Conservatives are up in arms over Mitt Romney's selection of Mike Leavitt as his transition chief because they think he is not sufficiently against Barack Obama's healthcare reform.

Talking Points Memo notes Leavitt has worked to convince states to implement the healthcare exchanges included in the law, and his private consulting firm has worked toward that end. That has a number of conservatives skeptical of his convictions, despite his on-the-record statements than the healthcare reform law should be repealed.

In a July meeting with a bipartisan group of governors, he called exchanges “a very practical solution to a problem that needs to be solved” and warned that ignoring the law’s requirement amounted to cutting off their own noses. The ACA empowers the federal government to step in and implement exchanges if intransigent states refuse, which means bucking the law only gives the federal government more power.

Leavitt’s pragmatism about exchanges is a deal breaker for the right. But pair it with some of Leavitt’s other public statements about the ACA, and it’s not clear why it should be — at least not if you step back and survey the entire spectrum of market-based reforms that Republicans, for the most part, continue to support.

There’s obviously tension between that view and his financial and ideological interest in seeing states set up exchanges. But a state exchange system wouldn’t necessarily have to serve as the foundation for a universal health care system like the one Obama envisions.

Leavitt has hinted at this endgame for a long time now. In an August 2010 Washington Post op-ed, he attacked the ACA’s Medicare reforms as illusory, arguing, “What’s needed is a new vision for Medicare. Instead of micromanaging prices, the federal government should provide oversight of a marketplace in which cost-conscious seniors choose among competing insurance and delivery system options.”