Obamacare is less and less of a political issue in the 2014 campaign, even as outside groups continue to focus on it in their ads.
The ad also plays up Tillis's work in the state House -- more specifically, on insurance reform for families of kids with autism -- as evidence of the kinds of reforms he would push.
The ad is at once a recognition that Tillis's image needs some help, but also that merely repealing Obamacare might not be the best move -- even in a state Mitt Romney carried in 2012.
Polls have long shown people preferred keeping the law and/or reforming it to repealing it. But the resonance of the "repeal" message was huge in the GOP base and big during the primary season. And indeed, as the general election has progressed though, "repeal" hasn't really been a watchword on the campaign trail.
This suggests at least one group sees the "replace" message -- which the group also used in an earlier pro-Tillis ad -- as more appealing to middle-of-the-road voters, and particularly the kinds of suburban women that Tillis needs to win over.