Long Islanders remain sharply divided over whether President Barack Obama's landmark health care law will curb costs and provide millions of Americans with insurance, or devastate the economy and dictate what kind of treatment people will get.
John DiBugno, 51, an accountant who works for the federal government and lives in Garden City South, said he plans to vote for Republican challenger Mitt Romney, who has vowed to repeal the law.
"You are going to kill the economy with this health care mandate," DiBugno said.
But Marie Laurent, 45, a hairdresser from Amityville who has no health insurance, said she supports Obama's Patient Protection and Affordable Care Act.
"Romney calls Obama 'a welfare president' but a lot of people need social services," Laurent said. The new law will have "a big impact on a lot of people. Not everybody is middle income or rich," she said.
How Obama and Romney view the historic law, passed in 2010 and largely upheld by the U.S. Supreme Court in June, illustrates the candidates' fundamentally different approaches to health care -- from who should provide insurance for working Americans, the poor and seniors to how to pay for it.
The law requires that most Americans buy health insurance. By 2014 every state will have an insurance "exchange," where people can purchase more affordable health plans, which will provide coverage to 34 million currently uninsured Americans, including more than 260,000 Long Islanders.
Obama says the law will cut the federal deficit and improve health care quality in the long term. He says it was modeled after Massachusetts legislation Romney worked to pass in 2006 when he was governor.
Romney has promised to repeal Obamacare "on Day 1," arguing that the law will sharply increase government health care spending and take away patients' right to choose their doctors. He defends the Massachusetts law, saying that it was appropriate for his state -- but not for the entire country. He contends the states are better equipped to develop their own affordable health insurance.
Obama, speaking in battleground Ohio last month, defended the law and said Romney has no viable health care proposals.
"I don't know exactly what the other side is proposing; I guess you could call it 'Romney doesn't care,' " Obama said. He vowed that the Affordable Care Act "is here to stay."
Romney, also speaking last month in Ohio, said Obama, "thinks that government can do a better job than you in the way you live your life, and Obamacare is point No. 1. He wants to put bureaucrats between you and your doctor. He believes that government should tell you what kind of insurance you have to have."
As the debate comments show, Obama and Romney hold sharply divergent views on how the health care overhaul will play out:
Cost: In their first presidential debate in Denver, Romney cited the nonpartisan Congressional Budget Office in saying that the Affordable Care Act will cost families $2,500 more a year than traditional insurance. The CBO has not produced a report with that figure. But when Kaiser looked at premium levels, it found they rose by $672 in 2010-11.
In the same debate, Obama countered that health care premiums have gone up in the past two years "but they've gone up slower than any other time in the last 50 years." But Kaiser figures showed that in those two years, premiums rose by 4 percent and 8 percent respectively -- higher than in 2009-10.
Romney has said that the ACA will add a trillion dollars to health care spending, referring to a July 2012 report by the CBO. The CBO estimated that the insurance provisions in the law will cost $1.168 trillion from 2012 to 2022.
Obama says that, over time, changes in reimbursements and improvements that encourage less wasteful, higher-quality health care will yield savings. A 2011 CBO report estimated that the Obama health care overhaul will reduce the federal deficit by a total of $210 billion between 2012 and 2020.
Medicaid: Obama's health law has expanded Medicaid; Romney wants to cut it back.
Under the new law, Medicaid -- health insurance for the poor and disabled that is funded jointly by states and the federal government -- will expand to cover up to 17 million new beneficiaries. The estimated cost to the federal government is $444 billion through 2019.
Romney has proposed eliminating these changes and instituting a block grant program. States would be given a set amount of money that they could spend with fewer federal restrictions. Romney has said he supports his running mate Rep. Paul Ryan's spending targets, which would hold Medicaid growth to the rate of inflation.
Medicare "vouchers": Romney wants to give seniors, beginning in about 10 years, a choice between staying in traditional Medicare or shopping for a plan in the private market. Under what he calls a "premium support system," seniors would be given a fixed amount to purchase a health plan. Competition among plans would hold down costs and improve quality of coverage, Romney argues.
Obama says Romney's plan would amount to a voucher system. Obama has argued this could end up shifting rising costs to seniors and force them to shop in a confusing insurance market.
Medicare spending cuts: Romney says Obama is cutting Medicare by $716 billion to help pay for the new law. Obama counters that the law lowers Medicare reimbursements to hospitals and insurers -- not seniors' benefits -- by that amount over the coming decade, a move supported by Ryan and one that Obama says will help keep Medicare solvent.
Rationing care: Romney criticizes Obama for creating the Independent Payment Advisory Board, an independent panel established under the health care law to hold Medicare costs in line. Romney says the board will tell patients what kind of treatment they can have. Democrats say the board is designed to curtail excess Medicare spending, not treatment. The panel is prohibited from submitting proposals that would ration care, including changing premiums, benefits, eligibility and taxes.
Impact in NY
Despite the candidates' divergent views, local experts said the difference between Obamacare and Romneycare in New York would be less dramatic than in some other states. Even if Romney were to shift responsibility for a health care overhaul to the states, New York is likely to continue implementing changes similar to those called for under the Obama federal law, they said.
"That train has left the station," said Arthur Gianelli, chief executive of NuHealth, which includes Nassau University Medical Center in East Meadow.
Nonetheless, Obama and Romney supporters in New York remain split over the law.
Amlan Das, 24, an entrepreneur from Richmond Hill, Queens, who still is covered under his parents' health plan, said he favors paying for health care out of pocket "rather than being mandated to buy insurance."
"I think Obamacare is going to lead to doctor shortages, salary caps, health care costs exploding and death panels, much longer times in terms of waits and the ultimate deterioration of the quality of medical care," he said.
But Omer Malik, 28, a fellow in hospital administration at Nassau University Medical Center in East Meadow, who has no health insurance, said repeal of Obamacare "would set us back.
Said the Astoria, Queens, native: "It's not a perfect system but we've come this far."