The best they can hope for is to be able to change the law in a way that’s more amenable to conservative ideals, as Frum was counseling them to do four years ago. What changed on Jan. 1 is that the “repeal” crowd became obsolete. The new coin of the realm for conservatives is coming up with a viable-seeming alternative to Obamacare that allows for the reality that Republicans are never going to strip millions of people of their health insurance. That’s what matters now.

Ironically, this is harder than ever for most Republicans to see, because the short-term effect of the law has been terrible for Democrats, and for Obama in particular, owing mainly to the debacle of the federal exchange website rollout, but also to ongoing problems of cost and narrower provider networks. The likelihood that Obamacare’s woes boost the odds that Republicans can win back the Senate in November will only add to the difficulty of accepting how much things changed on Jan. 1. But they have changed, so Republicans must pass through what the Washington Post’s Greg Sargent calls the “stages of Obamacare acceptance.” Unless and until they coalesce around an alternative, Obamacare is secure from their attacks.