The Patient Protection and Affordable Care Act inspired the usual red-meat rhetoric at the Conservative Political Action Conference just outside Washington on Thursday.

Sen. John Barrasso, R-Wyo., described it as a “national nightmare.” Amy Frederick, president of the 60 Plus Association, a conservative senior advocacy group, declared that the law's “DNA is imprinted with lies.” Rep. Marsha Blackburn, R-Tenn., vowed to put a “death nail in Obamacare.”

But even the name of the panel at the flagship gathering of conservative activists — “The Conservative Replacement to Obamacare" — suggested a realization that simply vowing to abolish the landmark health care law is no longer sufficient.

“This is a huge issue in our politics and our policy discussions,” said James Capretta, a health care policy expert at the conservative American Enterprise Institute. “It's absolutely imperative that we move forward with an alternative vision.”

The specter of the U.S. Supreme Court's decision in King v. Burwell, which could strike down premium subsidies in 34 states that haven't established their own insurance marketplaces, loomed over the session. Oral arguments in the case will take place next week, and a decision is expected by the end of June. At issue is whether the Obama administration exceeded its authority by allowing subsidies to be accessed nationwide.

“The court could strike down this illegal power grab,” Sen. Barrasso said. “If that happens, we know President Obama will launch an aggressive campaign to bully Congress into ratifying his actions. Conservatives in Congress will offer a better solution.”

Rep. Blackburn offered a similar assessment. “King v. Burwell and the aftermath of that is going to give us an excellent opportunity to expand this conversation,” she said.

But Republicans have so far failed to rally behind a coherent vision for replacing the landmark health care law. That's undoubtedly in part because simply trashing the ACA is easier than offering a plausible policy alternative.

Mr. Capretta pointed to three proposals that could serve as blueprints for conservatives to rally around either in the aftermath of a King v. Burwell ruling or during the 2016 presidential contest. Those include a plan put forth last month by Sens. Orrin Hatch, R-Utah, chairman of the Finance Committee, and Richard Burr, R-N.C., and Rep. Fred Upton, R-Mich., chairman of the Energy and Commerce Committee.

Mr. Capretta argued that any credible conservative alternative must address two issues: ensuring individuals with pre-existing conditions have access to coverage and providing financial support to the poorest Americans. “Those are the most important elements for a sensible replacement program,” Mr. Capretta said.

Paul Demko writes for Modern Healthcare, a sister publication of Business Insurance.