Republican presidential nominee Mitt Romney has repeatedly vowed to repeal President Obama’s health reform law and work with Congress to replace the most popular provisions with his own policies. But when it comes to exactly how he would achieve the same goals of making sure that people with preexisting conditions get insurance coverage and children can stay on their parents’ insurance plans up to age 26, Romney has no clear plan.
In a Sunday interview on NBC’s Meet the Press, host David Gregory pressed Romney on whether he would put in place a federal ban on insurance companies denying coverage to patients who have preexisting medical conditions, one of the most popular provisions of the health reform law.
“I’m not getting rid of all of health care reform,” Romney said. “Of course, there are a number of things that I like in health care reform that I'm going to put in place.”
While major news organizations seized on Romney's comments as a possible shift in his long-held position on the Affordable Care Act, the Romney campaign told conservative website National Review Online that his policy had not changed. Romney’s campaign later emphasized that Romney would in fact repeal the entire law.
Romney may be trying to have it both ways. He wants to allay the concerns of many middle-class voters who like the fact that the health reform law prohibits insurance companies from denying people coverage for their preexisting conditions and that their grown children can stay on their plans. But he also wants stay within the bounds of his promises to the Republican base to undo "Obamacare" once and for all.
Campaign staff reiterated Romney’s long-held position that he would allow people who have always had health insurance to get coverage on the individual market, even if they have a preexisting condition. They pointed to a speech that Romney gave in Florida in June as a detailed explanation of his position. “So we're going to have to make sure that the law we replace Obamacare with assures that people who have a preexisting condition, who've been insured in the past, are able to get insurance in the future so they don't have to worry about that condition keeping them from getting the kind of health care they deserve,” Romney said.
But his plan lacks an explanation of how those plans would be affordable for anyone who is sick. The cost of covering people with expensive preexisting conditions, like cancer or heart disease, is alleviated under Obama’s plan by the individual mandate. Since everyone is required to have health insurance, insurance companies can keep premiums down thanks to the estimated 30 million new customers they will get from the Affordable Care Act. That balances out the cost of covering sick and expensive patients.
Romney’s plan has no such requirement. Without federal regulations or subsidies, premiums for people with preexisting conditions would likely skyrocket beyond a point that is affordable for most middle-class Americans.
Romney also tried to assure voters that his approach would allow parents to keep their children on their health insurance plans up to age 26, another popular piece of the health reform law. Romney said he would “assure that the marketplace allows for individuals to have policies that cover their—their family up to whatever age they might like.”
In other words, he would let the market run free and his expectation would be that if consumers demand it, the companies would deliver plans that allow dependents to stay on their parents’ plans. The Romney campaign clarified that he would not propose a “federal mandate” that insurance plans allow parents to keep children on their plans up to age 26.
In theory, it is possible the market could deliver such a plan. But history does not bear out that result. Prior to the Affordable Care Act, almost no insurance plans offered coverage for dependents up to age 26. Even in conservative states with largely unregulated insurance markets, it was rare—if not impossible—to find plans that offered coverage for kids on their parents plan past the college years.