There’s a difference between disliking – strongly – a federal intrusion into the marketplace like the Patient Protection and Affordable Care Act and the policy & politics of a replacement (if any).
Republican Sen. Lindsey Graham outlines the policy problem with changes to the ACA:
“Once you say that everybody should be covered, can’t be denied coverage because they are sick – which most Americans would agree with that – you put yourself in a box. Insurance is about young people who are healthy buying insurance like you all to pay for me and him,” Sen. Lindsey Graham (R-SC) said, pointing to the oldest reporter in the scrum. “If you don’t have to buy insurance until you get sick, most people won’t. That’s where the mandate becomes important.”
Graham added: “Somebody’s got to work through this problem. If we’re going to accept the proposition that you can never be denied coverage because you’ve been sick, then somebody’s got to create a system where people participate.”
The political problem is on conservative Jennifer Rubin’s mind:
If the GOP votes to end Obamacare with no concrete plan in place, it will freak out millions of people, the very working-class voters who chose President-elect Donald Trump, and hand the Democrats the perfect vehicle for regaining majorities. Indeed, it is remarkable that Hillary Clinton did not tell voters over and over again — in response to Trump’s “What do you have to lose?” argument — that one thing they risked losing was health care.
For many Republicans, the Republican House and Senate majorities’ failure to pass a comprehensive alternative to Obamacare was a never-ending source of frustration. In truth, that alternative, as a political matter, is rather difficult to achieve.
That doesn’t mean that the ACA shouldn’t be changed, or replaced. It means that for those who voted for repeal but also want key provisions of the law to continue, there’s either going to be a sacrifice of some of their desires or a lot of creative work to be done. Promising an easy repeal and an acceptable replacement was easy only in the promising; there’s no legislative solution that won’t disappoint many.
For a look at some solutions (although ones that neither conservatives nor liberals may ever accept), see Replacing Obamacare: The Cato Institute on Health Care Reform (2012) and Cato’s more recent writings on the subject.
It has been easier to turn away from the marketplace for Democrats (2010) and Republicans (now) than it has been to find a legislative plan that won’t upset millions of people whose expectations are very high.