. But until we solve it, we do not have health reform," the Romney campaign official said.

(Editing by Michele Gershberg, David Lindsey and Lisa Shumaker)

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