Politics Romney: ‘We Don’t Have People Who Die Because They Don’t Have Insurance’ 
 
 Mitt Romney doubled down on his suggestion that uninsured Americans can find the care they need in emergency rooms, telling The Dispatch that people will always receive the treatment they need, and do not die or suffer because they can not pay for care. He pointed to federal law that requires hospitals to admit emergency patients, repeating his advice that patients rely on the most expensive form of care reserved strictly for emergencies. Romney told the Columbus Dispatch: 
 
 “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. 
 
 Emergency rooms serve as a place of last resort, but 45,000 Americans still die every year because they lack health insurance, or one every 12 minutes. Uninsured adults under age 65 are also at a 40 percent higher death risk. Hospitals may treat patients for emergency medical conditions regardless of legal status or ability to pay, but patients with chronic conditions that don’t require emergency interference are often unable to access needed care. 
 
 Romney’s health care proposal would leave 72 million Americans without health insurance and wouldn’t provide all uninsured Americans with a stable source of insurance. ||||| L 
 
 iberal critics of Mitt Romney's plan to repeal ObamaCare argue that a President Romney would leave tens of millions of Americans without health insurance they would otherwise have under Obama's reform law. In a meeting with the Columbus Dispatch editorial board this week, Romney sought to downplay the harm that such an insurance-revoking plan would cause. "We don't have people that become ill, who die in their apartment because they don't have insurance," Romney said, repeating a claim he made last month on 60 Minutes. Is Romney right, or is he underestimating the dangers faced by the nation's tens of millions of uninsured Americans? Here, a brief guide: 
 
 
 
 First off: What exactly did Romney say? 
 
 He told the newspaper's editors that even those without health-insurance coverage have a safety net, because federal law prohibits hospitals from turning even uninsured people away when they show up to an emergency room. "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,'" Romney said. "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." 
 
 
 
 Is Romney right? 
 
 About the law, yes, he is, says Rebecca Leber at Think Progress. Emergency rooms really do serve as "a place of last resort" for the uninsured. Still, an analysis released in 2009 by Harvard Medical School researchers found that 45,000 Americans die every year because they don't have health insurance. That's one person every 12 minutes. Other studies have put the figure lower — the Institute of Medicine estimated in 2002 that about 18,000 people die annually because they're uninsured. Indeed, the consensus among researchers is that you run a greater risk of dying if you're not insured. 
 
 
 
 Why do uninsured Americans die if hospitals must admit them? 
 
 Hospitals have to treat them in the emergency room, but many patients don't get there until it's too late. And patients with chronic conditions often can't afford care they need on a regular basis — basic services that emergency rooms aren't set up to provide. "For any doctor," Dr. Steffie Woolhandler, a co-author of the 2009 study, told Reuters, "it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent." 
 
 
 
 Why is Romney talking about this at all? 
 
 He's stuck with "defending his emergency-room plan as a tenable solution," says Steve Benen at MSNBC, because he knows full well his proposal to gut ObamaCare will strand tens of millions of Americans with no coverage. "The reality is plain for anyone who cares: Americans die because they lack basic coverage," and forcing hospitals and taxpayers to foot the bill for free emergency room care is "the most inefficient system of socialized medicine ever devised." But Romney isn't talking about returning to the pre-ObamaCare status quo, says John Hinderaker at Power Line. He wants to help get more people covered by doing things like "banning discrimination" against people with pre-existing conditions. So disagree with him if you must, but don't distort his plans. 
 
 
 
 Sources: Columbus Dispatch, MSNBC, PowerLine, Reuters, Think Progress 
 
 Read more political coverage at The Week's 2012 Election Center. ||||| Romney defends plan to repeal Obama healthcare law 
 
 By Elise Viebeck - 
 
 Repealing President Obama’s healthcare law would not keep people from getting insurance or quality care, GOP presidential nominee Mitt Romney said Wednesday. 
 
 In an interview with the editorial board of the Columbus Dispatch, Romney defended his plans to repeal the healthcare law, saying the uninsured could still visit an emergency room and that people with preexisting conditions could keep their insurance. 
 
 “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,’ ” Romney said. 
 
 “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,” he said. 
 
 “We don’t have people that become ill, who die in their apartment because they don’t have insurance,” Romney added. 
 
 The comment drew criticism from the Obama campaign, which said it showed Romney did not understand the struggles of middle-class families that lack insurance. 
 
 “If he did, he wouldn’t claim that no one in this country dies because they don’t have health insurance when, in fact, experts estimate that 26,000 people die prematurely every year because they don’t have coverage,” said Obama campaign spokeswoman Lis Smith. 
 
 Healthcare is a challenging issue for Romney, who backed an overhaul of the healthcare laws in Massachusetts as that state's governor that President Obama has said served as a basis for his own federal healthcare law. 
 
 Romney embraces the Massachusetts law, but argues that different states should be free to set up their own healthcare laws. He has described "ObamaCare" as a federal takeover of state healthcare law. 
 
 In the interview in Columbus, Romney also said he would ensure people with preexisting conditions could not be blocked from getting health insurance as long as they previously had health insurance. But he suggested insurance companies would not be obliged to cover people with preexisting conditions who had never had been insured. 
 
 “You have to deal with those people who are currently uninsured, and help them have the opportunity to have insurance," Romney told the Columbus newspaper. 
 
 "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." 
 
 The comments come as Romney has sought to edge toward the political center with some of his remarks. After an impressive debate performance last week, polls have shown Romney edging into a lead over Obama, and the two men are intensely fighting over centrist, Independent voters. 
 
 Obama's healthcare law remains unpopular in polls, and conservatives argue it will raise taxes and limit growth while adding to the deficit. 
 
 Obama and the law's supporters argue it will lower government spending and national healthcare costs, in part by requiring younger, healthier people to purchase insurance. 
 
 Federal law requires that virtually every U.S. hospital treat anyone who arrives needing emergency care, a guarantee passed in 1986 as part of the Emergency Medical Treatment and Active Labor Act (EMTALA). 
 
 The law was designed to prevent the situation Romney described on Wednesday — uninsured Americans dying in their homes for lack of care — but it also creates a “free-rider” problem by burdening hospitals with costs they pass to other patients. 
 
 Smith cited a report by the liberal advocacy group Families USA, which supports the healthcare law, that found 26,000 Americans die every year because of a lack of health coverage. 
 
 In 2009, nonpartisan researchers at Harvard Medical School pegged the number of U.S. deaths related to lack of coverage closer to 45,000 annually. 
 
 This story was updated at 3:30 p.m. ||||| Mitt Romney appears to have altered his position on the Obamacare ban on denying insurance to people with pre-existing conditions in an interview with the Columbus Dispatch editorial board. 
 
 “You have to deal with those people who are currently uninsured, and help them have the opportunity to have insurance,” said Romney, according to the paper. 
 
 “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.” 
 
 In the same interview with the Dispatch, he also argued that not having insurance does not in itself lead to deaths. 
 
 “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,’” Romney said. “Instead 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.” 
 
 Tune in to ABCNews.com on Thursday for livestreaming coverage of the 2012 Vice Presidential Debate in Danville, Ky. Coverage kicks off with ABC News’ live preview show at noon, and full debate coverage begins at 8 p.m. 
 
 Romney’s reference to a “choice” with regard to pre-existing conditions and his inclusion of giving opportunity to people “who are currently uninsured” would seem to contradict earlier statements from Romney and his own website, which suggest no ban on pre-existing conditions should be extended for people who don’t currently have insurance. A full transcript of the interview has not yet been posted by the Dispatch. The Romney campaign has not responded to a request for comment. 
 
 Read more about Romney and pre-existing conditions. 
 
 There were approximately 49 million non-elderly uninsured Americans in 2010, according to a Kaiser Family Foundation report that utilized U.S. Census data. More than 70 percent of those have gone without insurance for a year or more, according to the report. 
 
 Here’s what it says on Mitt Romney’s website about pre-existing conditions: “Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage.” 
 
 That has been taken to suggest that he favors a ban on insurance companies discriminating on the basis of pre-existing conditions, but not for people who are currently uninsured. “Continuous coverage” generally means three months, so presumably a three-month gap is allowed. 
 
 Romney has backed this assessment up, most notably in an interview during the GOP primary this spring with Jay Leno, when Romney was careful to stipulate that someone would need to have had insurance. “People who have done their best to be insured are going to be covered,” said Romney. 
 
 “If they are 45 years old, and they show up and say, ‘I want insurance because I have heart disease,’ it’s like, ‘Hey, guys. We can’t play the game like that,’” Romney told Jay Leno during a March appearance on the “Tonight Show.” ”You’ve got to get insurance when you are well, and then if you get ill, you are going to be covered. 
 
 “People who have been continuously insured, let’s say someone’s had a job for a while and been insured, then they get real sick and they happen to lose a job, or change jobs, they find, ‘Gosh, I got a pre-existing condition. I can’t get insured,’ I’d say no, no, no. People with pre-existing conditions, as long as they have been insured before, they are going to be able to continue to have insurance,” he said. 
 
 In the presidential debate last week, Romney said, “I do have a plan that deals with people with pre-existing conditions,” but he did not elaborate. ||||| WASHINGTON -- Downplaying the need for the government to ensure that every person has health insurance, Mitt Romney on Sunday suggested that emergency room care suffices as a substitute for the uninsured. 
 
 "Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care." 
 
 This constitutes a dramatic reversal in position for Romney, who passed a universal health care law in Massachusetts, in part, to eliminate the costs incurred when the uninsured show up in emergency rooms for care. Indeed, in both his book and in high-profile interviews during the campaign, Romney has touted his achievement in stamping out these inefficiencies while arguing that the same thing should be done at the national level. 
 
 And while Romney refused to agree on Sunday that the government's role is to ensure that every American has health care, he has endorsed such an idea in the past. 
 
 When asked in a March 2010 interview on MSNBC's "Morning Joe" whether he believes in universal coverage, Romney said, "Oh, sure." 
 
 "Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way," he said. 
 
 Watch Romney on "Morning Joe" in 2010: 
 
 And in a 2007 interview with Glenn Beck, Romney called the fact that people without insurance were able to get "free care" in emergency rooms "a form of socialism." 
 
 "When they show up at the hospital, they get care. They get free care paid for by you and me. If that's not a form of socialism, I don't know what is," he said at the time. "So my plan did something quite different. It said, you know what? If people can afford to buy insurance ... or if they can pay their own way, then they either buy that insurance or pay their own way, but they no longer look to government to hand out free care. And that, in my opinion, is ultimate conservativism." 
 
 Getting rid of high numbers of inefficient emergency room visits was actually a key goal of Romney's health care reform in Massachusetts, as he noted in his book "No Apology": 
 
 After about a year of looking at data -- and not making much progress -- we had a collective epiphany of sorts, an obvious one, as important observations often are: the people in Massachusetts who didn't have health insurance were, in fact, already receiving health care. Under federal law, hospitals had to stabilize and treat people who arrived at their emergency rooms with acute conditions. And our state's hospitals were offering even more assistance than the federal government required. That meant that someone was already paying for the cost of treating people who didn't have health insurance. If we could get our hands on that money, and therefore redirect it to help the uninsured buy insurance instead and obtain treatment in the way that the vast majority of individuals did -- before acute conditions developed -- the cost of insuring everyone in the state might not be as expensive as I had feared. 
 
 In the "60 Minutes" interview, Romney stressed that each state should address the problem of the uninsured through different means. But he didn't speak with the same alarm about the cost of emergency room care. 
 
 "Again, different states have different ways of doing that," Romney responded. "Some provide that care through clinics. Some provide the care through emergency rooms. In my state, we found a solution that worked for my state. But I wouldn't take what we did in Massachusetts and say to Texas, 'You've got to take the Massachusetts model.'" 
 
 Romney's efforts to limit emergency room care in Massachusetts were largely successful. 
 
 Six years after he signed health reform into law, visits to emergency rooms in Massachusetts are decreasing and the state has the highest rate of residents with health insurance. ||||| DENVER — Every Monday morning, like clockwork, one of Lucia’s children or her husband drives her to the emergency room at Denver Health Medical Center.. 
 
 Lucia’s body is broken; her head throbs. She is short of breath and nauseated, and she drifts in and out of consciousness. 
 
 The 51-year-old mother of five is in kidney failure, a result of her Type 2 diabetes. 
 
 Lucia (whose last name has been withheld at her request because of her family’s immigration status) is one of an estimated 6,500 undocumented immigrants in the United States who are living with end-stage renal disease, but only barely. 
 
 The chronic condition requires ongoing kidney dialysis, without which a person would die in a matter of days. 
 
 For more than 650,000 American adults, end-stage renal disease is a manageable illness, treated with dialysis three times per week and covered by private health insurance, Medicare or Medicaid, no questions asked. 
 
 But because Lucia is an undocumented immigrant, she is not eligible for traditional Medicare or Medicaid. 
 
 And because she is unable to afford private medical insurance or pay for her expensive treatment out of pocket, she is forced to wait until her condition deteriorates to a life-threatening medical emergency. 
 
 She must wait to nearly die before she can be revived and brought back to life. 
 
 At that point, but not a moment sooner — even though Lucia and her doctors know that her impending emergency is completely preventable — Lucia receives care under the Emergency Medical Treatment and Labor Act. 
 
 The 1986 law compels hospitals with emergency rooms to care for anyone and everyone whose life is in imminent danger, regardless of their citizenship status or ability to pay. 
 
 What’s more, over the past five years of dealing with her disease, Lucia has learned that if she shows up at the hospital too early, she will be turned away because her life is not in immediate jeopardy. If she waits just a few minutes too late, she might need to be revived from cardiac arrest. 
 
 Determining the precise minute to arrive at the ER is a critically important decision. Lucia’s life depends on it. 
 
 “The function of the kidneys is to filter blood of excess toxins and excess fluid,” said Dr. Lilia Cervantes, a physician at Denver Health who is involved in Lucia’s care. 
 
 “When both kidneys stop working, people, on average, will live anywhere from 10 to 14 days. And so, to continue living, you need some process to filter blood, which is a dialysis machine. 
 
 “If you don’t have dialysis, all that excess fluid and excess toxin builds up in the body. For example, if someone takes a spoonful of soup or a bite of watermelon or even a small gulp of water, your body isn’t able to get rid of that through urine. Instead, it stays in their system.” 
 
 For her part, Lucia knows that she cannot eat certain water-dense foods such as potatoes, tomatoes and oranges. 
 
 “I even have to measure the water,” she said through an interpreter. “I cannot drink a lot of water.” 
 
 It’s an unimaginable predicament to be in: needing water to live but knowing that consuming just a little too much of it could kill you. 
 
 “And so, for these patients, because they only come in … once every seven days instead of the three times per week, [the excess fluid] stays in their body, and it goes into the lungs,” Cervantes said. 
 
 “It goes into their legs. Separate from that, the toxins build up, one of the most important toxins being potassium, which, at high levels, can make the heart stop.” 
 
 The stark disparity between how American hospitals care for the insured versus the uninsured — and undocumented — is an issue Cervantes has dedicated her life and career to changing. 
 
 She was motivated to transition from clinical work to more of a research role by another patient she treated, who ultimately died four years ago as a result of her illness. 
 
 “After Hilda passed away, I looked at the literature, and I found one article that was particularly interesting,” Cervantes said. 
 
 It was written by Dr. Barry M. Straube, who was then the chief medical officer for the federal government’s Centers for Medicare and Medicaid Services. 
 
 “And in it, he discussed this issue of emergency-only hemodialysis and said that until we have the right research, the cost-effectiveness analysis, the comparative analyses, to demonstrate that this type of care needs to change, that potentially we wouldn’t change it until the right data are available,” Cervantes said. 
 
 “And so that’s when I set off to really begin to build the body of research.” 
 
 The Centers for Medicare and Medicaid Services, which is part of the U.S. Department of Health and Human Services, is responsible for making decisions as to what is and isn’t covered by Medicare, Medicaid and the Children’s Health Insurance Program. 
 
 Although some of the agency’s policies are black and white, others fall into a bit of a gray area, including what exactly defines a medical emergency — namely, when someone like Lucia can be provided care. 
 
 At Denver Health, where Lucia receives treatment, the criteria for admission to emergency dialysis include toxic levels of potassium and other blood electrolytes, as well as symptoms such as severe shortness of breath, substantial nausea and vomiting, confusion and diminished mental status. 
 
 Some states, including California, New York, North Carolina and Washington, have initiated programs and set aside funds to provide standard dialysis to undocumented immigrants who need it — before they are in critical condition. 
 
 Not only is this type of treatment more manageable for patients, studies have shown that it saves the government and taxpayers a significant amount of money. 
 
 A 2007 study conducted at the Baylor College of Medicine in Houston found that the cost of treating undocumented immigrants with emergency-only hemodialysis is 3.7 times more expensive than caring for them with standard dialysis three times per week. 
 
 It’s because patients like Lucia are so much sicker and require more care by the time they come in for treatment. And that money adds up — to approximately $285,000 vs. $77,000 a year — according to the study. 
 
 In her research at Denver Health, Cervantes found that five years after initiating dialysis, undocumented immigrants with end-stage renal disease who receive emergency-only hemodialysis have on average a 14 times greater risk of death compared with people who receive three-times-a-week dialysis. 
 
 In addition to the greater financial cost and the heavier toll this delayed treatment wreaks on the body, Cervantes found that many of her patients experience something she calls “death anxiety.” 
 
 “Participants described the overwhelming distress their families experienced as they watched a loved one cope with symptom accumulation and fear of dying each week,” Cervantes wrote in her research. “Parents described their children as depressed because they were afraid of losing their parent. 
 
 “Two participants described suicide attempts by their children. Participants preemptively said their goodbyes to their families each week because they were uncertain whether they would survive the process of waiting to be admitted or of undergoing hemodialysis under emergency conditions.” 
 
 Lucia, for one, said she is at peace with her illness and doesn’t worry anymore that she is not going to survive. 
 
 She feels grateful for the limited care she receives here in the United States, because she is acutely aware of the reality that she would not be entitled to any care in her native Mexico and would almost certainly have died by now. 
 
 Lucia and the other participants in Cervantes’ study were diagnosed with kidney disease after arriving in the United States and did not enter the country to seek treatment. 
 
 “It’s been really hard for my family,” Lucia said. “The worst is for my son. … He worries about me.” 
 
 Every week, 18-year-old Alex watches his mother steadily decline, not able to do anything about it until she arrives at the precipice of death — at which point, he will take her to the hospital. 
 
 What particularly aggrieves Cervantes is that patients such as Lucia are not eligible for organ transplants, even from a family member, but they are encouraged to give the gift of life and donate their organs when they die. 
 
 “I just want care to change so badly,” Cervantes said, as she started to cry. “I can do all the research, but it’s not until people actually listen … [that] access can finally change.”
– A comment from Mitt Romney on health insurance is making waves, especially among critics on the left. Speaking to the Columbus Dispatch editorial board (in all-important Ohio), Romney sought to convey the notion that sick people wouldn't be left high and dry with the repeal of ObamaCare. His quote: “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. 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.” It's that last part getting the most attention: White House: If Romney understood middle-class struggles, "he wouldn’t claim that no one in this country dies because they don’t have health insurance when, in fact, experts estimate that 26,000 people die prematurely every year because they don’t have coverage." See the Hill for more on that. ThinkProgress: Emergency rooms don't cut it as a last resort. "Hospitals may treat patients for emergency medical conditions regardless of legal status or ability to pay, but patients with chronic conditions that don’t require emergency interference are often unable to access needed care," writes Rebecca Leber. She cites a study putting the yearly death toll as a result at 45,000. The Note blog at ABC News thinks Romney might have actually shifted his position on pre-existing conditions in the interview, and The Week has more background and context on Romney's statements.