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Romney’s Pre-Existing Conditions Vow Puts 36M at Risk

Percent of the U.S. population without healthcare coverage, 2012, on average
Percent of the U.S. population without healthcare coverage, 2012, on average

Mitt Romney vows he’ll extend health insurance to people with pre-existing medical conditions, a pledge that comes with few details and strings attached.

The Republican presidential nominee says he would shield workers with coverage from being dropped if they change jobs. Romney’s plan doesn’t explain what it would do for many others, such as those with ailments seeking health coverage for the first time. Without specifics, he would leave it to the states to find solutions for everyone not covered under his proposal.

Health-policy specialists say Romney’s plan echoes such protection already in a 1996 U.S. law and doesn’t show how it would help at least 36 million sick people at risk of being denied coverage.

“It’s a complete mystery what he’s talking about,” said Joe Antos, a health-care economist at the American Enterprise Institute, a Washington policy group. “He’s clearly asserting that he’s got a new policy, but he hasn’t said what it is.”

The issue of covering those with pre-existing conditions has gained renewed attention in the presidential campaign’s final weeks. Romney has promised throughout his campaign to do away with President Barack Obama’s health-care law, which seeks to expand insurance coverage to millions of people, and to replace it with his policy.

As Massachusetts governor, Romney enacted a law in 2006 that was later cited as a blueprint for the Obama health-care overhaul that bars discrimination while requiring residents to carry insurance. Though Romney says the state’s law has resulted in 98 percent coverage, he says that’s not his plan as a presidential candidate.

‘Better Way’

During the Oct. 3 presidential debate, Obama challenged Romney on his pledge to repeal the federal health law, saying the Republican’s plan wouldn’t help those with chronic medical conditions while leaving as many as 50 million people vulnerable to losing coverage.

“There’s a reason why Governor Romney set up the plan that he did in Massachusetts,” Obama said during the debate at the University of Denver in Colorado. “The reason he set up the system he did in Massachusetts was because there isn’t a better way of dealing with the pre-existing conditions problem.”

Romney countered by saying he has a plan for covering people with pre-existing conditions and didn’t provide further details. He rejected the idea of letting the federal government have a significant role in the health-care market.

No Mandates

“The right answer is not to have the federal government take over health care and start mandating to the providers across America, telling a patient and a doctor what kind of treatment they can have,” Romney said.

Among the more popular aspects of the Affordable Care Act enacted in 2010 under Obama is a provision that bars insurance companies, beginning in 2014, from denying coverage or charging higher premiums to people with pre-existing medical conditions.

Eighty-two percent favored that part of the health-care overhaul, according to an October 2009 Pew Research Center poll released before the law’s enactment. A poll released by the Washington-based center in June found that 43 of those surveyed approved of the law, compared with 48 percent who disapproved.

To keep the provision from bankrupting insurers, virtually all Americans are required to have insurance or face financial penalties. The so-called individual mandate was upheld by the U.S. Supreme Court in June.

Common Conditions

Between 36 million and 122 million adults had conditions that could result in insurers charging higher premiums, limiting or denying coverage, according to a March report by the nonpartisan Government Accountability Office, which serves as the investigative arm of Congress.

The GAO said there’s no universally accepted list of such conditions because insurance companies vary in what they accept. The most commonly reported conditions were hypertension, mental disorders and diabetes, according to the GAO, while cancer was cited as the most expensive to treat. Women, whites and those between the ages of 55 and 64 were more likely to have pre-existing conditions, according to the GAO.

Romney’s plan would void the administration’s law and instead bar insurers from denying coverage to those “who have maintained continuing coverage,” according to Lanhee Chen, policy director for the Romney campaign.

Romney also supports limiting malpractice lawsuits, using tax subsidies to promote coverage and giving states more discretion over how to use Medicaid funds, among other changes.

Different Challenges

“States will have the flexibility and resources to design programs specific to the needs of those who cannot afford coverage,” Chen said in an e-mail. “States face very different challenges and circumstances, and will do a better job providing for their citizens than the federal government can.”

Andrea Saul, a Romney campaign spokeswoman, declined to answer further questions about the health plan.

The Republican’s proposal for covering pre-existing conditions sounds like a 1996 law known as the Health Insurance Portability and Accountability Act, which bars discrimination against workers with coverage as they move from one job to the next, said Stan Dorn, senior fellow at the Urban Institute, a Washington-based policy group.

Neither the 1996 law nor Romney’s proposal solves the issue of affordability because even if insurers can’t deny coverage, they can charge so much that it becomes unobtainable, Dorn said.

“It doesn’t matter if there’s theoretical access if it costs me an utterly unaffordable amount,” he said.

Unanswered Questions

The Romney plan doesn’t spell out how it would help those who are unemployed, who don’t work in a field where employers provide coverage or have had gaps in coverage. About 89 million Americans, a little more than one-third of those younger than 65, were uninsured for at least a month between 2004 and 2007, according to an August report by the Commonwealth Fund.

“You never want to have a gap in your insurance coverage in any case, but particularly if you have a chronic health condition that requires continual maintenance,” said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund, a New York-based advocacy group that supported the 2010 law.

Collins also questioned Romney’s call to encourage states to develop solutions even as he proposed reducing funding for Medicaid, the federal-state health-care program for the poor.

“If you want states to design their own ways to expand coverage, is there additional federal dollars available for them?” she said. “That is the question.”

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