Can you really “fire your insurance company”?

Mitt Romney has been taking lots of heat for his remark on the stump in New Hampshire, “I like being able to fire people.”

Pushing back against the criticism that it sounds like Romney takes pleasure from taking over companies and shutting them down for profit--as his former investment firm, Bain Capital, has been accused of doing, his campaign has pointed out that he was talking about health insurance customers having the right to drop an insurance carrier that displeases them and move to another.

That raises the question: Can you “fire your insurance company”?

The answer, as health policy expert

Aaron Carroll of Indiana University points out, is no. Or at least, “Lotsa luck.” As he writes:

The real issue, unfortunately, is that very, very few people have the luxury that Gov. Romney is endorsing. Let’s say that you are self-employed, and lucky enough to have found a company to provide you with health insurance. Then, let’s say you develop cancer. You suddenly find out that your insurance company stinks. So you fire them, right?

Of course not. You’re screwed. Now you have a pre-existing condition. There’s not an insurance company out there that wants to cover you. So you don’t fire them. You scream, and curse, and cry, but you’re stuck. Only healthy people have the luxury of picking and choosing.

As Carroll notes further, you would be able to freely fire your insurance company only in a system of guaranteed issue with a ban on exclusions of pre-existing conditions. In other words, under the healthcare reform act that President Obama signed and Romney wants repealed, and under the healthcare law enacted by Massachusetts under, yes, Gov. Mitt Romney.

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