This is an archived article that was published on sltrib.com in 2016, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

The Republicans who won the White House and maintained control of Congress have campaigned on a firm — if woefully fuzzy — promise to repeal and replace the Affordable Care Act.

If that is what they really plan to do, now is the time to start getting as specific, and as realistic, as they can about the details. The physical and financial health of millions of Americans, and the ability of the entire health care system to serve them, hangs in the balance.

President-elect Donald Trump has called the ACA, known to friend and foe alike as Obamacare, a disaster, even as he has promised that, "Nobody's going to be dying on the street if I'm president."

But, no matter who is president, the excruciatingly complex details of a future version of American health care will be worked out in Congress.

By senators and representatives who may soon realize that they don't want to be responsible for millions of Americans who had health coverage under President Obama to lose it under President Trump. By Utahns such as Senate Finance Committee Chairman Orrin Hatch, who now lacks the excuse of having a Democrat in the White House to veto whatever ACA alternative he might come up with.

The means to solving this problem are many. The metrics of success are two:

1) The United States must provide the kind of near-universal access to health care that every other civilized nation on Earth has offered its citizens as a birthright for a generation or more.

2) The United States must limit the sometimes astounding growth in the cost of health care, on the way to actually reducing the share of personal, corporate and government spending that goes to keeping us healthy.

Those goals may sound contradictory. But Obamacare has shown significant progress in both areas specifically because it has sought to meld them. Not enough to be called an unqualified success, but far too much to be dismissed as a failure.

Only some kind of centralized payer — whether government or private insurers — has the purchasing power to keep costs down. Individuals making their own choices and paying their own bills, as attractive as that may sound to free-marketers, just don't have the clout to take on a system that — again, unlike all other First World nations — leaves thousands of families bankrupt every year.

Members of Congress may also want to think twice before pulling back on such Obamacare components as the end of being refused insurance due to pre-existing conditions, the ability of young people to be covered by their parents' plans until the age of 26 or other factors that have seen the percentage of uninsured adults in the United States fall to record lows.

Doing away with the much-hated individual mandate will be particularly difficult. A system that can't turn down the sick, but can't count on a flow of premiums from the healthy, is either doomed to failure or requires billions more in government subsidies.

There will likely be a push to turn the whole mess over to the states. That may work in some places but, in Utah, too many of our lawmakers are able to see, in Oscar Wilde's definition of a cynic, the price of everything and the value of nothing.

But the state's major health care institutions — The University of Utah and Intermountain Health Care — are national leaders in efforts to analyze and reduce the cost of health care delivery without harming — sometimes even improving — its quality.

For those efforts to be successful here and applicable to the rest of the nation, the ACA cannot be merely repealed. It must be replaced.

This is what the Republicans wanted. Now, it is time for them to own it.