Lively sparring over health care issues -- especially Medicare and the Affordable Care Act -- marked the first three debates in the U.S. presidential election, with candidates for president and vice president tossing out charges and countercharges regarding their opponents' plans for both programs.

The fourth and final debate, slated for October 22, will focus on foreign policy issues.

The Republican nominee for president, former Massachusetts Gov. Mitt Romney, again declared in the first debate his intention to repeal "Obamacare," the nickname given the Affordable Care Act by its detractors but subsequently embraced by President Barack Obama.

"I just don't know how the president could have come into office, facing 23 million people out of work, rising unemployment, an economic crisis at the kitchen table, and spend his energy and passion for two years fighting for Obamacare instead of fighting for jobs for the American people," Romney said during the Oct. 3 debate. "It has killed jobs."

Obama responded with a full-throated defense of the Affordable Care Act, noting the protections and benefits it already has afforded Americans and promising that it will drive down health care costs in the long run.

"Let me tell you exactly what Obamacare did," the president said. "Number one, if you've got health insurance, it doesn't mean a government takeover. You keep your own insurance. You keep your own doctor. But it does say insurance companies can't jerk you around. They can't impose arbitrary lifetime limits. They have to let you keep your kid on your insurance plan until they're 26 years old. And it also says that you're going to have to get rebates if insurance companies are spending more on administrative costs and profits than they are on actual care."

Health care came up only tangentially in the second presidential debate, Oct. 16, with Obama noting the Affordable Care Act as one of the policies he pursued to help people deal with the tough economy.

"I said that we would put in place health care reform to make sure that insurance companies can't jerk you around and, if you don't have health insurance, that you'd have a chance to get affordable insurance -- and I have," he said.

Obama and Romney sparred over Medicare as well, but the topic drew even more heat during the debate between Vice President Joe Biden and the Romney's Republican running mate, Rep. Paul Ryan.

Romney and Ryan accused Obama of weakening Medicare by cutting billions from the program to help pay for the implementation of the Affordable Care Act. In turn, Obama and Biden accused Romney of planning to turn Medicare into a voucher system that would be unable to keep pace with health care inflation.

The Republican duo's attack on the Affordable Care Act focused on four points:

• Romney argued that the Affordable Care Act will increase the cost of insurance for families.
• He said that $716 billion will be cut from Medicare to help pay for health care reform.
• He noted that an unelected panel of experts will help determine the sorts of treatments that will be covered and promoted.
• He asserted that health care reform will cause small businesses to cut jobs.

"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," Romney concluded.

Obama countered that the Affordable Care Act came into being to combat rising health care costs, and that repealing it would leave America facing an unsustainable status quo.

"It wasn't just that small businesses were seeing costs skyrocket and they couldn't get affordable coverage even if they wanted to provide it to their employees," Obama said. "It wasn't just that this was the biggest driver of our federal deficit, our overall health care costs. But it was families who were worried about going bankrupt if they got sick -- millions of families, all across the country."

Obama also responded to Romney's allegations:

• He argued that with full implementation of the act, families will be able to purchase insurance from health exchanges and benefit from group rates "typically 18 percent lower than if you're out there trying to get insurance on the individual market."
• He noted that the $716 billion in Medicare funding Romney mentioned is actually savings derived from not overpaying providers, and he said that the AARP has noted that by plowing this money back into the system, the Obama administration has extended the life of the Medicare system by eight years.
• He explained that the health care panel created by the Affordable Care Act is barred from deciding which treatments are available to people.

The two candidates also clashed over how Romney would replace the current health care reform law.

Romney said that he plans to implement a new law that would cover people with pre-existing conditions and allow young adults to stay on their parents' health plan. He said would leave the task of bringing down health care costs to the free market, with some provisions to encourage improved efficiency with incentives such as performance pay.

"Free people and free enterprises trying to find ways to do things better are able to be more effective in bringing down the cost than the government will ever be," Romney said.

Obama scoffed at the notion that Romney's plan would cover people with pre-existing conditions.

"What your plan does is to duplicate what's already the law, which says if you are out of health insurance for three months, then you can end up getting continuous coverage and an insurance company can't deny you if you've -- if it's been under 90 days," the president said. "That's already the law, and that doesn't help the millions of people out there with pre-existing conditions."

Obama also noted that when Romney was faced with a health care cost crisis in Massachusetts, he set up a plan nearly identical to the Affordable Care Act.

"There's a reason why Gov. Romney set up the plan that he did in Massachusetts," Obama said. "It wasn't a government takeover of health care. It was the largest expansion of private insurance. But what it does say is that, 'Insurers, you've got to take everybody.'"

The debate over Medicare turned particularly acidic during the vice presidential debate, with Biden and Ryan exchanging jabs and allegations over the health care program for seniors.

Ryan defended the idea of turning Medicaid into a voucher program. "Give younger people, when they become Medicare-eligible, guaranteed coverage options that you can't be denied, including traditional Medicare," he said. "Choose your plan, and then Medicare subsidizes your premiums, not as much for the wealthy people, more coverage for middle-income people and total out-of-pocket coverage for the poor and the sick."

Biden attacked the plan, arguing that vouchers would not be able to keep up with inflation.

"The voucher says, 'Mom, when you're 65, go out there, shop for the best insurance you can get -- you're out of Medicare," he said. "You can buy back in, if you want, with this voucher, which will not keep pace with health care costs because if it did keep pace with health care costs, there would be no savings."

More information

The ACP website has more information on how the candidates' positions compare with ACP policy.