Republicans don't lack a plan to replace obamacare. they lack a unified theory.

• Author: Suderman, Peter
• Position: POLICY - Patient Protection and Affordable Care Care

THERE HAS NEVER been a shortage of GOP substitutes for Obamacare, from think tank white papers to congressional committee frameworks to fully drafted bills. But in the seven years that congressional Republicans spent promising to repeal and replace President Obama's health care law, none ever moved beyond the development phase, because what Republicans lacked wasn't a plan. It was a theory.

After the Affordable Care Act (ACA) passed, when Republican legislators were asked what sort of health system they preferred, most would say something about lowering costs, increasing affordability, and improving access. Some might criticize Obamacare for covering too few people, as Senate Majority Leader Mitch McConnell did in January. "What you need to understand is that there are 25 million Americans who aren't covered now," he said on CBS News. "If the idea behind Obamacare was to get everyone covered, that's one of the many failures."

But improved affordability and accessibility is an outcome, not a system. Republicans almost never took the time to describe the basic mechanics of how their preferred health care system might work. As a result, when the GOP took control of both Congress and the White House this year and the time came to draw up an actual plan to repeal and replace the ACA, it struggled to get out of the gate. Proposals were repeatedly altered and delayed. After the House repeal bill was released in March, it was met with an immediate chorus of criticism--with the loudest voices coming from the right.

IN HIS 2015 book Overcoming Obamacare, journalist Philip Klein wrote that conservatives and libertarians have generally split into three schools of thought on what should take the place of the ACA. The first group, which Klein dubbed the reform school, believed that those who opposed Obamacare should nonetheless take its existence as a given. The reform school is not so much a theory of health care policy as one of health care politics: Because Obamacare is already the law of the land, and industry players and state governments have organized themselves around it, opponents have to accept it as, at the very least, a starting point. The idea is not really to repeal Obamacare, but to improve it by pushing things in a more market-friendly direction.

That might mean incremental changes, like deregulating the law's exchanges. But in the long run, it could provide a path to reforms of the larger entitlement system. In a plan put forward by Avik...