Republican presidential nominee Mitt Romney risks developing a pre-existing condition of his own by twisting himself into a pretzel while trying to equate his position with President Barack Obama's on one of the most popular aspects of the health care reform law enacted in 2010.
During Wednesday's presidential debate in Denver, Colo., Romney declared that Americans with pre-existing conditions should be protected from discrimination by health insurance companies, repeating an assertion he's made throughout the presidential campaign.
"I do have a plan that deals with people with pre-existing conditions. That's part of my health care plan," Romney said. But health insurance companies would still be permitted to turn away such people under what Romney proposes.
What Romney has isn't so much a plan as it is an aspiration. Romney doesn't want to forbid health insurance companies from rejecting people with pre-existing conditions or charging them more than healthy individuals, as does the national health care reform law, as well as Romney's own 2006 Massachusetts law health care reform law.
Instead, Romney essentially expressed a hope that states would individually adopt consumer protections for sick people after he repeals Obama's national health care reform law.
Because Romney's campaign proposal only applies to people with pre-existing conditions who maintain continuous health care coverage, it would do nothing to help those who can't get health insurance in the first place. But losing coverage, if only for a short time, is common: 89 million Americans went without health insurance for at least one month between 2004 and 2007, according to a report published in August by the Commonwealth Fund, a New York-based research institution.
In his bid for the White House, Romney says he would slightly expand existing protections that allow people with pre-existing conditions who already have health insurance to switch to a new plan without being rejected. But Romney wouldn't push for federal regulations akin to Obama's or the Massachusetts law.
"What we did in Massachusetts is a model for the nation, state by state," Romney said Wednesday. Following the debate, Romney advisor Eric Fehrnstrom confirmed to Talking Points Memo that the GOP nominee would allow states to act, or not act, on the issue. "We’d like to see states do what Massachusetts did," Fehrnstrom told TPM.
Obama's health care law, the Affordable Care Act, prohibits health insurance companies from denying coverage to individuals with pre-existing medical conditions or charging them higher rates, as they can do today. Under the ACA, the prohibition on denial of coverage to patients with pre-existing conditions is set to take effect in 2014. The Massachusetts health care reform law Romney enacted as governor in 2006 includes similar prohibitions.
Romney has walked a tightrope on health care reform throughout the presidential campaign. He's unwilling to shun his Massachusetts law but vows to repeal "Obamacare," which is largely based on the Bay State's reforms of the health insurance market. Prior to Wednesday's debate, Romney asserted on the campaign trail and during appearances on "Meet the Press" and "The Tonight Show" that he would retain elements of Obama's law, including the ban on discrimination against people with pre-existing conditions.
The trouble, as Obama noted during the debate, is that a 1996 federal law offers that protection today for people with pre-existing conditions who get health insurance through their jobs. "Your plan duplicates what's already in the law," Obama said. "That doesn't help the millions of people out there with pre-existing conditions. There's a reason why Gov. Romney set up the plan that he did in Massachusetts."
In their respective health care reform laws, Romney and Obama sought to resolve one of the trickiest problems in the health insurance market: Those in greatest need can find themselves without coverage for their medical treatments precisely because they require more care. That makes them more expensive to cover than healthy people so health insurance companies try to exclude them.
To make sure that people don't wait until they get sick to buy insurance, the Massachusetts law and the federal Affordable Care Act include an "individual mandate" that stipulates nearly all people must obtain some form of health coverage. Both laws also provide Medicaid benefits to the poorest people and offer subsidies for low- and middle-income people.