The White House has joined in, showering unhelpful praise on the plan, which, like the federal law, includes a mandate for residents to carry insurance.
Romney has defended the program, saying that it was right for Massachusetts, but that he would not impose it on other states. His forceful criticism of the national law has been overshadowed by his Republican rivals trying to conflate the two.
Several Republican strategists who worked on Romney's first presidential campaign said they had urged him to try to get ahead of the controversy a year ago during the national health care debate. But they said their suggestions were overruled by Romney and his small circle of advisers.
"He made a huge mistake not litigating his health care record when Obamacare was on the table," said Alex Castellanos, a Republican strategist who advised the early stages of Romney's last campaign. "He should have been the leading opponent and said, 'I can tell you better than anyone, don't do this.' But now he's chosen to litigate this during a campaign, which is the worst time to do it."
Romney did not mention health care at the Conservative Political Action Conference. His spokesman said Romney would continue to speak against the national plan, but stand by his Massachusetts law.
"It's going to be an issue," said Eric Fehrnstrom, the spokesman. "I understand the temperature is higher now." He added, "What's important is that Mitt Romney agrees with every other candidate for the nomination that Obamacare should be repealed."
The health care law, particularly the individual mandate, has been a catalyst for the anti-Obama energy of Tea Party activists. But Romney and his advisers argue that voters will be more concerned with the economy and job creation in the months ahead.
Doug Gross, a prominent Iowa Republican and state chairman of Romney's last campaign, said Romney had a chance to create fresh appeal if he could present himself as genuine and not as someone chasing voters too far to the right.
"He was a relatively moderate governor of a Northeastern state, and he tried to come to Iowa to be a social conservative and it didn't work," Gross said. "If he can't be perceived as a true fiscal conservative and a limited government guy — the burden of proof is against him. He's got to overcome the burden."
Gross and more than a dozen other former supporters who are not aligned with other candidates said they worried whether Romney could withstand scrutiny without being tempted to reinvent himself again. But they urged him to campaign in Iowa, even with its heavy social conservative presence, because economic concerns topped nearly everyone's priority list.
"If the issue is jobs and the economy, he should fare well," said Christopher Rants, a former state legislator in Iowa who was a Romney adviser in 2008, but has not chosen a candidate this time. "That's his wheelhouse, and he needs to stick to it. If he does that he'll find support."
Four years ago, Romney focused considerable attention on the Iowa caucuses, only to finish well behind former Gov. Mike Huckabee of Arkansas, who spent a fraction of the money Romney did but surged with the support of evangelical voters and social conservatives. Romney has yet to settle on a strategy this year, but aides said that it would include all states.
James Merrill, R-N.H., who led Romney's effort in the state four years ago, said there were no questions about Romney's authenticity by voters in his state who have known him for years and carefully followed him when he was Massachusetts governor.
"You convey authenticity by the ability to take tough questions," Merrill said. "He's done it and he will do it again."
"Jobs and the economy is issue No. 1 in this race," he added. "Governor Romney is very well positioned to speak on those pocketbook issues, and he's ready to lead."
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