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Republicans are committed to repealing and replacing President Obama’s health care law, but one of the law’s fiercest critics warned that overhauling such a huge part of the economy will take time and might be a bit messy but will hopefully show clear results within two years by taking the federal government largely out of the health care business.

Galen Institute President Grace-Marie Turner says President Trump and congressional leaders are smart to make repeal and replacement of the Affordable Care Act the top priority out of the gate in 2017.

“The individual mandate, the employer mandate, the taxes, the Medicaid expansion all are on the table for repeal.  They’re going to provide a safety net.  If you’re on Obamacare now, you’ll be able to continue to keep your coverage for at least two years.  After that, they’re building the bridge so that people will have better options for going forward,” said Turner.

This week, Republican Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, introduced a bill that would give the states the option of keeping the current system in place if those states’ leaders felt it was best for their citizens.

Turner says any truly effective plan would only allow the states to keep Obamacare as a transition for a couple of years.

“This whole law is not working.  It’s like a house of cards.  Once some parts of it start to fall, others do as well.  But the money can continue to flow.  That’s really the main thing states want.  ‘Can you give us some money our citizens are getting through the exchanges for their subsidies and for Medicaid,” said Turner.

However, she says states may have the long term option of keeping their own exchanges in operation.

“Some of the states that have existing exchanges that they have set up may continue to use that exchange.  Others may decide to do private exchanges.  Others may set up a new kind of, much more flexible exchange state exchange to give people the opportunity to buy plans that are a lot more flexible,” said Turner.

She says removing power from Washington and sending it back to the states has to be a bedrock of any reform.

“It has not worked for the federal government to tell citizens of Manhattan they have to buy exactly the same coverage as somebody in rural Montana.  That doesn’t work.  You’ve got to have more flexibility where the states decide what kind of policies to approve that meet the needs of the citizens and the resources of the state,” said Turner.

“So the states will have a lot of leeway to use these new resources, meet goals, but not have to jump through all of these tens of thousands of pages of Obamacare regulatory hoops and instead thinking what’s the best way to solve this problem,” said Turner.

The Affordable Care Act was passed in March of 2010 but did not begin implementation until the disastrous healthcare.gov roll-out in October 2013.  Turner says patience will be a virtue as Congress and the Trump administration try to turn this ship around.

“There’s a long lead time.  The plans have to figure out what the states are saying are the parameters.  You know, what’s considered insurance.  Then they have to design their policies.  Then they have to go back for approval.  Then they have to start marketing them out.  That can actually be an 18-month or even a two-year process,” said Turner.

Turner says hopes for much lower premiums heading into the next coverage period are not well-placed.

“They’re just not going to see any relief this year.  I think that will be very hard.  But they’re trying to see what they could do to speed this process up so the people have better options in 2018 at least, certainly 2019,” said Turner.

Given that Washington would have a much smaller role, Turner is confident the new policies and increased options will be available to consumers much more quickly than Obamacare was launched.

And she says the politicians can read the calendar too.

“The replace part is going to rely on markets and rely on states and make sure that people are covered in the meantime.  So I don’t have that crystal ball.  I wish I did, but I know that they are very motivated to show results before the 2018 elections,” said Turner.

Turner is optimistic that the states and the marketplace can turn things around.  She says the creation of Health Savings Accounts in 2003 were available to consumers within weeks.

“That legislation passed in early November in 2003.  On January 1, 2004, less than two months later, the first Health Savings Account was sold.  That’s how quickly the market can turn around if you’re giving them new flexibility, new freedom and the ability to turn around and sell something that people actually want to buy,” said Turner.