Shots - Health Blog
4:26 pm
Mon September 10, 2012

Mitt Romney's Shifting Stance On Health Care

Mitt Romney seemed to make health care news in a Sunday interview on NBC's Meet the Press.

He said he might not want to repeal all of the Affordable Care Act.

"I'm not getting rid of all of health care reform," he told host David Gregory. "Of course, there are a number of things that I like in health care reform that I'm going to put in place. One is to make sure that those with pre-existing conditions can get coverage."

Of course not getting rid of the entire Affordable Care Act is not only an express violation of the Republican Party 2012 platform, but also is at odds with Romney's own position as detailed on the campaign's website.

So, not surprisingly, it was only a matter of hours before the campaign walked the candidate's comments back.

The conservative National Review Online wrote Sunday afternoon: "An aide pointed out that Romney first said on Meet the Press that 'I say we are going to replace Obamacare. And I am replacing it with my own plan.' "

Beyond that, however, a Romney aide said that plan included the idea that "in a competitive environment, the marketplace will make available plans that include coverage for what there is demand for," the National Review Online reported.

In other words, no federal requirements.

Later, that explanation was revised again, to reiterate comments Romney made in June about people with pre-existing conditions. Specifically, that "we're going to have to make sure that the law we replace Obamacare with assures that people who have a pre-existing condition, who've in insured in the past, are able to get insurance in the future."

But it turns out that's trickier than it appears.

The Affordable Care Act's ban on health insurance discrimination against people with pre-existing conditions — in terms of coverage or price — is one of that law's most popular provisions. It takes effect for adults in 2014.

Currently, millions of people can't buy health insurance at any price because they've had cancer or have diabetes or high blood pressure or even something more minor. Starting in 2014, insurance companies won't be able to deny those people coverage — and, equally important — will no longer be able to charge them higher rates because of their pre-existing condition.

The tradeoff for the insurance industry in doing this was to make sure there were enough healthy people in the pool so the companies wouldn't go broke paying for care of sicker people. That's how the law ended up with the controversial individual mandate — the requirement for most people to have health insurance or pay a fine. It's the tradeoff for everyone being able to get affordable coverage.

It's also the same tradeoff they made in Massachusetts in 2006 that Romney signed into law as governor.

Now Romney's current position on helping people with pre-existing conditions get coverage differs substantially from the Affordable Care Act.

First of all, the 1996 Health Insurance Portability and Accountability Act already says health insurers can't deny you coverage for a pre-existing condition if you maintain continuous coverage. And if you stay in the group health insurance market, you can't be charged more for that pre-existing condition, either.

The problem comes when there's a break in coverage, or when people who've had group coverage, such as from an employer, go out to buy their own insurance. That can happen when they start a business or take a job that doesn't offer health insurance.

Currently, before the Affordable Care Act changes kick in, a health insurers can say no, if there's a gap in coverage of more than 63 days. And even if coverage is continuous, individual coverage can be prohibitively expensive.

Yet what Romney is proposing doesn't appear to answer either of the shortcomings of the 1996 law. He says he only would protect people with continuous coverage, so people who can't get insurance now wouldn't be helped. And so far he hasn't said anything about preventing insurers from charging people more if they have pre-existing conditions.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

Mitt Romney is getting some attention for appearing to shift his position on health care. He did it as a guest on yesterday's "Meet The Press." Romney said he might not want to repeal all of the Affordable Care Act.

(SOUNDBITE OF TV SHOW, "MEET THE PRESS")

GOVERNOR MITT ROMNEY: Of course, there are a number of things that I like in health care reform that I'm going to put in place. One is to make sure that those with preexisting conditions can get coverage.

CORNISH: But by the end of the day, the Romney campaign had walked back the candidate's own remarks, not once, but twice. With us to try and sort out what's going on here is NPR health policy correspondent Julie Rovner. Hello, Julie.

JULIE ROVNER, BYLINE: Hey, Audie.

CORNISH: So let's start with the current health care law. What does it do to make sure that people with pre-existing health conditions can get health insurance?

ROVNER: Well, this is considered one of the biggest achievements of the law. And it hasn't even taken effect yet. Right now, millions of people can't buy health insurance at any price because they've had cancer or they have diabetes or high blood pressure or even something more minor. Starting about 15 months from now, in 2014, insurance companies will no longer be able to deny those people coverage. And equally important, will no longer be able to charge them higher rates because of their preexisting condition.

Now the tradeoff for the insurance industry in doing this was to make sure there were enough healthy people in the pool that they wouldn't go broke paying for those sicker people. That's how the law ended up with that oh, so controversial individual mandate - the requirement for most people to have health insurance or pay a fine. It's the tradeoff for everyone being able to get affordable coverage. And, I might add, it's the same tradeoff they made in Massachusetts in 2006 that Mitt Romney signed into law as governor.

CORNISH: Now, apparently, that's not his position now, is it? I mean, despite what he said yesterday.

ROVNER: That's right. You know, the Republican Party has made tearing this law out by the roots, as they say, a real article of faith. And by yesterday afternoon, the campaign had walked back the governor's comments that he wouldn't necessarily repeal the entire law. In a statement to the conservative website, The National Review Online, they said, quote, "There had been no change in Romney's position, which would be to repeal the entire law." And that, quote, "In a competitive environment, the marketplace will make available plans that include coverage for what there is demand for."

Then last night the campaign went back even a little further to Romney's position as announced last June, which is that he would ensure that if people who have preexisting conditions remain continuously covered, insurance companies won't be allowed to discriminate against them.

CORNISH: So what's the difference that stance on preexisting conditions versus what the Affordable Care Act would do?

ROVNER: Well, a whole lot. First of all, there's already a popular law from 1996 that was passed with bipartisan support that says if you maintain continuous coverage, you can't be denied continuing coverage because of a preexisting condition. The acronym for the 1996 law is HIPAA, you've probably heard of it. And it says, if you stay in the group health insurance market, you can't be charged more for that preexisting condition, either.

The problem comes when there's a break in coverage or when someone who's had group coverage, like from an employer, goes out to buy their own - if they start a business or they take a job that doesn't offer health insurance. Without the changes made by the Affordable Care Act, if there's a gap in coverage of more than 63 days, right now, you can be turned down. And even if the coverage is continuous, individual coverage can be and is prohibitively expensive.

Now the problem with what Governor Romney is proposing is that it doesn't appear to answer either of those shortcomings of the 1996 law, the one that's currently in effect. He says he only would protect people with continuous coverage. So people who can't get insurance now would not be helped. And so far, he hasn't said anything about preventing insurers from charging people more if they have preexisting conditions.

CORNISH: Well, how do we know that he wouldn't make those insurers charge those people less?

ROVNER: Because basically the only way you can do that without putting those insurers at a serious economic disadvantage is to make sure everybody is covered. That's why the federal law has that individual mandate, and that's why the Massachusetts law that Governor Romney signed has it, too. You can't really have it both ways. If you don't have the mandate, it's going to be very hard to help people with preexisting conditions, as popular as that is. In health care, the popular stuff only comes with the not-so-popular stuff.

CORNISH: Julie, thank you for explaining it.

ROVNER: Thank you, Audie.

CORNISH: NPR health policy correspondent, Julie Rovner. Transcript provided by NPR, Copyright NPR.