Republican presidential nominee Mitt Romney says that having insurance is not a matter of life and death for Americans.

During a Wednesday interview with the Columbus Dispatch, the former Massachusetts governor said he would give people a window of time to make a “choice” to buy insurance — even if they had pre-existing conditions.

And for those who didn’t make the “choice” to pay for coverage and got sick anyway, “Romney minimized the harm,” according to the paper.

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“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 explained. “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.”

The candidate recently told CBS News that insurance coverage was not necessary for the poor because federal law requires emergency rooms to stabilize anyone who comes in with a life-threatening condition, although experts consider this to be the most expensive type of care.

And Romney’s plan to give people a “choice” to buy insurance seems to be reversal from his earlier insistence that pre-existing conditions should only be covered “as long as they’ve been insured before.”

“Well, if they’re 45 years old, and they show up, and they say, I want insurance, because I’ve got a heart disease, it’s like, `Hey guys, we can’t play the game like that. You’ve got to get insurance when you’re well, and if you get ill, then you’re going to be covered,'” he remarked to NBC host Jay Leno in March.

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As Think Progress noted on Thursday, a Harvard Medical School analysis determined that nearly 45,000 people died in the United States each year largely because they did not have insurance.