Serious political debate in Republican circles over the substance, scope, and scale of what should “replace” the Affordable Care Act (ACA) has been more or less frozen in suspended animation since its enactment in March 2010 for three reasons. (1) Grassroots activists focused on outright repeal as a common unifying goal. (2) Elected GOP officials and other Republican candidates for office scrambling to stay in front of the energetic parade opposing ObamaCare found it much easier to hope that the Supreme Court would do most of their work by ruling the Affordable Care Act unconstitutional and invalid in its entirely. (3) Developing a coherent and popular replacement plan is a much heavier lift, particularly once one tries to move beyond the facile rhetoric and sound bites of past proposals that dodge the difficult policy complexities and political tradeoffs of sustainable health reform.