Conservatives used to say that a conservative was a liberal who had been mugged. In other words, your abstract political ideology has to shift when it bumps up against unpleasant reality. Something similar can happen with politicians—not that they undergo wholesale ideological shifts, but many have some issue on which they have personal experience that leads them away from their ideology. For instance, Alan Simpson, a staunch conservative in almost every way, has advocated against harsh sentences for minors who commit crimes, because he himself grew beyond his run-ins with the law as a teenager.
As you've probably heard, Ann Romney suffers from multiple sclerosis. In a new video on the Romney campaign's web site, the Romneys talk about how they've dealt with the disease, and encourage people to donate to the National Multiple Sclerosis Society. Which is good, but when you run for president, your own personal life is necessarily political. It's important to be sensitive in how we talk about this, but Jonathan Cohn says exactly the right thing. It's terrific that Mitt Romney has been so devoted to his wife, "But if you have MS, or any other serious chronic illness, you need more than a devoted spouse. You need a way to pay your medical bills." For people with any chronic illness, paying those bills, and getting and keeping coverage in our brutal private insurance system, can be difficult and at times even impossible. Cohn goes on:
The Affordable Care Act will not fix all of these problems. The standards for insurance it sets allows for substantial out-of-pocket expenses, which means many patients with MS and other chronic disease will still struggle with the cost of care. But the health reform law will certainly make the situation better, by making sure almost everybody can get health insurance, no matter what their pre-existing conditions, and by making sure everybody's coverage includes at least a minimum set of benefits and limits on cost-sharing. Although those changes won't happen until 2014, a few of the law's reforms have already started to take effect—among them, the elimination of those lifetime limits on benefits and an initial reduction of those limits on annual benefits. (The law eliminates the latter entirely by 2014.) These are just some of the reasons that the MS Society, like virtually every other chronic disease group, advocated for the law and endorsed it after enactment.
But patients with chronic disease like MS will lose most or all those protections if Romney becomes president and, as he has promised, he repeals the Affordable Care Act. He's promised to replace it with other reforms but, based on what he's said, his reforms won't be much of a substitute. Worse still, the tax and regulatory changes he's proposed would quite likely undermine existing insurance arrangements without providing a suitable alternative, as experts such as Harvard's David Cutler have pointed out. People with chronic disease who now rely on job-based plans could find themselves with weaker coverage, or even none at all.
I have no idea how Mitt Romney really feels about this prospect. It's entirely possible that his own family's experience with chronic disease made him think about what it would be like to go through such a trial if you didn't have great wealth or good insurance. Perhaps this was part of the reason he worked hard to pass a plan in Massachusetts that made it possible for everyone in the state to get insurance. But then he decided to run for president in the Republican Party, and political necessity dictated that he not only disavow the best thing he did as governor, but pledge to undo the Affordable Care Act. The personal may be political, but if you want to be president there are some things you simply cannot do. Coming out and saying that his family's experience with chronic illness convinced him that it's critical that everyone be able to get health insurance, and so while there are ways we might change the ACA, simply repealing it would harm too many people? That would have been just too much.
Mitt Romney is not stupid, and he knows a good deal about the health insurance system, so he surely knows that if he follows through on his pledge to repeal the ACA it will mean that millions of families not as fortunate as his will continue to find their medical challenges turned into impossible financial challenges as well, which inevitably compounds their medical challenges. Perhaps when he stops to think about it, he tells himself that this is just one price that must be paid for him to become president, and if he wins in November he'll be able to do all sorts of good things that will make up for this awful thing he'll also have to do. I don't know, and it would be pointless to ask him, since he'd just give some pat answer that would tell us nothing. But what goes through his mind when he meets a voter who tells him that someone in their family has a chronic disease, and they can't get insurance?