Just like all the rest of the Republican candidates for the presidency, the Texas senator, Ted Cruz, wants to abolish Obamacare. But as I have pointed out multiple times he and the rest of the GOP has yet to come up with an alternative to covering the 20 million it insures.

Sam Lebovic 
reviewed the Senator’s position and how radical he has been in the past. And we all know how Ted Cruz feels about Obamacare. He’s the guy who shut down the government in a bid to kill it — and should he reach the White House, he will probably take a blowtorch to the law. But Cruz isn’t very clear about what — if anything — he’d do to replace a law covering 20 million people. And some establishment Republicans as well as Independents suggest that he address this head-on before the pivotal New York primaries, where Republican leaders have been more aggressive in fleshing out alternative health plans.

Cruz raised his political profile by defying the Republican establishment to force the government shutdown over Obamacare more than two years ago. We see how he did in the Wisconsin and just recently the Colorado and Wyoming primaries — which may be the party’s best chances to prevent Donald Trump’s nomination — he needs to court voters who’ve elected politicians like House Speaker Paul Ryan, a policy wonk who’s called on his party to offer a replacement plan.

“I think it would benefit [Cruz] as a candidate, period, but especially in Wisconsin,” said Brian Fraley, a Republican strategist who describes himself as a “Never Trump” voter who backed Cruz in the state’s primary. “The insurance industry is big in Wisconsin. The health care industry is big in Wisconsin. This is a race where every brick helps in the foundation.”

Cruz, who in 2013 spent roughly 21 hours straight on the Senate floor voicing his disdain for Obamacare, hasn’t detailed how he’d expand coverage or extend Obamacare’s insurance protections like covering people with pre-existing conditions — protections that remain popular even as the country is split on the health care law.

“As leaders, we have an obligation to put our best ideas forward — no matter the consequences,” Ryan said in a high-profile speech this week. “With so much at stake, the American people deserve a clear picture of what we believe.”

Ryan, who will chair the GOP convention in July, is remaining neutral in the race. But notice that just recently with all the talk of a contentious convention he said that he was nnot interested in being the nominee and would not accept if nominated. Walker plans to endorse a candidate soon and has said Cruz is the only one who could block Trump’s march to the 1,237 delegates needed to secure the nomination. The victory in Wisconsin, which appeared to be a wide-open race, netted Cruz the vast majority of the state’s 42 delegates before a series of contests in Northeastern states where he’s not expected to do well.

Few can claim they’ve gone to the lengths Cruz has to scrap the president’s signature domestic achievement. A landmark moment of Cruz’s brief Senate career came in 2013, when his ill-fated effort to defund the law precipitated the first government shutdown in nearly two decades — and angered establishment Republicans, who accused Cruz of waging an unwinnable fight just to help his own standing with the party’s base.

He’s steered clear of other replacement bills that Republicans have circulated over the years that never gained traction. When a Supreme Court case last year threatened Obamacare’s insurance subsidies, Cruz offered a replacement bill that primarily would have allowed health insurers to sell plans across states lines — an idea long favored by Republicans that hasn’t had any success in limited, real-world practice.

Cruz’s struggle to explain his Obamacare replacement during an Iowa town hall in January produced one of his campaign’s worst moments. A voter who said his late brother-in-law was able to obtain coverage only because of Obamacare pressed Cruz on his health care replacement — but Cruz stuck to his standard anti-Obamacare talking points as the voter fought back tears. “I’m pointing out, there are millions who had health insurance, who liked their health insurance, and who have had it canceled because of Obamacare,” Cruz said in an exchange that was covered widely. “So there are millions of stories on the other Cruz went on to win the Iowa caucuses days later. To be sure, Cruz has discussed boilerplate GOP health care policies in the Senate and on the trail that he says would lower insurance costs and allow more people to purchase coverage without the threat of a federal mandate. In a January debate, he emphasized interstate insurance sales, expanding the use of health savings accounts and allowing people to carry over coverage when they switch jobs. “I think that’s a much more attractive vision for health care than the Washington-driven, top-down Obamacare that is causing so many millions of people to hurt,” he said. Cruz’s campaign did not respond to questions about whether he will present a more detailed Obamacare replacement plan, or who is advising him on health care. It’s unclear how much the ideas he sketched out would cost, or how many people they would cover. “He’s got to articulate not just repeal, but what is the center-right health care system that he’s defining as the future of health care?” said David Winston, a Republican pollster who advises GOP leaders in Congress. “Everyone needs to define what the alternative is. I think it’s incumbent upon all candidates to do that.” Some Obamacare critics who’ve urged Republicans to keep up their fight against Obamacare said Cruz is missing an opportunity to draw a clear distinction between himself and Trump. “One of the defining decisions the rest of the way in the Republican race is whether Cruz decides to put out a full-fledged alternative and really vaults Obamacare to the center of the race,” said Jeffrey Anderson, a senior fellow at the conservative Hudson Institute think tank. “It’s always seemed like it could be his best issue, but by not putting out an alternative he’s been unable to capitalize on it.” Endorsing any specific plan comes with political peril — it offers a bull’s-eye for opponents. The Committee for a Responsible Federal Budget skewered Trump’s high-level health care proposal, a Washington-based think tank that said his plan would add hundreds of billions to the federal deficit and insure a tiny fraction of those covered by Obamacare. And the three Republican candidates who offered detailed Obamacare replacement blueprints — Walker and former Govs. Bobby Jindal and Jeb Bush — failed to gain any traction in the race. The takeaway for the remaining presidential candidates may be that sticking with the Obamacare red meat is better than getting bogged down in specifics. “The safe rhetoric has yet to move beyond repeal and replace for these guys,” said Terry Holt, a Republican strategist who worked for John Kasich when he chaired the House Budget Committee. “Better to keep your powder unless you want to blow up the anti-ACA coalition.”                                                                                                                                            As I have also questioned-what is the chance that Obamacare, the ACA, could ever be repealed?

Bruce Japsen a Forbes staff member, discussed the possibility of dismantling the ACA. In the first week of April a parade of healthcare experts from doctors and policymakers to insurance industry executives and Washington lobbyists are telling the nation’s health journalists this weekend that they don’t believe Republican presidential candidates will make good on promises to dismantle the Affordable Care Act.                                                                                                                               Attendees at the Association of Health Care Journalists annual conference in Cleveland are hearing testimony saying the law, now six years old, has bipartisan support in Congress for several key aspects, including value-based initiatives and the effort to move away from fee-for-service medicine. There’s little, if any, serious discussion among healthcare experts about the “repeal Obamacare” mantra that continues to be floated by Texas Sen. Ted Cruz or reality show host and businessman Donald Trump.  Peter Lee, executive director of California’s health benefit exchange known as “Covered California,” told health journalists Friday that many Republicans outside of the media and political “glare” tell him: “We cannot pull this thing back” in reference to the ACA.

No matter who is elected President, including the hated Ted Cruz, speakers including Lee are telling journalists here that there would no longer be a “personalized lightening rod of Obamacare,” as President Barack Obama’s second term ends in January 2017. That alone will dampen some of the enthusiasm for repealing the ACA once a new chief executive is in the White House.  More broadly, the Congress would still have to approve any changes to the law and gridlock remains in Washington and isn’t expected to go away next year even if the GOP would retain control of the U.S. House and U.S. Senate.                                     Health reforms under the health law are essentially too entrenched and many not part of the Presidential campaign and election year politics such as Medicare and private insurance payment forms under the law.

Marilyn Tavenner, president of America’s Health Insurance Plans, a trade group and lobby representing some of the nation’s largest health insurers including Anthem, Cigna and Humana said she hears from Republicans and Democrats who like accountable care organizations (ACOs). Such relationships are critical as the Affordable Care Act, private insurance companies and self-insured employers increase their contracts with accountable care organizations (ACOs), which group providers of medical care together to care for a population of patients. If the group of providers under the ACO reduces costs over a year’s time, it shares in the savings with the insurance company.

So, once again I repeat that the Republican party get its act in gear and realize what the ACA has brought to the table. The goal was to get more health care for more people. The problem is that the average American voter did not and still does not realize the cost, both financial and effect on their care. There are many things that can and should be done to modify and sustain the ACA, but we all should realize that to continue with a health care system that covers all, especially a larger group of non paying, non taxed part of our population. Bernie Sanders may have more sense than I thought about free health care but his math is extremely flawed and therefore either increases in income taxes, national sales tax, value added taxes or extreme cost containment strategies including delay in care, restriction in surgical procedures and medications, or all and more will be needed.

Be prepared America!