Obama campaign says 89 million Americans 'could' be denied health coverage under Mitt Romney

The "Obama Truth Team" wants you to tell your Facebook friends: Bad things will happen if Mitt Romney repeals the Affordable Care Act.

A recent image posted to the team’s Facebook page pairs photos of President Barack Obama and Romney under the label "The Choice." Then it contrasts two numbers. "Number of Americans who could be denied coverage if they have a pre-existing condition" under Obama? Zero. Under Romney? 89 million.

Obama’s health care law forbids insurers from using someone’s health or lack of it to "determine eligibility, benefits or premiums." Romney, the Republican candidate for president, has promised an effort to repeal the law. But he says that people with pre-existing conditions, as long as they’ve been insured in the past, shouldn’t be denied coverage.

(He introduced confusion for a day Sept. 9, 2012, when he told NBC’s Meet the Press that, "I'm not getting rid of all of health care reform. 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." But his aides quickly clarified he still meant protection just for those who had maintained "continuous coverage.")

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We wanted to know: Could 89 million people be vulnerable to insurers using pre-existing conditions to deny them health coverage under Romney?

There’s some support for this statistic — alongside significant caveats.

The Romney plan

Romney’s health care plan doesn’t pack a lot of details, and his campaign didn’t answer our requests for clarification.

But he has consistently said that the Affordable Care Act should go away, and that people with health conditions who have "maintained continuous health insurance coverage should be guaranteed the ability to retain coverage."

Democrats argue that means people who suffer gaps in coverage — after, say, a lost job — wouldn’t be protected under Romney. And that’s where the "89 million" figure comes from: a recent study of the number of people who lost insurance coverage for at least a month between 2003 and 2007.

The idea is that if some of those 89 million happened to have a pre-existing condition, a gap in their health insurance could mean "denied coverage" later. But it’s not that simple.

We checked out a summary of the August 2012 study from the Commonwealth Fund, and chatted with one of its authors and several other health care experts about the accuracy of the campaign claim.

"If you take it very literally, it's accurate," said Pamela Short, one of the Commonwealth Fund study authors, who was a health care expert on President Bill Clinton’s Council of Economic Advisers. "... It doesn't mean it would, but it could."  

Other experts were less generous.

Yuval Levin, a fellow at the Ethics and Public Policy Center and founding editor of conservative magazine National Review, called the statistic "absurd and false."

Here’s how both of them are right.

• The 89 million encompasses those with coverage gaps — not necessarily those with pre-existing conditions. Estimates of how many Americans actually have pre-existing conditions vary widely.

• Even if Obamacare disappeared, a 1996 law protects most people from denial after gaps of less than 63 days. Health experts we talked to assumed 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 perhaps strengthen it so it also applied to the individual market. But the group in the study is bigger than that, including those with coverage gaps of "at least one month."

• That same law, the Health Insurance Portability and Accountability Act, only allows insurers to look back 18 months for coverage gaps of 63 days or more. But the study tallied those who had gaps over a four-year period.

• The study looked at people ages 4 to 64 with public and private health care coverage. But people who qualify for Medicaid, for example, couldn’t be at risk for being "denied coverage if they have a pre-existing condition."

• Some people rejected for coverage for pre-existing conditions before the Affordable Care Act qualified for insurance through state-run "high-risk pools," an idea Romney includes in his health care proposals.

So the Obama campaign claim is true only under the most literal reading of Romney’s approach — that "continuous coverage" could mean exactly that, with no allowances even for short gaps protected under the law for many people since the 1990s. (And even then, you’d have to subtract people who could take advantage of public insurance and high-risk pools.)

Meanwhile, conservative health experts say that the group of reforms recommended by Romney, which focus on separating health insurance from employment, would 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," Levin said.

The ruling

The Obama campaign says that under Romney, 89 million Americans could be denied coverage if they have a pre-existing condition. Democrats point to Romney’s promises to repeal the Affordable Care Act as evidence, along with Romney’s statements that people should be protected from denial only if they have been continuously insured.

The "89 million" comes from a study that looked at coverage gaps, without a focus on pre-existing conditions. Some of those 89 million — those on public insurance, or whose gaps were less than 63 days or more than 18 months old, or who qualified for high-risk pools — could be protected in a non-Affordable Care Act world. That reduces the number of people who could suffer coverage denials.

So while Romney would work to repeal blanket protection for people with pre-existing conditions, the claim that he could expose "89 million" to the possibility of denied coverage is only partially accurate, and leaves out important details. We rate it Half True.