With a few short social-media posts, Donald Trump revived the dormant debate over repealing Obamacare. Trump posted that he was “seriously looking for alternatives” and said, “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!” And he vowed that were he to return to power, “America will have one of the best Healthcare Plans anywhere in the world.“

We’ve seen this movie before.

In the four election cycles between the law’s passage in 2010 and Trump’s 2016 victory, Republicans ran on repealing and replacing Obamacare. But when finally given full control of Washington, they failed to deliver. Before taking office, Trump boasted that he would secure health insurance for everybody that was “much less expensive and much better,” without an actual plan to do so. Essentially, he deferred to Congress to work out the details. While his short attention span, erratic leadership style, and lack of interest in the mechanics of policy may have hindered the repeal effort, ultimately, he would have signed anything. Republicans had been talking about repeal even before Trump had entered politics, so they should have been much better prepared. They should now act on the lessons from that failure.

Given current polling, it’s quite likely that Trump will be the nominee and quite possible that he will become president again. Were that to happen, Republicans cannot be caught flat-footed once again on the issue of health care. They need to use the coming year to hash out whatever differences there are within the caucus and lay out a vision that could be unifying in the event that they take power.

While some parts of Obamacare were scaled back during the Trump presidency — most dramatically, the individual mandate was neutered by zeroing out the penalties for noncompliance — much of the program’s spending and its web of regulations remain in place. In 2017, Republicans balked at the idea of clawing back the law’s Medicaid expansion and its insurance subsidies, and it’s doubtful that they would have the stomach to do so in 2025, after these policies have been in effect for more than a decade. This is especially true given the party’s ideological shift. The Republican majorities in 2017 were dominated by members who had been elected by the Tea Party wave that was spurred by the Obamacare fight, but in the current Congress, populist members are much more comfortable with social spending.

With Obamacare now entrenched, it would be inapt to frame the conversation in terms of root-and-branch “repeal.” Instead, Republicans should seek a health-care system that is more decentralized, patient-centered, and efficient — and be willing to undo aspects of the health-care law that get in the way of achieving this. Obamacare herded millions of people into Medicaid, and imposed rules on insurance that made it unaffordable for those who don’t qualify for subsidies. A better system would leave more room for market innovation and provide more coverage choices, especially for younger and relatively healthier individuals who don’t require policies that are as comprehensive.

The fact that 3 million Americans enrolled in cheaper and less comprehensive short-term plans that were allowed by the Trump administration (before being restricted by the Biden administration) demonstrates that Americans want more choices than those offered to them by Obamacare. Republicans should look at a permanent legislative approach to allowing plans that don’t force individuals to pay for expensive plans with more benefits than they need. Republicans could also build on the successes of Medicare Advantage plans (which are now chosen by more than four in ten Medicare enrollees). And Republicans should make health-savings accounts larger, and allow individuals to use the funds to pay for insurance premiums rather than restricting them to medical expenses only.

Heading into an election year with divided government, Republicans realistically won’t be able to enact health care or any other major legislation in 2024. So that’s why it’s the perfect time to get more serious about policy and prepare for the possibility of the party regaining power. As they learned in 2017, the legislative window can close quickly.

While it may be tempting for Republicans to just quietly accept the status quo rather than engage in complicated policy work with no immediate payoff, that’s a recipe for Democrats to simply expand the government role in health care even further, as we’ve seen time and again. After Hillarycare failed, Democrats licked their wounds, learned their lessons, and regrouped for their next opportunity to push for a national health-care program, which culminated with Obamacare. Leaving Obamacare mostly intact when Republicans had a chance to repeal and replace it provided President Biden with the opportunity to expand the subsidies within Obamacare, at least temporarily — and now Democrats want to make that temporary expansion permanent.

So sitting on their heels doesn’t mean preserving the health-care status quo. Instead, Democrats will continue to blame excessive reliance on markets for the escalating prices and industry consolidation that has been caused by Obamacare’s regulations. That will be the opening to further expand the law as they gain more power, with the eventual goal of a socialized health-insurance system.

To prevent this outcome, Republicans need to get to work.