Mitt Romney's Health-Care Dilemma

March 29, 2010 -- Mitt Romney, the once and likely future Republican presidential candidate, is back in Iowa today.

The stated purpose of his visit, which includes speeches in Des Moines and Ames, is to promote his new book, "No Apology: The Case for American Greatness."

The broader mission, however, is to begin to reintroduce Romney to the state that holds the first in the nation presidential nominating contest.

When Romney ran for president in 2008, his most delicate task was trying to convince social conservatives that he was, in the words of former Romney adviser Mike Murphy, "a pro-life Mormon" who had been "faking it as a pro-choice friendly" when he began his political career in liberal Massachusetts.

Now that Romney, 63, is gearing up for a second presidential run, his most challenging task might be convincing Republicans that the health-care plan he approved in Massachusetts is not a template for the health-care plan approved at the federal level by President Obama.

"Romney has a huge albatross around his neck, which really wasn't an issue in 2008: We are implementing a national health care plan that is very much like what he did in Massachusetts," a Republican strategist unaligned in the 2012 race who was granted anonymity so he could be more candid told ABC News.

By some measures, Romney's Massachusetts health-care plan should be a signature achievement: The Bay State has succeeded in raising the amount of insured residents to 97 percent by extending subsidies to the previously uninsured.

But the costs of the plan have strained the state treasury and it was accomplished through the kinds of mandates that are anathema to some Republican activists.

Similar to Obama's recently enacted federal health-care plan, the Massachusetts plan requires individuals to buy health insurance and imposes tax penalties on those who don't.

Furthermore, both the federal and Massachusetts plans penalize businesses above a certain size that don't provide coverage to their employees.

Romney Distinguishes 'RomneyCare' From 'ObamaCare'

Romney's aides have sought to distinguish his plan from the one enacted by Obama, in part, by noting that it was a state-based rather than a federal effort.

"Obama's plan is a Dr. Jekyll version of what Mitt Romney passed in Massachusetts with higher taxes, cuts in senior care, price controls and an over-reaching federal government," Romney adviser Eric Fehrnstrom said. "Gov. Romney believes states should come up with their own health care solutions, as we did in Massachusetts."

For one Iowa Republican activist, the variations between Romney's plan and Obama's are a distinction without a difference.

After the Associated Press reported Friday that Romney is attacking a health care law similar to his own, Barbie Miller, an Iowa Republican activist, circulated the article with a note saying: "Romney is hiding from the truth about his Massachusetts health-care bill that he signed into law in 2006. That is right, ObamaCare was started by a 'faux Republican' called Mitt Romney. This article is so true about Romney, and he cannot buy his way out of this one nor can the elite party Republicans."

Romney is attempting to inoculate himself against attacks on his health-care plan by making a series of donations to Republican congressional candidates opposed to Obama's plan and touting the program as a "Prescription for Repeal."

The Republican strategist who spoke with ABC News is skeptical about whether Romney can truly inoculate himself on the issue.

"'Prescription for Repeal' may help at the margins, but I think as much if not more it reminds people that when it comes to core conservative beliefs, Romney will say whatever he thinks you want to hear," the Republican strategist said.

The GOP strategist added that the Republican National Committee and the Republican congressional leadership would have spent more time during the health-care debate harping on the costs of the Massachusetts health-care experiment if the program had not been enacted by a leading Republican presidential candidate.

Eric Woolson, Mike Huckabee's 2008 Iowa campaign manager who is unaligned thus far in the 2012 presidential race, said he believes that Romney will open himself up to new questions about his authenticity if he tries to distance himself from his Massachusetts health-care plan.

"I think he's going to have problems on that issue because it is more alike than different than the Obama plan," Woolson said. "Certainly, that is the perception."

Romney won 11 GOP nominating contests in 2008 but dropped out of the presidential race after he concluded that he could not catch up to Sen. John McCain of Arizona, the eventual nominee, with former Arkansas Gov. Mike Huckabee still in the race.

ABC News' Matt Loffman contributed to this report.