That dynamic, if it continues in the next Congress, might mean that efforts to reform the ACA could face their toughest opposition from the right, not from Democrats whose own fellow party member, Obama, got the law passed.
"We have a climate right now where even a rational, conservative approach can't get votes," Laszewski said. "You'd have to have a different kind of leadership, you'd have to have the kind of leadership that would stand up to the right wing of the Republican Party ... some leadership to say, 'We've got to cut this out, and we need to govern.'"
Laszewksi believes there is a third option beyond repeal and replace by Congress, an option that is much easier for a Republican president to pursue once elected.
He said that much of Obamacare can be changed through regulations, as opposed to legislation.
For instance, a Republican administration could grant waivers to states that would give them much more control over Medicaid, allowing them to do things such as requiring people to have a job if they receive benefits, and requiring enrollees to pay at least some premium for their coverage, Laszewski said.
And a Republican president could address concerns that individual insurance plans under Obamacare remain too expensive by loosening regulations on insurance companies, allowing the monthly premium prices on lower-value plans to come down to a level that would make them more affordable to many people who remain uninsured, he said.