Romney has said that if Congress does not repeal the law, he would act unilaterally, giving states waivers that would allow them not to participate.
He has pledged to replace the law after repealing it, but has said little about what the replacement would be. In a recent television interview, Romney said he would keep protection for some people with preexisting medical conditions. His plan, however, would only protect those who have had "continuous coverage" — those who have kept insurance throughout their lives.
That continuous-coverage rule has been in federal law since 1996, when Congress required that when most people change jobs, they can't be excluded from a new employer's health plan. But the rule does not help people who come new to the insurance market or those who have had a lapse in coverage — for example, those who have been unemployed for a long period of time and without insurance.
Advisors say Romney favors a plan that would give Americans a tax break to buy insurance on their own. That likely would be expensive — a similar plan offered in 2008 by Sen. John McCain would have cost about $1 trillion over 10 years, about the same as the Obama law. Unlike the Obama law, however, it would not have come close to covering everyone.
The argument in favor of that plan is much the same as the one advanced for changing Medicare to a premium support system: Giving people a fixed amount of money and having them buy insurance on the open market will bring down costs by expanding competition.
Critics say the change would leave millions of people uncovered, particularly those who have existing health problems or are too poor to buy insurance even with the tax break. Depending on how the tax system is changed, the shift could also encourage companies to drop their existing health plans.
Romney would also change Medicaid, the joint federal-state program that covers the poor.
Currently, about 70 million people at some point during the year get coverage from Medicaid (Medi-Cal in California) and the related Children's Health Insurance Program. The states and the federal government share the costs, with Washington paying just over half the tab in the wealthiest states and more than three-quarters of the cost in the poorest — West Virginia and Mississippi.
About half of the patients nationwide are children in poor families, but 70% of the costs involve the one-quarter of patients who are disabled or elderly. Low-income seniors often use Medicaid to cover nursing home bills, which are not covered by Medicare. Medicaid covers about 40% of all long-term care costs in the country.
The price tag for Medicaid has doubled in the last decade and now costs the federal government nearly $300 billion a year. Romney aims to cut the program's cost by about $1.5 trillion over the next decade.
He would do so by moving to a system in which Washington gives each state a sum of money, or block grant, that states could spend as they wish to provide care to the poor. The amount of the block grant would increase by no more than 1% beyond overall inflation — far less than the current rate of increase in healthcare costs.
Supporters of the idea say that cutting the funds would give states an incentive to save money and the block grant would give them the flexibility to do so.
Independent analysts, including the Congressional Budget Office, estimate that the cuts in federal spending would be so deep that states would either have to spend much more of their own money — unlikely — or eliminate coverage for millions of poor children and elderly nursing home patients.
In almost every speech, Romney criticizes Obama for over-regulating, and he has made cutting regulations in two areas — the financial industry and the environment — a staple of his campaign.
Obama's financial industry regulations stem from the Dodd-Frank law, approved by Congress in 2010. Romney wants the law repealed. He has suggested he wants to replace it with something else, but hasn't said what.
"Dealing with all the new regulatory burden has caused a lot of community banks to pull back at the very time we'd like them to step forward and provide financing to small business," he told reporters recently. "I'd like to get rid of Dodd-Frank and go back and look at regulation piece by piece."
The Dodd-Frank law established a new Consumer Financial Protection Bureau, which started setting up shop last year. The bureau's first enforcement action came in July, when it ordered Capital One to pay $210 million in refunds and fines for allegedly using deceptive marketing tactics on credit card customers. The bureau also has unveiled a simplified mortgage disclosure form, proposed new rules to limit mortgage fees, and started overseeing credit reporting firms.
The law also called for toughening up rules for the nation's banks and investment funds.
Although he said he would like to have the law repealed, Romney also said he supported regulation to ensure "greater transparency in the trading of derivatives" and "capital requirements for banking institutions so that people don't go out and leverage themselves to the point where any small hiccup could cause the entire institution to fail."