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September 10, 2012 12:00 PM A Few Points About Romney’s “Repeal and Replace”

By Austin Frakt

Sarah Kliff helpfully interprets Mitt Romney’s Meet the Press statements about health reform as meaning he is in favor of preventing individuals with pre-existing conditions from being turned down from a plan if they have continuous coverage. That is, if you remain enrolled in some insurance plan, you can switch from plan-to-plan without any barriers due to pre-existing conditions.

Kliff then points to the 1996 Health Insurance Portability and Accountability Act (HIPAA), which already provides such protections. Families USA has a nice summary that explains how HIPAA works in the group and non-group markets. In light of this, it is not clear to me what new Romney is offering in terms of portability.

Of course neither HIPPA nor Romney’s portability concept(s) address circumstances in which individuals do not have continuous coverage. That is, they don’t by themselves help the uninsured. Additionally, just because one has access to a plan, doesn’t mean one can find one that is affordable. I know Romney has some ideas that he believes will reduce the cost of insurance (see his vision here). It’s not clear to me that they are intended to match the level of subsidization to low-income families that the Affordable Care Act (ACA) offers. In fact, I think that’s probably the point. That’s one reason why the proposal is likely less costly for the federal government.

Next, Romney wants to level the playing field with respect to the tax treatment of health insurance. I’ve addressed that point already, explaining how current law will roughly and gradually achieve just that (the Cadillac tax).

Now, neither the Cadillac tax nor HIPAA is ideal. And my point is not that they are necessarily preferable to whatever Romney is offering (though details on his vision are insufficient for a full comparison). My point is only that there are elements of his vision that are already in some way addressed in current law. To some extent, they deviate from better ideas due to political forces that would also buffet Romney’s proposals. That’s political reality.

Finally, striving for universal coverage does not appear to be a priority of the Romney plan. If it is, I haven’t seen how it will work. Of course, Romney once had a pretty good idea in this regard. Once again, it seems like a lot of his vision(s) has (have) already made it into law (portability, tax equivalence, insuring the uninsured). He’s actually fairly good at health policy. He really ought to take more credit for that. I, for one, applaud him. Now, I’d like to see him put his effort into fleshing out some of his more novel ideas.

[Cross-posted at The Incidental Economist]

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Austin Frakt is a health economist and an assistant professor at Boston University's School of Medicine and School of Public Health. He blogs at The Incidental Economist.