The problem is that the only way to provide better, less expensive care for everyone that improves on the ACA is the universal, government-backed insurance offered by nearly every other developed country in the world. Allowing insurers to sell across state lines would create a regulatory race-to-the-bottom and do almost nothing to lower costs. Most Americans have so little in savings they can't retire or put their kids through college, much less cover $500,000 of cancer treatments through an HSA. And covering people with pre-existing conditions through market processes requires a mandate to make it work.

Republicans know all of this. They know it because the ACA is actually the conservative, market-based alternative to single-payer. It was essentially was the Heritage Foundation's alternative to Hillary Clinton's 1993 healthcare plan. It became the basis of Romneycare, the plan backed and enacted by the 2012 Republican nominee for president. It's the Republican alternative to single-payer.