Too many Republicans have also endorsed the ACA protections for those with pre-existing conditions while eliminating the mandates to get a plan that will get a score from the Congressional Budget Office that will satisfy moderates. The way the health insurance market works, a mandate is necessary to keep everything functional if the government is prohibiting discrimination based on pre-existing conditions. Otherwise, healthy people can just wait to buy insurance until they truly need it.

There are ways around these complications, but only if Republicans can muster sixty votes. Conservative policy thinkers have for years been designing health policy plans that could protect pre-existing conditions, foster lower costs, and insure more people. But these plans would radically redesign our healthcare system; they are not budgetary tweaks that could pass through the reconciliation process.