Politically, taking on the Affordable Care Act or not taking it on are both risky. While lots of voters don't understand all that the federal health law does, some of its guidelines delight in broad support. That's especially true of the defenses for people with medical issues under the current law, insurance providers are barred from declining them for coverage or charging them more than individuals without such conditions.

Analysts on both sides expect issues about health costs and health law to play a big role again in 2020. For Republicans, "the threat of doing absolutely nothing potentially leaves no port in a storm if the ACA is reversed legally," Rosen says. "But a more minimal variation, which is what most Republicans are for, is most likely to be met the same issues.

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