The ACA was considered a Republican-friendly approach to health care prior to it becoming a partisan issue (More or less the same approach was introduced by Romney in Utah). It's not particularly progressive, either in comparison to other countries or past attempts in the U.S., and is only really considered such because it turned into a blue team vs. red team issue.
> The ACA was considered a Republican-friendly approach to health care prior to it becoming a partisan issue
That's...misleading. Sure, the broad outline of a policy like the ACA first emerged as a joint Republican/insurance industry idea for national reform after the failure of the Clinton healthcare plan when it looked like there might still be enough demand for some national reform that they could use a strategy, and yes something broadly similar was pushed successfully by Republican Governor Romney at the state level (in Massachusetts, not Utah.) But even the national Republican party had moved right since then, under Bush, they had toyed with mandatory purchase of specifically HDHP/HSA plans, rather than traditional insurance, before deciding that health reform wasn't something that even needed to be on the agenda at all.)
Something like the ACA as a state-run program had none of the Constitutional problems the ACA has as a federal program. Then again, pretty much every elected American politician only believes in federalism when it suits their agenda.
I think you may also find that what's considered a Republican-friendly compromise in Massachusetts in 2006 - where Romney was actually governor - may be different from where the party of Trump and McConnell find policy to be Republican friendly.
Sorry, I was wrong on the location. I don't think that opposition to the ACA began with Trump though (witness the resistance getting it through in the first place). Republicans opinion of it did a nearly complete 180 almost immediately after Obama started advocating for it - far too short a time for the Republican party ideology to change.
Is it too short a time for Massachusetts Republicans to make different compromises than the national party in federal legislation, though? Let's not pretend that a Republican in Massachusetts, California, Illinois, or New York is in the same situation as a Republican in Alabama. Nor is a Democrat in any mostly red state going to have as much leverage as in Massachusetts.
