“Obamacare is the law of the land,” Roy told me in a phone conversation on Wednesday, defending his position. “It has been for four years and will be at least for seven years [assuming it can’t be repealed until 2017, after Obama leaves office]. So, my view has always been that we have to, on the conservative side, contend with that. I don’t see that as a concession. I see that as the real world.”

His plan reforms and deregulates the insurance exchanges at the heart of Obamacare, and then, over time, relies on the exchanges to cover Medicare and Medicaid beneficiaries — creating what he refers to as “universal exchanges.”

Roy argues that his vision for a reformed insurance exchange will help bring down premiums relative to Obamacare. To that end, his plan would return more power to the states, reduce the number of benefits that insurers are forced to provide, and allow insurers to charge older Americans more for insurance — meaning a lighter burden would be placed on younger Americans. In addition, he would scrap a health insurance tax, subsidize health savings accounts and encourage higher-deductible plans.