In the 2010 election, Republicans framed their response to the passage of President Obama's health care overhaul around two words: repeal and replace. When Republicans retook the House, they immediately staged a mostly symbolic vote to repeal the health law. But replacement has proven a far more difficult task. It's not just the threat of the presidential veto, or the fact that Republicans don't have the votes in the Senate for either a repeal or replacement measure. It's that Republicans still don't know what exactly they want to replace ObamaCare with.

In January, Republican legislators promised that they would have a replacement measure ready by this summer. The idea was to have legislation standing by should the Supreme Court strike down all or part of the health law.

By March, however, the message had changed slightly, and the promise scaled back: Senate Minority Leader Mitch McConnell would only commit to eventual incremental reformism — a series of small steps that would eventually add up to a replacement.

Even that proved a little too ambitious. By this month, Republicans in Congress made it fairly clear to The Hill that no replacement bill would be forthcoming. Staffers had been putting together options for months, but weren't able to create consensus. Getting Republican legislators to agree on any sort of clear legislative alternative apparently proved too difficult.

Instead of substitute legislation, reports The Washington Examiner's Philip Klein, House Budget Committee Chairman Paul Ryan says that Republicans will merely present a "vision" for the kind of health reform they'd prefer. "We do feel obligated to articulate our vision for replace," Rep. Ryan told The Examiner. I'm sure that Ryan, who has arguably been the GOP's most consistent and effective policy entrepreneur for at least the last five years, really does feel that obligation.

Nevertheless, it's telling that two years ObamaCare, the party is still waffling indecisively on exactly what to do about health policy. Part of the reason that Democrats have been relatively successful at passing major health policy legislation is that they have spent a lot of time working on it. But with a few exceptions, that's just not the case for Republicans. Obama was able to campaign effectively on health reform and pass the 2010 law in large part because Republicans had ceded the issue to Democrats following the defeat of President Bill Clinton's attempted health care overhaul in the early 1990s. Democrats, meanwhile, regrouped, and created a aggressive policy infrastructure devoted to exploring both the politics and policy aspects of health care. With the passage of ObamaCare, it finally paid off.

Republicans, meanwhile, have taken the law's passage and subsequent unpopularity mostly as an opportunity for short-term political gain rather than as a call to begin laying out and making the case for their preferred structural reforms. It's nice to see that Ryan is promising to release a set of health care priorities and principles, but it should have happened years ago. And the fact that it didn't is part of the reason why Democrats were able to pass ObamaCare in the first place. As with so many policy areas, Republicans know what they're against, but not what they're for.