“In the end, avoiding grants with significant policy strings attached, while important, is only part of the task for state lawmakers opposed to Obamacare. They should also be pursuing their own agenda of patient-centered, market-based reforms that will constitute the “replace” part of “repeal and replace.” Given that the political, judicial, and logistical impediments to implementing Obamacare are actually increasing over time, those alternatives might be needed sooner than anyone expected.”