What is different about Republican calls for repeal today — as opposed to calls for repeal from 2010 to the end of 2013 — is that Obamacare is now in place. It exists. Exchanges are running — many of them badly, but running. Subsidies are being paid. Insurance companies have changed the way they do business. Medicaid has been expanded. Special taxes are being collected.

Even though the system is new, millions of Americans have gone to a lot of trouble to adjust to it, and it would be disruptive to them to just stop cold. Halt subsidies? Undo Medicaid expansion? Just as last fall, when millions of Americans received coverage cancellation notices, millions more would face new burdens under the repeal of Obamacare.

“Rolling key provisions of the Affordable Care Act back would only create a new set of offended parties who would want to keep the insurance they have,” health care analyst Robert Laszewski wrote recently. “Have you heard the one about, ‘If you like your health insurance, you can keep it’?”