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Becky Bowers
By Becky Bowers October 5, 2012
Angie Drobnic Holan
By Angie Drobnic Holan October 5, 2012

Mitt Romney says his health care plan covers pre-existing conditions

If there’s one thing people tell pollsters they like about "Obamacare," it’s the rule that says health insurance companies can no longer reject people for having pre-existing conditions.

Republican nominee Mitt Romney said it’s an aspect of the health care law he wants to keep if elected president.

"Pre-existing conditions are covered under my plan," Romney noted at the debate in Denver on Oct. 3.

President Barack Obama challenged Romney on that point. "Well, actually, governor, that isn't what your plan does," Obama said. "What your plan does is to duplicate what's already the law, which says if you are out of health insurance for three months, then you can end up getting continuous coverage and an insurance company can't deny you if it's been under 90 days. But that's already the law, and that doesn't help the millions of people out there with pre-existing conditions."

Romney responded by simply repeating his earlier point: "In fact, I do have a plan that deals with people with pre-existing conditions. That's part of my health care plan."

So what’s the truth? Does Romney have a plan to help people with pre-existing conditions?

‘Obamacare’ vs. the Romney plan
The real name of the current health care law is the Patient Protection and Affordable Care Act. At the debate, Romney called "Obamacare," and Obama replied that he didn’t mind the term and had actually "become fond" of it.

Under "Obamacare," which goes into effect fully in 2014, insurers can’t reject people for having pre-existing conditions.

During the drafting of the law, insurers warned that the provision could drive them out of business if people can wait until they get sick to buy insurance. So to address that concern, the law requires everyone to have health insurance or pay a tax penalty. That penalty clause is called "the individual mandate," and the Supreme Court ruled it constitutional this summer.

Romney opposes that mandate, and has consistently said the health law should be repealed and replaced. But his health care plan doesn’t pack a lot of details.

His website, though, says people "should be guaranteed the ability to retain coverage" if they have "maintained continuous health insurance coverage." That means if you already have health insurance, other insurers can’t deny you if you have pre-existing conditions. (After the debate, his spokesman confirmed this was still his position.)

But people who’ve lost coverage for an extended period of time don’t get the same guarantee.

How many people would that be? The Obama campaign has said it could be as many as 89 million, a claim we rated Half True. That number is inflated — it counts people who would qualify for public insurance programs, for example.

Still, anyone who does go without coverage for an extended period of time and then needs to buy their own insurance could be rejected by private insurers under Romney’s plan.

Obama said during the debate existing law already has protections similar as to what Romney has proposed, and he’s right about that.

If the 2010 health law disappeared, a 1996 law protects most people from denial after gaps of less than 63 days. The Health Insurance Portability and Accountability Act established that time frame, and it only allows insurers to look back 18 months for coverage gaps of 63 days or more.

Health experts we talked to assume Romney would basically firm up the requirements of that law — which applies primarily to people with employer-based coverage, not less common individual policies — and strengthen it so it also applied to the individual market.

It’s also possible under Romney’s plan that some people rejected for coverage for pre-existing conditions would qualify for insurance through state-run "high-risk pools," an idea Romney includes in his health care proposals. Romney encourages states to design their own programs, according to a statement from policy director Lanhee Chen that the Romney campaign sent us.

Conservative health experts say Romney’s reforms focus on separating health insurance from employment, and that will cut down on gaps in health coverage.
"The idea is that you create a new system in which it's much easier to get insurance yourself, give people a window (a kind of open season) to get insured in that system if they're not already insured, and then after that protect those who are from then on continuously insured," said Yuval Levin, a fellow at the Ethics and Public Policy Center and founding editor of conservative magazine National Review.
Our ruling
Romney said his health care proposals include protections for pre-existing conditions What he didn’t say at the debate -- but which his website states and advisers confirmed after the debate -- is that people would be protected from denial only if they have been continuously insured.
The health care law, though, offers protections whether people have current coverage or not, so it offers more robust protection. The law also includes a requirement that everyone have insurance or pay a tax penalty. Romney’s plan doesn’t have that requirement.

Romney did not mention the qualifier that people have to stay insured to get the protection. That’s a significant omission. We rate his statement Mostly False.

Featured Fact-check

Our Sources

CNN, Debate transcript, Oct. 3, 2012, "Health Care," accessed Oct. 5, 2012

PolitiFact, Obama campaign says 89 million Americans 'could' be denied health coverage under Mitt Romney, Sept. 14, 2012

Email interview with Robert Terra of the Mitt Romney campaign, Oct. 5, 2012

Email interview with Kara Carscaden of the Barack Obama campaign, Oct. 5, 2012

Email interview with Yuval Levin, editor of National Affairs and fellow at the Ethics and Public Policy Center, Sept. 11, 2012

Email interview with Jonathan Oberlander, professor of Social Medicine and Health Policy & Management, University of North Carolina-Chapel Hill, "The cost of repealing the Affordable Care Act: People with pre-existing conditions," March 20, 2012
Department of Health and Human Services: "At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans; 129 Million People Could Be Denied Affordable Coverage Without Health Reform," accessed Sept. 12, 2012
USA Today, "Romney: Why I'd repeal ObamaCare," March 22, 2012

New York Times, Paul Krugman, Romney’s Sick Joke, Oct. 4, 2012

Washington Post's Wonkblog, "Who would be left out of Romney’s preexisting conditions plan? About 89 million Americans," Sept. 10, 2012
Washington Post's Wonkblog, "Romney does have a plan for pre-existing conditions. Here’s how it works — and how it doesn’t," Sept. 9, 2012
Commonwealth Fund, "New Estimates of Gaps and Transitions in Health Insurance," Aug. 3, 2012
National Review, "Pre-existing ignorance," Sept. 10. 2012
Heritage Foundation, "Saving the American Dream: The U.S. Needs Commonsense Health Insurance Reforms," June 22, 2012
U.S. Department of Labor, "FAQs About Portability Of Health Coverage And HIPAA," accessed Sept. 12, 2012
Kaiser Family Foundation, "HHS Report Examines Pre-Existing Conditions in the U.S. Population," Jan. 19, 2011
Families USA, "HIPAA Definitions," accessed Sept. 13, 2012
ABC News' The Note, "Fact Check: Mitt Romney on ‘Obamacare’ and Pre-Existing Conditions," Sept. 10, 2012
New York Times, "It Will Be Tricky for Romney to Keep Best of Health Law While Repealing It," Sept. 20, 2012
Email interview with Josh Archambault, director of health care policy and middle cities, Pioneer Institute of Public Policy Research, Sept. 11, 2012
Email interview with Jonathan Gruber, economist at the Massachusetts Institute of Technology, Sept. 11, 2012
Interview with Timothy Jost, professor at the Washington and Lee University School of Law, Sept. 11, 2012
Email interview with Mark Pauly, professor of health care management, business economics and public policy at the University of Pennsylvania's Wharton School, Sept. 11, 2012
Interview with Michael Tanner, senior fellow at the Cato Institute, Sept. 11, 2012
PolitiFact's Obameter, "Require insurance companies to cover pre-existing conditions," March 26, 2010 (Promise Kept)
PolitiFact's GOP Pledge-O-Meter, "Ensure access for patients with pre-existing conditions," July 25, 2012 (Not Yet Rated)
PolitiFact, "Barack Obama film says health care law aided 17 million kids with pre-existing conditions," March 16, 2012 (Mostly False)
PolitiFact, "Debbie Wasserman Schultz says Ryan Medicare plan would allow insurers to use pre-existing conditions as barrier to coverage," June 1, 2011 (False)
PolitiFact, "Pelosi says Democrats tackle pre-existing conditions, Republicans don't," March 3, 2010 (Mostly True)
PolitiFact, "AMA president says pregnant women are barred from buying individual health policies," Aug. 18, 2009 (True)

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