While Republicans still appear divided over the American Health Care Act, one of the fiercest critics of Obamacare says the GOP plan “is the best they could come up with” and that conservatives need to realize the starting point is a cratering health care system and not a “clean slate.”

Galen Institute President Grace-Marie Turner is also lead author of “Why Obamacare Is Bad for America.”  She says the GOP plan is the best way to use the budget reconciliation process and protect coverage for Americans as major changes hit the health care system.

“The repeal and replace really need to come together because it takes time for the states and the health insurance industry to respond to the new policies that would be offered in the American Health Care Act and to get that up and running,” said Turner.

“You want to create the lifeboat for people to be protected, both those with Medicaid as well as those with [Affordable Care Act] exchange coverage while this new bridge is being built to a new system.  So they’ve got to do both at the same time,” said Turner.

Several members of the conservative House Freedom Caucus say the best approach is to do what lawmakers promised they would do: fully repeal Obamacare and then replace it with a market-based system.  They point to all Republicans supporting full repeal in 2015, when the plan passed Congress but was vetoed by President Obama.

While she wishes Congress could just rip out the old system and start over again, Turner says the current realities must be addressed.

“Conservatives may not like it, but we’re not starting with a clean slate.  We’re starting with Obamacare and we’ve got to figure out how we protect people and then move toward a system that really does give people the kind of choice and more affordable coverage that they’ve been saying for years that they want,” said Turner.

Turner says full repeal also leads to sticky procedural issues in Congress.

“All those you are saying, ‘All we want to do is repeal the law first and worry about replace later’ are not respecting what their constituents are asking.  But also those who say, ‘We want to repeal the whole law,’ are not paying attention to the process,” said Turner.

“The only way they could do this is through the budget reconciliation process that allows 51 votes (to pass legislation), but it doesn’t allow most of the regulations to be repealed in this law.  That’s going to have to come later through other measures,” said Turner.

Republican leaders do plan to use reconciliation for the American Health Care Act, or AHCA.

“The [American Health Care Act], I believe, pushes as far as they could, the limit of what they could get through with reconciliation.  They already are moving the legislation to allow the purchase of health insurance across state lines.  That will pass in a separate measure and I think that you very well may get some Democratic support for that,” said Turner.

She also think Democratic votes might be there to repeal the Independent Payment Advisory Board, or IPAB, which has often been referred to by critics as “death panels.”

Turner also believes time is of the essence since so many other Trump administration priorities are on hold until the work on health care is done.

“They can’t do tax reform, which corporate America in particular is desperate for if we’re going to create jobs and enhance our international competitiveness.  They can’t get to that until they pass this.  They have the debt ceiling coming up and they have the confirmation of a Supreme Court justice coming up.  There are a lot things backed up behind this,” said Turner.

Some Obamacare critics have suggested that letting Obamacare implode for another year will gin up more support for more aggressive action.  Even President Trump has said if the AHCA fails, he plans to blame the floundering health care system on Democrats.

Turner says that is irresponsible because the ongoing exodus of insurance options could leave many people with no choice at all.

“The leadership of Congress are being statesmen here.  Coinservatives may not like it, but they are saying, ‘We have an obligation to people to protect them.  If you waited a year, you would find people in the middle of cancer treatment were losing their coverage because there’s no insurer in their area to provide that coverage.  They can’t wait,” said Turner.

Turner says Republicans have been working on this legislation ever since Rep. Paul Ryan, R-Wisc., became speaker in October 2015.  The effort included exchanges of policy ideas among both lawmakers and policy experts, including Turner, who contributed suggestions both to the AHCA and Speaker Ryan’s “A Better Way” campaign during the 2016 elections.

“I believe this is the best they could come up with.  It’s not perfect.  nobody loves all of it.  I don’t love all of it, but I think it’s the best they could come up with under the circumstances to get this through the House and be able to move on with the rest of the agenda the American people care about, including jobs,” said Turner.