As governor of Massachusetts, Mitt Romney oversaw the most ambitious revamping of a health care system by any state in the country. And as a presidential candidate, he contends that's how health care reform should be handled: state by state.

Romney has provided few specifics on what the federal government would do to help states expand coverage for uninsured Americans or make the health care system more efficient.

But he has made clear he believes that competition and giving consumers the ability to choose among a variety of health plans and providers can lead to better quality at a lower cost.

"The general approach is there," said Nina Owcharenko, a policy analyst with the Heritage Foundation, a conservative policy and research organization. "But the details - I guess we will just have to wait and see."

At the same time, Romney has said he would not just repeal the Affordable Care Act but also replace it - and critics contend his campaign has provided scant information on just what would replace the law.

"They have nothing of substance to replace it with," said Robert Laszewski, a consultant and former health insurance executive who writes a respected blog, the Health Policy and Marketplace Review. "And that's the important thing to understand."

Romney's proposals contain little to expand coverage for the tens of millions of Americans who work in low-wage jobs that don't provide health benefits, who have pre-existing health conditions that prevent them from being able to buy health insurance or who have lost their jobs and health insurance.

"His proposal, to the extent that he has any details, would do very little to expand health insurance coverage and in contrast would very likely would lead to an increase in people without coverage," said Thomas Oliver, a professor at the University of Wisconsin School of Medicine and Public Health.

Recent studies by the Commonwealth Fund and Families USA - organizations that support the Affordable Care Act - projected that Romney's proposals would result in the number of people without health insurance increasing at a faster pace in the next decade, in part because of his proposal to limit future growth in federal spending on the Medicaid program.

For certain, Romney has made reducing the federal budget deficit one of his top priorities, and he has risked backing bold plans to limit future federal spending on Medicaid and eventually Medicare.

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Romney favors health care competition, gives few details