During an at times confrontational second meeting between President Barack Obama and former Massachusetts Gov. Mitt Romney, health care and the landmark health care reform bill rarely were mentioned. As Tuesday’s debate was the last time the candidates would discuss domestic issues prior to election day, some health care watchers were left wanting.

On the few occasions the Patient Protection and Affordable Care Act did come up — the word “Obamacare” was mentioned a scant five times — it was primarily used as an attack vehicle.

Romney used the health care law to attack Obama’s record. “This is a president who has not been able to do what he said he'd do,” Romney said during the Oct. 16 debate at Hofstra University in Hempstead, N.Y. “… He said that by now middle-income families would have a reduction in their health insurance premiums by $2,500 a year. It's gone up by 2,500 [dollars] a year. And if Obamacare is … implemented fully, it'll be another 2,500 [dollars] on top.”

Although no audience member asked a question directly about PPACA, Romney continued his attack later in the debate: “One of the things I find most troubling [about Obamacare] is that when you go out and talk to small businesses and ask them what they think about it, they tell you it keeps them from hiring more people.”

For Obama, PPACA was touted as part of a response to another questioner regarding what he’s done to earn a second term in office. “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.

Such fleeting mentions of the law throughout the 90-minute debate left those wanting the candidates to address the issue of health care wanting more. Said Sam Fleet, president of AmWINS Group Benefits in a tweet near the end of the debate, “Where’s the health care question?”

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