President Donald Trump’s address to a joint session of Congress was a powerful moment in his young presidency. Political analysts Left and Right praised Trump for his performance. Chris Wallace of Fox News reacted to the speech by saying, “Tonight, Donald Trump became president of the United States.” In the speech, Trump addressed a range of issues from education to immigration to health care.

There is no doubt that the president emerged from the speech with gravitas and purpose. And while conservatives were largely pleased with Trump’s performance, serious questions have emerged regarding how the president and Republicans in Congress will deal with one of the key objectives highlighted in the address: repealing and replacing ObamaCare.

Many conservatives hope that a free-market health care system can be devised in which government plays no role. Unfortunately, this is mostly wishful thinking. Since Hillary Clinton tried to make health care an entitlement in 1993, Democrats have dominated the discussion and set the terms of the debate.

Interestingly, it really wasn’t Republican opposition that brought down HillaryCare as much as a popular advertising blitz by health insurance lobbyists featuring “Harry and Louise” as two concerned citizens trying to grapple with the mountain of bureaucracy and limited choices. Even many Democrats opposed the plan.

Once HillaryCare was out of the way, Republicans should have pounced on the opportunity to control the narrative. Unwilling or unable to come up with their own ideas, Republicans allowed Democrats to control the debate for another 20 years.

And now, given the full implementation of ObamaCare, we may be at a point of no return. Thanks to Democrats, and to the failure of Republicans, millions of Americans are now conditioned to believe that government-provided health care is an entitlement.

Consequently, Republicans must operate within this mindset. They can limit the extent of government’s role through legislation, but it’s perfectly evident that any suggestion of a truly free-market system will be mischaracterized by the press and demonized by Democrats. This usually sends Republicans running away in fear.

Once again, Republicans are left to tinker with the progressive machine rather than smashing it or at least keeping it from growing. Other than Sen. Rand Paul’s ObamaCare Replacement Act, no other plan comes close to removing entitlement characteristics from health care or minimizing the federal government’s connection to health insurance.

With little support on Capitol Hill for a complete repeal, Republicans may have to devise a plan that addresses the concerns of those who now think it’s the responsibility of Congress to provide health care. This means government will have its hand in whatever replaces ObamaCare. And no matter what plan is eventually agreed upon, the Republican stamp will be on it.

Two of the components that just about every Republican-proposed plan currently offers are a repeal of both the health insurance mandate and essential benefit coverage. Otherwise, there is less of a consensus on how to provide coverage and how to pay for it.

A few ideas in the works are tax deductions, tax credits, and health savings accounts. These are free-market ideas, but the key is going to be helping those in lower income brackets who are more likely to need assistance (and are more likely to oppose efforts for a complete repeal of ObamaCare.)

Some Republican lawmakers, including Senators Ted Cruz, Mike Lee and Rand Paul, oppose more progressive alternatives to the current system. They believe any plan should repeal key components of ObamaCare, such as greater funding for Medicaid, individual and employer mandates, exchange subsidies, and more than a dozen taxes.

Republicans arguably lost their chance long ago to ensure a truly free-market health system, so the new plan must include everyone. This doesn’t mean we have to enact ObamaCare Lite, and we should push our elected leaders to minimize government’s role in the replacement plan. But there’s a political reality that must be considered: Millions of Americans will not — cannot — accept repealing ObamaCare without a replacement. The good news is there are plenty of free-market health care proposals floating around.

A growing number of conservatives are concerned, however, as there is more of an emphasis right now to replace ObamaCare than to repeal it. Republicans ran away from the health care debate for years, even when they had the power to make a difference. What will they do now, with the ball firmly in their hands?