By 2017 – the earliest the GOP could theoretically control both houses of Congress and the presidency – an estimated 36 million Americans will be purchasing health care insurance through either a state or federal ObamaCare exchange.

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When it comes to ObamaCare, should Republicans repeal or reform it?

As a conservative, the answer depends on whether you think there is anything in the law worth saving.

Because ObamaCare was passed on a party-line vote and seems like an effort to kick-start the march toward a single-payer, nationalized health care system, most Republicans favor complete repeal.

Sensing a political opportunity, GOP lawmakers have vowed to “Repeal and Replace” ObamaCare with a more patient-centric, free market alternative.

So far, the Republican-controlled U.S. House of Representatives has made good on its repeal promise. Since the party’s victory in 2010, the House has voted 54 times to repeal all or part of ObamaCare. Most of those votes have died in the Democrat-controlled Senate, but a few – like repealing the costly CLASS Act – have made it into law.

The “Repeal and Replace” slogan speaks to the conservative conviction that the only way to get the right kind of health care reform is to rip out ObamaCare by the roots and start over.

Despite sparse coverage in the mainstream media, conservatives in and outside Congress have proposed comprehensive ObamaCare alternatives that aim to increase the number of American citizens covered by health insurance, decrease barriers to access and reduce costs.

ObamaCare alternatives inside Congress include H.R. 3121, “The American Health Care Reform Act,” introduced by Rep. Phil Roe (R-TN) and authored by the conservative Republican Study Committee. As for think tank proposals, Steve Capretta of the American Enterprise Institute has developed an intriguing plan.

To date, however, conservative ObamaCare alternatives assume full repeal of the health law because that’s the strategy uniting the party.

But what if there’s something worth saving in ObamaCare after all?

That’s the proposition defended by Avik Roy of the Manhattan Institute in a proposal that would reform ObamaCare instead of repealing it.

Essentially, Roy wants to keep the exchanges and the subsidies that help low-income users pay for health insurance, but he wants to “emancipate” them from federal oversight. To do this he would let states regain the power to regulate the content of insurance plans. He would also expand eligibility to participate in the exchanges to current Medicaid recipients and future Medicare enrollees. Roy’s idea is to migrate all federally funded health care beneficiaries onto state-regulated exchanges, but without any of ObamaCare’s mandates or taxes (he gets rid of them all except the “Cadillac tax”). Instead of coercion via the IRS, Roy ties eligibility for subsidies to participation on an exchange.

The upshot of Roy’s plan is that it revitalizes federalism by giving states more say on health policy. It also reduces federal health outlays because it caps per person spending, and limits eligibility for premium support subsidies to those with the most need. Those reductions will eventually eliminate the deficit for either the federal budget or Medicare, whichever lawmakers decide is more important. Finally, Roy’s plan gets the government out of the health care business by putting all its beneficiaries into exchanges where private medical providers compete for customers.

Critics of Roy’s plan note that its most glaring weakness is that it expands ObamaCare’s exchanges to become a one-size-fits-all government health program. Run the clock forward a few years and perhaps a creative – and very liberal – Congress and president find a way to turn 50 state government-run marketplaces into a federally controlled system. By leaving ObamaCare’s exchanges in place and steering all public beneficiaries into the same program, doesn’t Roy’s plan increase the risk of leading to an eventual single-payer system?

Roy doesn’t address that criticism directly in his proposal, but he does focus on a political reality. By 2017 – the earliest the GOP could theoretically control both houses of Congress and the presidency – an estimated 36 million Americans will be purchasing health care insurance through either a state or federal ObamaCare exchange. Pulling the plug on the system would cause major coverage disruptions for that population, likely creating a huge political headache for Republicans similar to the one experienced by Democrats when millions lost coverage and were forced onto the exchanges.

Even if Republicans have the votes, would they really jeopardize popular support for an ObamaCare alternative that – as Roy claims – would work equally well if the hated law is repealed or reformed? Why not just pick the path of least disruption and get all the benefits of a health care policy that actually works?

Conservatives shouldn’t be quick to embrace Roy’s plan, but neither should they discard it without deliberation. If the GOP manages to earn control of Congress and the White House in 2017, it will likely have only one chance to get health reform right. Carefully considering how to transition from ObamaCare to something better requires that all options be on the table.