In 2013, much of the news was dominated by the Republican effort to defund Obamacare as well as the botched implementation of the program.

The difficulty for Republicans seeking to craft a health care policy at the moment is that it’s very difficult to predict what the health care landscape will look like a few months from now, let alone several years from now when a potential Republican president would have a chance to make changes.

Without knowing how much of Obamacare could be in play, it’s hard to settle on a policy. On the one hand, basing policy on the assumption that Obamacare can be entirely repealed is likely unrealistic, while on the other hand, treating Obamacare as mostly untouchable could cause Republicans to preemptively concede too much policy ground. Mounting failures of Obamacare could put more of the law in play than seemed possible just a few months ago.

Most likely, the future of Republican health care policy will be sorted out as its presidential candidates begin to lay out their plans during the 2015 primaries. But those candidates will have to adopt policies in an environment that’s largely a product of what happens in 2014.