It’s hard to tell what Mitt Romney would do to solve the problem of sick uninsured Americans. Right now, these people often can’t find insurers willing to sell them policies or, if they can, the costs are prohibitive. Under Obama’s Affordable Care Act, insurance companies will be required, beginning in 2014, to sell policies to anyone who wants one and to ignore customers’ health status when setting prices. This is possible because the ACA also requires nearly everyone to buy health insurance, flooding the market with millions of new customers, including healthy people, whose premiums will subsidize the cost of covering the sick.
Covering people with pre-existing conditions is one of the most popular pieces of Obamacare, and Mitt Romney is doing his best to imply that his health care plan would accomplish this lofty goal as well. But there are a few problems. Romney wants to repeal Obamacare and he doesn’t really have a comprehensive plan to replace it, at least not one that he’s made publicly available. In the absence of this, voters can look at his runningmate Paul Ryan’s budget proposals that include health care policy or they can look at Massachusetts, which essentially has a state version of Obamacare championed by Romney when he was governor.
He’s at the top of the ticket, so it’s not fair to judge him by Ryan’s past proposals, he says. And the Massachusetts health care reform was right for Massachusetts, but not the nation, he says, so it’s not fair to judge his presidential plans based on that. That’s fine. But surely it must be fair to judge what Romney said about the problem of the uninsured last time he was running for president, right?
Here’s what Romney said in January 2008, explaining why, prior to reform in Massachusetts, uninsured people who could afford insurance nonetheless didn’t buy it:
They said why should we buy it? If we get sick, we can go to the hospital and get care for free…They shouldn’t be allowed just to show up at the hospital and say somebody else should pay for me, so we said no more free riders…We said if you can afford insurance, then either have the insurance or get a health savings account, pay your own way, but no more free ride…I think it’s the conservative approach – to make sure that people who can afford insurance are getting it at their expense, not at the expense of the taxpayers or the government. That I consider a step towards socialism.
Four years later, Romney talks about emergency room hospital care for the uninusured as a safety net, not as proof of irresponsibility. Here’s how the Columbus Post Dispatch reported what Romney told its editorial board on Wednesday:
“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’ ” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.
“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”
He pointed out that federal law requires hospitals to treat those without health insurance — although hospital officials frequently say that drives up health-care costs.
Romney made similar comments to 60 Minutes back in September, explaining that people without insurance have an option to get care—in the hospital.
This week, Romney also told the Post Dispatch that people with pre-existing conditions should have the “choice” to buy insurance, but he didn’t specify how he might make that affordable for customers. Nor, for that matter, did Romney say that hospital emergency care was only an option for people who couldn’t have afforded to buy insurance. His comments create the same kind of confusion left after he said in September that people with pre-existing conditions could get coverage under his plan, without specifying how he would accomplish this very difficult and expensive task.
If cogent health care policy is about anything, it’s the specifics of how exactly you get to goals that are hard and expensive, but popular—like covering the uninsured and people who are sick, and especially people who are both of these things. So does Mitt Romney no longer believe in “no more free riders”? My guess is that he still thinks people should take responsibility for their own health care. He also said this to the Post Dispatch:
“You have to deal with those people who are currently uninsured, and help them have the opportunity to have insurance,” said Romney, who favors letting states craft their own plans.
“But then once people have all had that opportunity to become insured, if someone chooses not to become insured, and waits for 10 or 20 years and then gets ill and then says ‘Now I want insurance,’ you could hardly say to an insurance company, ‘Oh, you must take this person now that they’re sick,’ or there’d literally be no reason to have insurance.
“It’d be the same thing as saying, ‘Look, you’re not required to have homeowners insurance, but if your home catches fire, then you can get insurance at that point.’ That wouldn’t make a lot of sense.”
Romney seems to be implying that he favors a limited open enrollment period. Buy insurance in this window and you can get it for a reasonable price. Get sick later and want insurance? You’re out of luck. Stay uninsured and head to the emergency room where some or all of the tab will probably be picked up by the federal government. Smart health policy wonks have pitched similar ideas in the past. But this plan could only work in the context of a comprehensive health insurance plan that somehow makes insurances prices reasonable. Obamacare gets to affordability with federal subsidies. Romney? We still don’t know.