Hillary Rodham Clinton began to carefully ease away from President Obama on Wednesday, saying she wanted to build upon “what works” in the president’s signature health care law and opened the door to health insurance changes usually backed by Republicans.
The former secretary of state also said her presidential campaign was working on a plan to “jump start” small businesses that have been held back during the economic recovery by excessive regulations and government red tape.
The business-friendly rhetoric from Mrs. Clinton stopped short of criticizing her former boss in the White House, but it marked the start of her campaign’s effort to draw distinctions with Mr. Obama and combat the perception that she represents his third term.
“I am committed to building on what works in the Affordable Care Act,” Mrs. Clinton told a group of small-business owners at a roundtable discussion in the warehouse of Capital City Fruit, a produce distributor in Norwalk, Iowa, just outside Des Moines.
Her support for Obamacare was tempered by an acknowledgment that those around the table still faced difficulties providing health insurance for themselves and their employees under the law, and she offered to make changes to fix it.
“We’ve learned a lot in the last few years,” she said. “We’re all just going to have to get around the table and get back to work.”
When asked by a business owner about allowing insurance companies to compete across state lines, a proposal long supported by Republicans, Mrs. Clinton refused to rule it out.
“I think it’s something we should look at,” she told the businessmen. “I haven’t made a final determination myself, because this is the way it’s been for a long time.”
On the economy, she promised to be a champion for small businesses.
“I want my campaign to figure out how we’re going to jump-start small businesses,” Mrs. Clinton said.
She said that while studying statistics in preparation for the roundtable discussion she was struck by a World Bank survey the showed the U.S. “ranks 46th in the world in how hard it is to start a business.”
“We need to be — we have to be — No. 1 again,” she said.
The former first lady, senator and top diplomat blamed the difficult business environment in part on excessive regulations, a problem conservatives regularly pin on the Obama administration.
“Slowly, over time, it’s become more difficult, more expensive, more red tape, unnecessary regulation that has really put a damper [on business startups],” said Mrs. Clinton. “And then that was unfortunately exacerbated greatly by the effects of the great recession where a lot banks stopped lending.”
She said she wants to ensure that entrepreneurs “don’t get either deterred or stopped in their tracks.”
“I think that’s the spirit we want to focus on. We want to ignite again,” she said. “We’ve got to get the economy growing from the bottom up.”
Mrs. Clinton didn’t offer any policy proposals or take a firm stand on any issue, which has been her practice since she announced her run for president Sunday.
“Before I roll out my policies, I want to hear from people who are on the front lines,” she said.
The roundtable capped Mrs. Clinton’s two-day campaign swing though Iowa, which holds the country’s first nominating contest and in 2008 dealt Mrs. Clinton’s presidential campaign a shuddering blow when she finished third behind Mr. Obama and former Sen. John Edwards.
Mrs. Clinton, who remains the odds-on favorite to win the Democratic presidential nomination, is determined to connect with Iowa voters on a closer, more personal level this time.
She also has labored to reintroduce herself to America as a woman of the people rather than a jet-setting, megawealthy, celebrity politician.
In remarks to the business owners, Mrs. Clinton played up her humble family history.
“My father was a small businessman, really small,” she said. “He printed fabric for draperies and then he went out and sold them. He was a person who really believes in hard work, and he was also a waste-not, want-not kind of a guy.”
“My grandfather was a factory worker, and my father was a small-business man. Small businesses are at the heart and backbone of the American economy,” Mrs. Clinton said.
Earlier, Mrs. Clinton chatted with a different group of small-business owners over coffee at a diner in Marshalltown, a small town about an hour northeast of Des Moines.
She kept the mood casual, chatting warmly with the owners of the Tremont Grille, a diner that boasts itself “Home of Muddy Waters Coffee Co.” and is part of a small hotel.
“Hi! Great to be here. Hi, how are you,” Clinton said, shaking hands with the owners, J.P. and Jennifer Howard, according to a poll report.
“How long have you had this place? Oh wow! That is great. So you live upstairs?” said Mrs. Clinton, who nodded to the replies that were inaudible to the reporters.
In the back of the diner, about 10 regular patrons sat in booths or at the bar eating their meals and watching the scene unfold near the front of the restaurant.
• This article is based in part on wire service reports.