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An attendee talks to democratic presidential candidate former Secretary of State Hillary Clinton as she greets supporters during a "get out the caucus" event at Iowa State University on January 30, 2016 in Ames, Iowa. With two days to go before the Iowa caucuses, Hillary Clinton is campaigning throughout Iowa.

U.S. presidential hopefuls are crisscrossing Iowa in last-ditch efforts to connect with voters before Monday's party caucuses. Sometimes the connections don't go quite as planned.

Take the meeting that Ted Cruz had early Saturday in this small Iowa farm town of 845 people, where he came face-to-face with the human cost of his promise to abolish Obamacare.

After finishing his stump speech to a high school cafeteria packed with local voters, Mr. Cruz opened the floor to questions.

Mike Valde stood up. His brother-in-law, a barber named Mark, couldn't afford health insurance before the Affordable Care Act, he told Mr. Cruz. When he finally got coverage, he went to his doctor and learned he had multiple tumours behind his heart, liver and pancreas. It was too late, Mr. Valde said, and he died soon after.

"He was a barber, a small business, never got a paid day off, never got a vacation day, never got a holiday, couldn't afford health insurance…he'd never been to a doctor for years," the 63-year-old retired lawyer recounted, fighting back tears. "Mark never had health care until Obamacare. What are you going to replace it with so people like Mark can have health care?"

This sort of unscripted interaction with voters is one of the pervasive features of this Midwest state of 3.1 million, where months of campaigning culminates Monday in the first electoral test and straw poll of the marathon U.S. presidential election.

And amid the astounding possibility that upstart candidates – billionaire businessman Donald Trump or Mr. Cruz on the Republican side, and Socialist Vermont Senator Bernie Sanders for the Democrats – could upset the establishment favourites here, the campaigns are pulling out all the stops in the final weekend. But sometimes, as Mr. Cruz's event shows, contact with real voters can stop them in their tracks.

"Well, sir, I'm sorry for your family's loss. I'm sorry for your wife's loss," Mr. Cruz replied to Mr. Valde in Hubbard, before launching into his talking points about how Obamacare has not made insurance cheaper.

"In fact, I've joked that anyone whose premiums have dropped $2,500, as President Obama promised, should vote for Hillary Clinton. I'll take everybody else," the smooth-talking Texas senator said, to chuckles from the crowd.

Mr. Valde wasn't laughing.

"My question is: what are you going to replace it with?"

"Sir, I promise you I will answer your question. I'm laying out, first of all, the problem," Mr. Cruz said. "The biggest barrier to access is cost. You ask people why they don't have health insurance. Your father-in-law, he couldn't afford it – "

"My brother-in-law."

"Brother-in-law. Okay. Your brother in law couldn't afford it. The biggest barrier is cost. If you want more access, what you want is more choices and lower cost. What does Obamacare do? Fewer choices and higher cost."

"But he could afford it, he finally got it under Obamacare."

"But he didn't get it, did he?"

"He got insurance, but by the time he got to a doctor it was too late he was dying – " "What I can tell you is millions are losing their insurance now," Mr. Cruz cut in, before arguing that, through the magic of the free market, removing all restrictions on insurance would ultimately lead to more competition and lower prices.

Mr. Valde, who plans to support Hillary Clinton Monday, said he happened to be staying nearby with his parents – his 92-year-old father is in the hospital – when he saw in the newspaper that Mr. Cruz would be in the area. Frustrated with the Texas senator's anti-Obamacare rhetoric, he decided to confront him.

"I think he's got some pat answers down," Mr. Valde said afterward, dismissing Mr. Cruz's response to his question. "The free market was probably a good part of the reason [Mark] couldn't afford health care in the first place."

On the Republican side, the voting will likely winnow the field down, with some of the 11 contenders dropping off and the front-runners battling to consolidate their support. Mr. Trump leads the pack with 30.4 per cent in the RCP average to Mr. Cruz's 24.2. Florida Senator Marco Rubio is in third, with 15.2 per cent, while the rest of the field is in single digits.

A Sanders win on the Democratic side would leave former secretary of state and First Lady Hillary Clinton damaged, and elevate Mr. Sanders from a popular protest candidate to a serious contender for the nomination. In the latest RealClearPolitics average of polls, Ms. Clinton leads Mr. Sanders 47.3 per cent to 44 per cent, with former Maryland governor Martin O'Malley trailing at 4.4.

Mr. Sanders has been furiously shuttling aroud the state, with four or five campaign stops daily, often drawing crowd in the thousands. The Vermont senator has crafted a campaign fuelled by anger at Wall Street, whom he accuses of still revelling in the excesses of capitalism despite pushing the economy to collapse in the 2008 financial crisis. His appeal lies also in his willingness to promise the sort of big-ticket government programs – universal health care and free university tuition among them – that Ms. Clinton has shied away from.

"There are people out there who say the American people don't have the courage or the capability of standing up to the drug companies and the insurance companies, and creating a health care system that guarantees health care to all. I disagree," Mr. Sanders thundered to a rally of more than 1,000 rapturous supporters in Cedar Rapids, an industrial city of 130,000 in the eastern part of the state, on Saturday evening. "There are those who say we don't have the courage or the capability of standing up to the fossil fuel industry and addressing the crisis of climate change. I disagree."

Mr. Sanders's message has particularly resonated with so-called "millennials," who seem attracted by his bold promises, his ideological purity and his refusal to take campaign donations from large corporations.

"I like the fact that he has a consistent message. He's very hard-hitting on a lot of the issues that a lot of our more seasoned politicians like to dance around," says Austin Sinclair, 26, an apprentice machinist who attended the Cedar Rapids rally. "This is the first time I've ever been this emotionally invested in a candidate."

Ms. Clinton is battling back, dispatching her husband, popular former president and master orator Bill Clinton, to whistle-stop across Iowa, hosting several rallies a day to exhort voters to help elect the country's first female president.

On the Republican side, Mr. Rubio is struggling to keep the nomination in the hands of the party establishment but so far has made little dent in Mr. Trump's or Mr. Cruz's campaigns in Iowa. Still, a third-place finish could solidify him as the choice of the party establishment and allow him to siphon off mainline GOP voters from the campaigns of former Florida governor Jeb Bush and Ohio governor John Kasich, who are languishing in the single-digits. Mr. Rubio, like Mr. Cruz and Mr. Sanders, is making four or five stops daily this weekend, holding numerous events trying to cling to a respectable share of the vote.

Mr. Trump, meanwhile, has preferred to jet into Iowa from New York for large rallies – he draws crowds in the thousands – and wage a war of words via Twitter and the talk-show circuit. Mr. Trump spent Sunday morning blasting Mr. Cruz on television.

"Nobody likes him," Mr. Trump said on ABC, referring to Mr. Cruz's reputation for having no friends in the Senate. "You can't run a country that way. It will be a total mess. It will be worse gridlock than you have right now."

The billionaire has built an impressive poll lead in a crowded field by hitting hot-button issues – promising to ban Muslims from immigrating to the country, building a wall along the Mexican border and scrapping free trade deals – while playing up his unpolished, bombastic persona as the antithesis of a career politician.

Not all Republicans, however, are smitten with Mr. Trump. Many see him as a tourist in the party who is faking his conservative credentials. They point to past statements praising Ms. Clinton and expressing pro-choice views on abortion as evidence of his political opportunism.

"Twenty years ago, Ted Cruz was the same guy he is today," says Ted Frandson, 52, a farmer who attended Mr. Cruz's Hubbard event. "Two years ago, Donald Trump was a progressive liberal."

Adds his wife, Julie Ann, 49: "And Rubio is establishment all the way. He will make deals and not do one thing for us."

To his supporters, Mr. Cruz – a committed social and economic conservative – is the real deal and someone they trust to implement the government-cutting, Obamacare-repealing agenda the GOP base craves.

"On this health care: I know you're from Canada, but your ... system is a train wreck," Mr. Franson said. "They come down here for treatment. Anyone who has money comes here."