After President Obama signed the Affordable Care Act, conservative writer David Frum, who had been a speechwriter for George W. Bush, chided his compatriots for the strategy they had employed in opposing it. Had they worked with Obama on a compromise, he argued, the result could have been a more conservative version of the law; by simply opposing it in its entirety, they wound up with nothing once the law passed. For raising this criticism, Frum was declared a traitor and banished from the conservative movement; these days his (still conservative) ideas get a better hearing on the left than the right.
And what has been the Republican strategy on health-care reform since the ACA's passage? Well, first they tried to kill it through the courts. That didn't work, though they won for Republican governors the right to refuse the Medicaid dollars that would enable them to offer insurance to their states' poor (congrats on that), though many of them are coming around to accept the money. In the one house of Congress they control, they've held dozens of symbolic repeal votes, so many that it's become a national joke. They're now threatening to shut down the government (very bad) or default on America's debts (even worse) unless Obama agrees to shut the law down, a plan even many within their own party realize is insane. So they've ended up looking like petulant children who don't know when they've lost, not to mention viciously cruel ideologues who would literally rather see people go without health insurance than allow them to get it through a system tainted in any way by contact with a law with Barack Obama's signature on it.
So once again, they're not getting what they want substantively, and they're losing politically as well. Even Newt Gingrich—Newt Gingrich!—is criticizing them for not bothering to come up with the "replace" part of "repeal and replace." Why didn't they? It's partly because, as I've argued before, the whole topic of health-care reform is something they just don't care about. But Ed Kilgore adds an important insight: their stance of opposition to every single component of what is a pretty conservative reform plan not only left them defending the status quo, but has pushed them step by step so far to the right that they've now reached a point where they've almost rejected the very idea of insurance. They're attacking Obamacare on the grounds that healthy people will have to buy insurance, but might not use it as much as sick people, even going so far as to encourage young people to stay uninsured. But that's how insurance works! Is it a "bad deal" for many healthy young people? Absolutely, just like car insurance is a bad deal for people who never get into an accident, and homeowner's insurance is a bad deal for people whose houses never burn down. You don't have to be a health-care wonk to hear them saying these things and say, "Geez, these people are nuts."
The real problem is that, as usually happens in a complex political world, the Republican "strategy" to oppose Obamacare was no strategy at all. It was a bunch of ad-hoc decisions, based on a mixture of reason, ill-informed judgment and emotion, made by people not necessarily working together, over an extended period of time. And now it's falling apart.