Despite Mitt Romney's formerly reasonable stance on health care, the candidate told 60 Minutes on Sunday that we do actually provide care for everyone in America – it just sometimes happens that the only care anyone can get is in an emergency room:
“Well, we do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and – 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.”
Not only are emergency room visits among the most expensive care available, but it means people who have access to health care only through emergency rooms miss out on the major components of an actual health care plan – like preventative and routine care – that prevent emergencies from the start.
Of course, Romney knew this when he was governor of Massachusetts, and it's one of the reasons he supported universal health care there. He was also aware of this reasoning when he wrote 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.
It makes a shocking amount of sense. But now that he's running for president, Romney is content to let emergencies be the only times some people get health care – people who can't afford it and aren't able to access it through the government or employers.
Fortunately, whether they like it or not, states are gearing up to implement the provision of the Affordable Care Act that involves setting up statewide insurance exchanges to help make health insurance more accessible and affordable. And on November 16, states have the option of either implementing their own exchanges, or letting the federal government do it for them. So far, only thirteen states and the District of Columbia have promised to set up exchanges. Six have said they won't. The rest are weighing options, with some trying not to get too invested in anything before the election gives insight into the probable fate of the ACA.
Regardless of how the exchanges are set up, the health insurance provisions of the ACA can't kick in soon enough in Texas. With the highest uninsured rate in the country, and home to four of the five U.S. metro areas with the highest share of uninsured residents, Texas needs a whole lot more than emergency rooms.