This exchange from Mitt Romney’s interview with CBS last night, in which he points out that those without health insurance do have the option of going to emergency rooms, is understandably generating a lot of chatter today:

QUESTION: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

ROMNEY: Well, we do provide care for people who don’t have insurance, people — we — if someone has a heart attack, they don’t sit in their apartment 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.

My colleague Sarah Kliff points out that back when he was making the case for his universal health care bill in Massachusetts, Romney saw emergency room care as the problem. Romney argued we should move care out of emergency rooms into primary care to lower costs and prevent insurance premiums from getting driven up.

But a health care researcher I just spoke to points out another angle here, echoing a point raised earlier by Steve Benen: What does this say about Romney’s vision of what we should do about those with chronic conditions who lack insurance, and need regular care?

“It’s shocking that Governor Romney would say it’s just fine for the uninsured to access emergency care when he’s seen in his own family the importance of health insurance in assuring care for those with chronic conditions,” the Urban Institute’s Stan Dorn, who has done extensive research on the uninsured, tells me.

“Thank God his wife has had health insurance to cover her multiple sclerosis,” Dorn continued. “But research shows that the uninsured with multiple sclerosis have less than 30 percent the likelihood of receiving the medicine they need than those with insurance do. Governor Romney knows how dependent these people are on prescription drugs and doctor visits. Yet he’s apparently said that for 50 million uninsured Americans, it’s okay for them to be limited to emergency room care. He’d never accept that for his wife and he should never accept that for others in this country.” (Quote fixed.)

It’s unclear to me that Romney is going this far. Romney seemed to be rebutting the idea that the uninsured have no access to health care in this country, by arguing that they can get care at emergency rooms. It’s unclear from the quote whether he’s declaring that he sees this as morally acceptable. But he didn’t say that he sees it as morally unacceptable, either. And Romney, who vows to repeal Obamacare, would not replace it with anything that would guarantee care for those with preexisting conditions but have lacked continuous coverage, say, from a previous job from which they got fired.

And so, until Romney tells us what he would do, if anything, for those millions of Americans, this remains one of the starkest differences yet between what a second Obama term would look like and what a first Romney term would look like. If Romney wins, protections like the one preventing discrimination against people with preexisting conditions could very well be taken away from millions of people. If Obama wins, they will continue to be implemented and will slowly become part of the fabric of American life, just as many of the progressive reforms of the last century have done.