At that point, Republicans will face two broad groups of choices (groups because each choice comes in many themes or variations).

The first choice? Try once again to rally the losers from Obamacare into an election-winning coalition.

Obamacare is a highly redistributive social program. Most of the benefits flow to the poorest 20 percent of the population, while costs are widely shared. In this, Obamacare looks much more like America’s unpopular anti-poverty programs than securely popular universal entitlements like Social Security and Medicare. The net losers from Obamacare include wealthier people who must pay higher taxes; older Americans who fear that the costs of Obamacare will jeopardize Medicare; securely employed workers whose insurance is made less generous and more expensive by cross-subsidies; and upper-income state taxpayers who will pay the cost of expanded Medicaid rolls without ever using Medicaid themselves. Together, this coalition represents enough voters to win off-year elections like 2010 and 2014. True, it fell short in 2012. But with some refinement and tinkering—and facing a less compelling Democratic presidential candidate—perhaps it could succeed in 2016.

The second choice is accepting Obamacare as a fact. Republicans would seek to amend those of its features they find most obnoxious by controlling its costs, spreading its benefits, and reforming its financing. Instead of outright repeal, Republicans would allow states more leeway to run their exchanges as they see fit, and free private insurers to impose tougher cost discipline on hospitals and other healthcare providers. This approach would also rely less on costly Medicaid to extend coverage to low-income Americans—and more on cheap clinics for everyday medicine and state-subsidized high-risk pools for critical care. To further trim costs, it might open the medical profession to more competition from nurse practitioners, dental hygienists, and others now restricted by state law from offering equal services at lower prices.

It would also require a new approach to financing the program, junking Obamacare’s ultra-redistributive taxes on work and saving and replacing them with taxes that fall more broadly on the population as a whole. If everybody benefits from a program, everybody should pay. I’d nominate as substitutes a new excise tax on sweeteners; higher taxes on alcohol; very high taxes on marijuana in those states that legalize it; and taxes on carbon emissions as well. (Obesity, drug and alcohol over-use, and car accidents are major drivers of health costs. I’d also personally wish to raise the excise tax on gun and ammunition purchases as well, because of the terrible costs to society of accidents and injuries, but here we’re entering dreamland.)

It might seem almost unimaginable that the GOP could ever adopt this second approach. The party has entrenched itself so deeply and for so long on the “no compromise” battle line. But the party has also shown itself deeply reluctant to deprive voters of benefits they have already begun to receive under Obamacare. It has been unable to develop—much less agree upon—a coherent alternative that would preserve those benefits. As 2016 approaches, it probably would prefer not to make the presidential election a referendum on treatments for cancer patients. The first choice may be the message that wins cheers from party faithful. But what if party professionals become convinced that it’s a choice that will cost them four more years out of the White House? Unwillingly, grudgingly, grumblingly, the second choice will come to seem the only choice there is—as it has been, in reality, all along.

* This post originally stated that it had been less than a year since the Supreme Court upheld the individual mandate. In fact, the ruling was handed down in June 2012. We regret the error.