Filtered through the haze of advertisements, debates, fliers, and campaign speeches, both presidential candidates agree on certain aspects of the Affordable Care Act — but they disagree on the role the federal government should play.

President Obama

Obama believes the federal government should have a large role in American health care. He signed the Affordable Care Act into law on March 23, 2010, and continues to heavily advocate for the bill. 

“Access to proper treatment and medicine is critical to our country and our state,” Sen. Tom Harkin, D-Iowa, wrote in an email. “Under the Affordable Care Act, millions of Americans are able to get the treatment and medical care they need, but have been denied in the past.”

Families USA, a nonpartisan interest group based in Washington, D.C., strongly supports the Affordable Care Act.

“[The act] does the remarkable thing of expanding health-care coverage,” said Ron Pollack, the executive director of Families USA. “It helps make coverage a lot more affordable. It protects those that need health care the most.”

GOP presidential candidate Mitt Romney

Romney promised to repeal the Affordable Care Act if elected into office, although he does admire a few aspects of the act. He believes health-care reform should be the responsibility of individual states or be driven by the marketplace.

“The reason for the repeal of Obamacare mostly rests upon the mandate that the federal government make you purchase health insurance,” Sen. Chuck Grassley, R-Iowa, said in an interview with *The Daily Iowan*. “If states want to do it, let them do it.”

Similarities have been drawn between what Romney signed into law as governor of Massachusetts and the Affordable Care Act, but Romney stresses it was a state decision.

“The best course for health care is to do what we did in my state — craft a plan at the state level that fits the needs of the state,” he said during the second presidential debate. 

Is repeal even possible?

Officials question whether Romney would even be able to repeal the act.

“I don’t really think that in the end, if Romney wins the election, repealing the Affordable Care Act will be all that easy,” University of Iowa sociology Professor Kevin Leicht said. 

There is also a question of whether Romney will have support in Congress, which he would need to repeal the act.

“If it’s going to be repealed, Romney has to be elected and there has to be Republican control of both houses of Congress,” Grassley said.

The alternative to the Affordable Care Act

In the Affordable Care Act, there are points that Romney agrees with and says will remain if the act is repealed. However, he has not given a definitive outline on how this will work, leaving officials to question whether it is possible.

Peter Damiano, director of the Public Policy Center and director of the Health Policy Research Program at the University of Iowa, believes that without the individual mandate [which requires all Americans to obtain health insurance or opt to pay a penalty], insurance companies will not agree to maintain many of the elements that politicians on both sides of the aisle agree with.

“[The individual mandate] is there because the insurance companies said ‘The only way we’ll get rid of pre-existing conditions and maximums is if you bring everyone into the system,’ ” he said. “You really can’t separate the pieces very well.”

Officials also say the alternative will probably resemble the current act, leaving those who dislike the Affordable Care Act disappointed.  

In fact, President Twila Brase of interest group Citizen’s Council for Health Freedom based in St. Paul, Minn., is very worried the alternative will resemble the current law and sees similarities between the two candidates.

“If [Romney is elected], then what we are looking at is whether or not he will repeal the whole law,” Brase said. “A lot of our concern is that some of the big things in Romneycare are in Obamacare.”