If Ann Romney weren't wealthy, she might have even more in common with Kelly Gaeckle.

Both women suffer from multiple sclerosis, a chronic neurological disorder that impairs motor function, cognitive abilities and vision and can cause uncontrollable muscle spasms, fatigue and dizziness. Patients eventually can lose the ability to walk.

Romney, whose husband is Mitt Romney -- the leading Republican presidential contender, the ex-governor of Massachusetts and a former corporate honcho worth as much as $250 million -- presumably doesn't struggle to pay for her treatments, even if she doesn't consider herself wealthy.

Romney, who turns 63 later this month and also has a history of breast cancer, would likely be in dire straits if she had to turn to the open market for health insurance -- without her husband's millions.

"Ann Romney would literally be unable to get health insurance in most states in America and if she could get it, she'd pay an unbelievable price," said Jonathan Gruber, an economist at the Massachusetts Institute of Technology. And it probably wouldn't cover treatments for M.S. and cancer, he said. Gruber helped develop both the Massachusetts health reform law signed by then-Gov. Mitt Romney in 2006 and the national law enacted by President Barack Obama two years ago.

Kelly Gaeckle, a 35-year-old stay-at-home mother and a part-time fitness instructor who lives in Santa Cruz, Calif., is lucky enough to have a high-cost insurance plan, but it doesn't cover many of the medications she needs. She and her husband, who runs his own business, struggle to pay the $1,500 monthly premium on their plan, which covers the couple and their four kids. They put just about enough money into a health savings account every year to cover the plan's high $6,500 deductible, but the funds run out quickly. After they meet the deductible and their out-of-pocket expenses hit $6,000, the insurance pays practically the full cost of their medical treatments -- but only those that are actually covered. The couple worries that its insurer will raise rates to something completely out of reach, a perfectly legal move under California law.

"I am 100 percent certain that if we lost our health insurance we would lose our house. At this point we are living month to month," Gaeckle's husband Peter wrote in an e-mail. The family budget is squeezed because of a rough patch in his business; access to health care services for themselves and their four children, two of whom have heart conditions, is a pressing concern. According to the most recent data available from the National Multiple Sclerosis Society, the direct medical costs of treating M.S. were as high as $27,000 a year for an individual in 2007.

As the country waits to hear the Supreme Court's decision on health care reform, a look at the Gaeckles' health insurance offers a glimpse of what free-market health care means to those who are not receiving coverage through a company's health-care plan or lucky enough to live in Massachusetts. Reforms that former governor Romney put in place in the state would cover Gaeckle at a much lower rate than she currently pays. Much like the national health care law now before the high court, the Massachusetts law mandates that insurance companies cover everyone, sets limits on how much more they can charge people with pre-existing conditions, provides financial assistance for low- and middle-income people, and requires nearly everyone to get coverage.

Gaeckle tried a drug called Copaxone a few years ago but the side effects and the $2,600 monthly cost of the medicine, which the family had to put on its credit card, were more than she could bear. She also has avoided another M.S. drug, Avonex, because of the expense, and she puts off MRIs and other tests until later in the year when her insurance picks up the cost.

Still, she's happy to have any coverage. "M.S. is very unpredictable," said Gaeckle. "I could be okay and functioning right now, but you know tomorrow could be different so I definitely feel better knowing if I can get into the doctor."

Insurance companies in California aren't allowed to kick you off a plan if you already have insurance, but state law allows health insurance companies to raise rates on expensive customers, which can price them out of coverage, said Anthony Wright, the executive director of Health Access, an advocacy group in the state. "We in California are the wild, wild west for health insurance," he said.

California law also lets insurers deny applicants or provide them with a plan that doesn't cover their pre-existing conditions, Wright said. A family like the Gaeckles would have a hard time on the open market if they were to find themselves without coverage, he said.

Access to stable, reliable insurance varies for people with pre-existing conditions if they don't get it through work or a government program like Medicare or Medicaid. Some states require insurance companies to provide plans to people with pre-existing conditions but premiums can become unaffordable. Other states allow insurers to reject customers they believe would be too costly, or even decline to renew their policies after they receive diagnoses of ailments like cancer and M.S. Insurance companies also can offer plans to sick people that cover everything except their pre-existing conditions.

Starting in 2014 when the biggest parts of Obama's health overhaul take effect, people with pre-existing conditions will have access to coverage like what's available in Massachusetts.

Mitt Romney's health care proposals would reinforce the current patchwork of state regulations, don't require insurance companies to offer plans to everyone and don't limit how much they can charge based on people's medical histories.

During a recent appearance on "The Tonight Show," Mitt Romney told host Jay Leno that he wanted to guarantee access to insurance for people with pre-existing conditions, but only if they're already covered. He didn't explain how he would help people who are uninsured because of their medical histories.