WASHINGTON -- In a speech in Orlando on Tuesday, presumptive GOP presidential nominee Mitt Romney outlined once again what he would do to replace President Barack Obama's health care law, which he has pledged to throw out if elected. In a follow-up statement to The Huffington Post, his campaign clarified that he would not tackle one of the central issues contained in the Affordable Care Act -- the prohibition of discrimination against people with pre-existing conditions.
The approach Romney described centers around proposals to return much of the decision-making to the states while allowing for greater portability of coverage. He has long disavowed federalizing the individual mandate that he passed while governor of Massachusetts, which requires the uninsured to purchase coverage or face a penalty. And so attention has turned to the most closely related provision, a ban on discriminating against individuals with pre-existing conditions.
In his Tuesday speech, Romney said that under his plan, a person who is covered by his or her employer and has a pre-existing condition could not get dropped after switching jobs. The Obama campaign's policy director, James Kvaal, argued in response that such a concept was already law. Under the Health Insurance Portability and Accountability Act of 1996, a person can't be excluded from health insurance coverage because of a pre-existing condition provided that he or she has had continuous coverage.
Romney aides insist that their proposal is more tailored to the modern economy, making it so that even individuals who leave big companies to start mom-and-pop shops won't be at the whims of insurers who discriminate.
The devil is ultimately in the details of the actual plan -- though as the Washington Post's Ezra Klein notes, there are precious few available. But even when (or if) that plan is produced, it will include an obvious hole.
For starters, there is the question of what happens to individuals with pre-existing conditions who lose their jobs rather than move to a new one? Often, COBRA coverage doesn't fully cover treatment costs or last long enough. Another, perhaps more pertinent question is what happens to people who enter the insurance market already suffering from a pre-existing condition?
Andrea Saul, a spokesman for the Romney campaign, addressed the latter point in a statement to The Huffington Post.
Fixing our health care system means making sure that every American, regardless of their health care needs, can find quality, affordable coverage. That is why Governor Romney supports reforms to protect those with pre-existing conditions from being denied access to a health plan while they have continuous coverage. And for those purchasing insurance for the first time, he supports reforms that empower states to make high risk pools more accessible by using cost reducing methods like risk adjustment and reinsurance. Beginning on his first day in office, Governor Romney is committed to working with Congress to enact polices like these that protect Americans’ access to the care they need.
The statement confirms that under a Romney presidency, there would be no federal prohibition barring health insurers from discriminating against pre-existing conditions. Instead, his administration would push reforms that help eat away at the problem. It would allow "reinsurance," in which insurance companies pool resources for a joint plan to cover high-risk patients (essentially an insurance policy for health insurers); provide block grants of Medicaid dollars to the states while giving them flexibility to cover their uninsured population; and encourage the creation of high-risk pools.
The Romney campaign believes that while a combination of these reforms won't eliminate the problem of people entering the health insurance market with a pre-existing condition and encountering discrimination, it will decrease it.
The Huffington Post asked the progressive-leaning coalition Health Care for America Now if it had any research showing the effectiveness of different states' approaches to dealing with uninsured individuals with pre-existing conditions. The group tellingly did not, noting that it was a patchwork of messy data and policy.
The Obama administration, for its part, has viewed guaranteed and mandated coverage as going hand-in-hand -- a position that many conservatives have also held in the past. In its brief to the Supreme Court defending the constitutionality of the Affordable Care Act, the administration wrote that under a plan that had the former but not the latter, "premiums would increase significantly ... and the availability of insurance would decline."
When asked to respond to Saul's statement, as well as to the Romney campaign's approach on a broader level, Obama's reelection campaign piled on, arguing that Romney was merely reshuffling old concepts and ideas.
"High risk pools and 'supporting the states' are both old Republican ideas that do very little to help people in need," campaign spokewoman Kaite Hogan said in an email. "When Romney talks about leaving responsibility for the uninsured to the states, he is actually talking about block-granting Medicaid with massive cuts in funding – cuts that independent experts estimate would mean that up to 27 million people are kicked off the Medicaid roles. And high risk pools are just another idea that has been in place for decades and hasn’t solved the problem.
"States have had high risk pools for years and Congress has been funding high risk pools since 2002," Hogan continued. "Pooling sick people together doesn’t make coverage more affordable – it’s a solution that has left millions of people without health insurance. Romney’s just doubling down on the failed ideas of the past, and he won’t show the leadership needed to address these problems."
Below, a look back at the biggest lies told during the health care reform debate:
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