Poor Mitt Romney. His singular achievement as governor of Massachusetts was enactment of bipartisan health care reform. And now that achievement has come back to haunt him.

The Massachusetts law became the template for the coverage expansions in the Affordable Care Act: It had regulations requiring insurers to provide basic coverage even to people with pre-existing conditions, subsidies for people who couldn't afford premiums on their own, and a requirement that everybody obtain insurance known as an individual mandate. But while the law had a long and distinguished conservative pedigree, the concept became politically toxic on the right once Democrats embraced it as their own. Romney, who formerly and quite justifiably cited the plan as proof that he could govern, has had to play down the accomplishment as he seeks the Republican presidential nomination.

But playing down the Massachusetts reforms apparently isn't enough. Politico's Carrie Budoff Brown reports today that conservative activists are demanding that Romney disown and apologize for the law. My colleague Jonathan Chait points out the obvious dilemma here for Romney. If he doesn't apologize, his opponents will say he's a liberal. If does apologize, opponents will say he's a flip-flopper. Maybe he can get away with one or the other; in early 2008, I was sure McCain would never sell himself to the Republican base as a conservative. But his chances look awfully slim.

In any event, I'm less interested in what conservatives think of Romney than I am in what conservatives think of health care reform. And, sorry, I continue to find the extent of opposition baffling--or maybe not so much baffling as damning.

The right's ire has focused on the individual mandate. I understand why that offends Republicans who don't like the government telling people what to do. But plenty of conservatives don't have such libertarian leanings; that's why they were the ones who first proposed, and for many years, supported the individual mandate. 

As any expert will tell you, if you want to make sure everybody has at least basic insurance, at a reasonable price, and you want to do it primarily through private coverage, the individual mandate is essential. So unless you oppose the mandate from the left--that is, you prefer people get coverage from some kind of public insurance--to oppose the mandate is to oppose the idea that people with high medical risks deserve access to the same insurance, at the same price, as people who are healthy. I know that's how a lot of conservatives feel. But that's now become a litmus test for the party's nomination? Whatever happened to compassionate conservatism?

One other fact ought to figure into this conversation: The Massachusetts reforms happen to be working pretty well. According to the latest Census figures, Massachusetts was one of a handful of states in the number of people without insurance fell over the last year, despite the bad economy. As of last year, just 4.4 percent of residents lack coverage--the lowest uninsured rate in the country. And not only are people less likely to go without coverage. They are also less likely to skip care because of cost. There's still a lot of room for improvement and the reforms haven't, so far, reduced the cost of care--although that's because they weren't designed to do that in the first place. But polls show the state's residents like the reforms and want to keep them.

In a rational political universe, the governor who signed the Massachusetts law would brag about it. Apparently Republicans don't live in that universe.