Yesterday Mitt Romney said that, if elected, he would retain elements of the Affordable Care Act.  The New York Times noted that Romney was “adopting a new tone” and that the statement was a “marked departure” from Mr. Romney’s prior tone and positions.

Romney said in particular that he wants to make sure people with pre-existing conditions can still have guaranteed coverage. Let’s focus on that little statement for a moment.

The Affordable Care Act says that insurance companies cannot turn down someone based on a pre-existing condition.  Under current law, insurance companies can deny coverage to persons with pre-existing conditions.  In effect, this means that if you have a chronic condition or a medical history indicating high risk, you cannot purchase health insurance.

To understand the significance of Romney’s statement, you need to understand a bit of health insurance policy.  So bear with us a moment while we get wonky.

The policy problem is that people with pre-existing conditions are very expensive to insure.  Insurance companies deny coverage because they believe that they are likely to lose money on these folks.  The insurance companies correctly fear that many people will not purchase health insurance until they develop a chronic condition or expect large medical bills.  This is sort of like people who live along a river not buying flood insurance until the river starts to rise.

Romney himself actually made this policy point rather nicely on the Tonight Show earlier this year.  He said, “You don’t want everyone saying, ‘I am going to sit back until I get sick and then go buy insurance.’ That doesn’t make sense.”  Watch it yourself:

If all the government did was prohibit insurance companies from denying coverage on the basis of pre-existing conditions, the insurance companies would either go out of business or have to charge prohibitively high rates.  The solution in the ACA was an individual mandate.  The basic idea is that in order to make insurance affordable and spread the cost of insuring individuals with preexisting conditions, everyone needs to be in the insurance pool.  As this article in Forbes notes, the individual mandate was pushed by the insurance companies for this reason.

That is the irony of Romney’s statement about pre-existing conditions.  As a policy matter, it is simply impossible to prohibit insurances companies from denying coverage based on preexisting conditions without maintaining the individual mandate.  We know Romeny gets this, because that is essentially what he did with health reform in Massachusetts.

But we are here to talk politics, not policy.

We expect the right wing here in Ohio to (freak out) calmly and reasonably point out the policy implications of Romney’s position.  Nationally, the conservative National Review’s Corner Blog put it succinctly:  “Some conservatives are aghast that Mitt Romney [said] that there are some health reforms he would support.”

The right wing in Ohio, as wells as the leaders of the Ohio Republican Party, have been pretty clear on this issue.  They want a full repeal of the Affordable Care Act.

An Ohio Tea Party activist at the State convention last spring in Columbus was quoted by CBS News saying, “We got to either have Romney who says ‘I will repeal it’ or we are going to have President Obama who says he is going to support it. Which one do you want?”

One of our friends on the right-wing Ohio blog, Third Base Politics, argued just last month that Ohioans should support the Republican ticket because “Mitt Romney has vowed to repeal Obamacare.”

What about the top of the Ohio ticket?  The Ohio Republican seeking the U.S. Senate seat, Josh Mandel, has been very critical of Obamacare.  Mandel criticized Obamacare as the biggest tax increase in U.S. History.  This claim earned him the coveted “Pants on Fire” designation from PolitiFact.

Josh Mandel’s website on Obamacare is not a model of clarity on this issue.  Embarrisingly, the site does not appear to have been updated since the Supreme Court upheld the constitutionality of the legislation.  The site says that Mandel’s position is:  “If it is not overturned by the Supreme Court, this legislation must be repealed and Congress must start over with healthcare reform that reduces costs, improves accessibility, and protects the doctor/patient relationship.”

An archive of the site maintained by says that Mandel’s site on April 28, 2012 contained the following statement:  “Government-run healthcare should be repealed in whole immediately. We should then adopt common-sense reforms to reduce costs and increase efficiency.”

Did you catch that key language?  Mandel says that the Affordable Care act should be “repealed in whole.”

The Republican Base in Ohio wants a full repeal of Obamacare.  Josh Mandel wants a full repeal.  The House Republicans led by Ohio’s own John Boehner have voted something like 31 times (!) for full repeal of the law.

In contrast, Mitt Romney now says he wants only a partial repeal.

It’s time for the mainstream media to follow-up on this issue.  We were pleasantly surprised this morning to see the Dispatch engage in some actual journalism on the issue.  In his article describing the Romney shift of position, reporter Joe Vardon did some actual fact checking of the claims by the campaigns.  (Compare that with the coverage from Fox News, which featured the deceptive headline “Romney, Ryan sound bipartisan tone on taxes, health care.”  LOL.)   In evaluating the Vice President’s claim that a repeal of the Affordable Care Act would lead the end of insolvency of the Medicare trust fund in 2016, Vardon wrote:  “The president’s health-care law also provides added years of solvency for Medicare, so repealing it with no other companion action would theoretically take away those added years.”  For good measure, he added this truth-nugget:  “the Republicans’ pledge to repeal Obamacare would, if not replaced by something with similar components, cancel the ‘doughnut hole’ coverage that the Obama law provides seniors for prescription drugs.”  (Keep it up Dispatch, and remember we said this nice thing about you.)

Along these lines, the Main Stream Media, who has much better access to candidates than we do, should ask all leading Republicans to clarify their positions on two issues:

  1. Do they support full repeal of Obamacare of the Romney partial repeal approach?
  2. Do they support the continuation of the ban on insurance companies denying coverage based on pre-existing conditions?  If yes, then how can this be accomplished without a universal mandate?