President Obama returned to Iowa Wednesday fresh off an energetic performance in Tuesday night’s debate to defend his record and tout the accomplishments of his first four years in office. The signature achievement of Obama’s first term, the Patient Protection and Affordable Care Act, once again came under fire on Tuesday night from Republican candidate Mitt Romney, who has pledged to repeal the current law and replace it with a plan of his own that would emphasize state-level health-care solutions.

In discussing his own plan, Romney twice claimed that it would mandate that insurance companies not deny coverage on the basis of a customer’s pre-existing medical conditions — first in a “Meet the Press” interview in September and again in the first presidential debate, on Oct. 3. Both times, the Romney campaign had to walk back the candidate’s claims. Whoever wins the election, be it Romney or Obama, it is essential the government mandate that insurance companies may not deny coverage to anyone based on pre-existing health conditions.

An independent analysis by the Government Accountability Office released in March estimated, using data from 2009, estimated the number of Americans with medical conditions that an insurance company could conceivably cite as grounds for refusal of service. The study used five lists of qualifying conditions ranging from least to most inclusive and found that between 36 million and 112 million Americans have medical conditions that could disqualify them from receiving insurance. The most common of these conditions include hypertension, diabetes, and mental-health disorders.

A Congressional investigation conducted in late 2010 found that between 2007 and 2009, the four largest for-profit health-insurance providers in the United States denied coverage to more than 650,000 people on the basis of pre-existing conditions; all total, private health insurers turned away one of seven applicants. The current legal framework pertaining to the relationship between consumers and insurance companies, established by the 1996 Health Insurance Portability and Accountability Act, is insufficient to protect individuals in this country.

This law protects individuals with medical conditions and continuous, employer-provided health insurance from losing their insurance if they change employers. Current implemented law provides no protection for individuals moving between two individual-market plans or for anyone who is uninsured or whose insurance has lapsed. The Affordable Care Act, when it goes into full effect in January 2014, will replace the convoluted regulations outlined in the 1996 law with a single blanket provision that universally bans insurance companies from denying coverage to individuals with pre-existing conditions.

But while Romney has praised this provision as one of the components of the president’s health care law that he supports, he has also pledged to repeal it and start over. Romney’s plan for reforming access to health insurance would likely rely on the expansion of provisions in the ineffective 1996 law to include protection for people transitioning between individual-market insurance plans. Romney’s insurance reforms, similar to the 1996 law, would apply only to individuals who have been continuously insured for 18 months without any lapses longer than 63 days.

For most of the 48 million uninsured people in the United States, 72 percent of whom have been without insurance for more than a year, Romney’s plan would provide no protection from insurance companies seeking to deny coverage to individuals with pre-existing conditions. Romney has said that states should help subsidize purchases for individuals whose pre-existing conditions make insurance prohibitively expensive, but he has outlined no mechanism by which his administration would protect consumers after repealing the Affordable Care Act as promised.

Romney has made political hay out of his opposition to the act during this election season, but he has not been shy about cherry-picking the law’s popular provisions and co-opting them without regard for his actual health-care plans. Romney continues to pay lip service to individuals with pre-existing medical conditions, saying that he will protect them from being denied insurance, but he offers no plan to make it happen.