As the Iowa caucus kicked off on Monday, candidates on both sides sparred over their plans for healthcare and the future of President Obama’s Affordable Care Act in general.

In the Democratic race, Hillary Clinton is supporting the Affordable Care Act, saying she will reform certain provisions to improve it. Meanwhile, Sanders seeks to replace the law with a government-run Medicare-for-all program.

Clinton, who on Monday led Sanders in the polls 48 percent to 44 percent,  said reigniting a debate over the ACA would be wrenching for the country.

“We can’t repeal it and we can’t start over,” Clinton said Saturday, according to the New York Times.

Sanders attacked Clinton Jan. 21, saying she is lacking details of her plans to improve the ACA.

“How exactly would Secretary Clinton, as she vaguely put it, ‘get us the rest of the way?’ She hasn’t told us,” his campaign said. “Her website promises she’ll ‘expand affordable coverage, slow the growth of overall healthcare costs and make it possible for providers to deliver the very best care to patients.’ How exactly? Does she have a plan to improve Medicare or Medicaid? Does she have a plan to provide insurance for 29 million Americans who still lack coverage and more who are underinsured?”

Meanwhile, former Maryland Gov. Martin O’Malley, who’s locked up a paltry 4 percent in the latest Iowa polls unveiled a health plan in late November that would build on the Affordable Care Act and attempt to reduce prescription drug costs, among others things.

"The next president must build on the (ACA’s) success, while continuing to reduce costs, expand access, and improve the quality of care," the plan said.

O’Malley would prohibit price gouging for prescription drug costs and use the government's purchasing power to ensure more reasonable prices for drugs.

But while Democrats are pitching reforms to the ACA, the Republican field is more apt to replace it.

“This law is a disaster,” Sen. Ted Cruz recently said on Fox News. “People are hurting.”

Fox Host Chris Wallace has said the Cruz plan to replace the ACA by selling insurance across state lines, expanding health savings accounts and making insurance portable between jobs, “would have almost no effect in giving people who are not uninsured health coverage.”

But Cruz, who on Monday was closing in on frontrunner Donald Trump, shot back that the analysis of organizations like the Congressional Budget Office about his plan were “simply not accurate.”

Trump was leading Cruz in the latest Iowa polls on Monday, 29 percent to 24 percent.

Trump has said he would dismantle the ACA, but has not given any specific plans. 

"We're going to work with our hospitals," Trump said on Jan. 10 to ABC. "We're going to work with our doctors. We've got to do something. ... We'll work something out. That doesn't mean single-payer."

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Florida Sen. Marco Rubio, currently in third place in Iowa polls with 17 percent of likely voters, proposed on his website “common sense, free-market ideas to make healthcare more accessible and affordable.” That means repealing and replacing the ACA, allowing individuals to control their own healthcare choices and returning control of health policy to the states, he has said.

Jeb Bush’s plan to repeal the ACA would limit federal payments to states and create a transition for the 17 million people receiving insurance coverage under the law. Bush would also limit tax-free status of employer-provided health insurance, empower states to design Medicaid programs and increase funding for the National Institutes of Health.

Meanwhile, Ben Carson, would focus on tax-protected “health empowerment accounts” and high-deductible health insurance plans. Carson's plan also called for overhauling Medicaid by giving users private insurance options funded through state-run Medicaid programs.

Only Ohio Gov. John Kasich, who on Monday showed 3 percent of voters backing him in the polls, would keep some portions of the ACA. In fact, he worked to secure a $13 billion Medicaid expansion to cover more people in his state.

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