I don't know, except to say that national health policy has become a political football. I don't think there's an ideological reason for the decisions Congress has made; the system we have now was the Republican's proposed system in the 1990s (and was even a policy plank the the 1996 Republican Platform).

It's very easy to explain Republican opposition to the ACA. The 2016 election has made it clear that the GOP is motivated not by outcomes, not even by ideology (the current GOP, driven as it is by one person, has no coherent ideology), but by tribalism. Obama was and still is considered an enemy who cannot be allowed to score a victory at any cost, and so Republicans had to oppose the ACA.

I know that this take is likely to be viewed as extremely uncharitable to Republicans, but there really is no other logical way I can see to explain the party's anti-ACA plank.

(I think it's actually quite counterproductive to the conservative movement, because by abandoning ideology in favor of naked partisanship the GOP has guaranteed that Democrats will never give them a seat at the table when health care reform comes up again while Dems are in power. As a liberal, I couldn't care less, of course, but I can't help but note the irony...)

That's an argument I'm familiar with and sympathetic to, but not something I'd necessarily argue in mixed company, which is what I think of HN as. I don't understand the current coherent argument the GOP has regarding health care but I'm open to there being an ostensible argument and would only ask that Republicans recognize that whatever the new argument is, it's distinct from the original argument, which is that we should have a system that looks basically exactly like the ACA.

This is what I don't understand either. I understand the desire to cut medicaid to reduce taxes and the size of government argument. But weren't there free market incentives they could have done as well?

Here's one: tax cuts to insurance companies based upon the number of people they insure over time, to help offset the cost of insuring sick people.

This seems like a no-brainer republican solution, which probably would have gotten a fair number of democrats on board.