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HUBBARD, Iowa — Senator Ted Cruz is often asked about doing away with President Obama’s health care law. He is rarely pressed by voters on what will replace it.

But at a middle school cafeteria here, a man, Mike Valde, presented him with a tragic tale. His brother-in-law Mark was a barber — “a small-business man,” he said. He had never had a paid vacation day. He received health insurance at last because of the Affordable Care Act. He began to feel sick and went to a doctor.

“He had never been to a doctor for years,” Mr. Valde, 63, of Coralville, Iowa, said. “Multiple tumors behind his heart, his liver, his pancreas. And they said, ‘We’re sorry, sir, there’s nothing we can do for you.’ ”

The room was silent.

“Mark never had health care until Obama care,” Mr. Valde continued. “What are you going to replace it with?”

Mr. Cruz expressed condolences and pivoted quickly to a well-worn answer assailing the health care law.

Mr. Cruz said “millions of Americans” had lost their jobs and their doctors as a result of the law, and that many had “seen their premiums skyrocket.”

He said he had often joked about a pledge by Mr. Obama that premiums would drop: “Anyone whose premiums have dropped $2,500, as President Obama promised, should vote for Hillary Clinton,” Mr. Cruz said. “I’ll take everybody else.”

Many in the room laughed.

Mr. Valde — who said in an interview later that he did in fact intend to caucus for Mrs. Clinton — pressed on.

“My question is, what are you going to replace it with?” he said.

Mr. Cruz said he was getting there, but had to lay out the problems with the law first. “There are millions of stories on the other side,” he said, describing voters who had liked their insurance plans and lost them because the plans did not provide the level of coverage the new law required.

He went on to describe elements of his plan, which includes an effort to allow people to purchase insurance across state lines.

Mr. Cruz turned back to Mr. Valde. “Your father-in-law, he couldn’t afford it,” he said.

“Brother-in-law,” Mr. Valde said.

“Your brother-in-law couldn’t afford it,” Mr. Cruz said.

“Right,” Mr. Valde said. “But he could afford it — he finally got it under Obama.”

“He would have gotten it earlier, if he could have afforded it earlier,” Mr. Cruz said. “But because of government regulations he couldn’t.”

Moments later, Mr. Cruz wrapped up and Mr. Valde sat down.