Well, this is a bit of a problem for House Speaker Paul Ryan.
Trump's "yes" man has a very serious problem here in making those kinds of promises. That's because Republicans are now in all-out warfare over how they're going to do repeal. Not "replace," mind you. They haven’t gotten that far. They’re still stuck on the one part they all agree on: repeal.
The more centrist wing of the party wants to slow the entire process down. They say Republicans need to act deliberately to avoid public panic over millions potentially losing their insurance. The party, they argue, needs to put forward a replacement plan—or at least as much of one that can pass using a special, majority-vote mechanism—before it ditches the law. Forget the 2015 repeal bill that Barack Obama vetoed, they add: It's not relevant now that Republicans own the problem.
“It’s not realistic,” said Sen. Jeff Flake (R-Ariz.) of the 2015 bill. “The imperative is to do it right and I don’t think that does it right. I don’t think you’ll find much currency for that approach in the Senate.”
Conservatives are in a different place entirely.
Senate hard-liners are joining with the House Freedom Caucus and some top Republican Study Committee members to demand a back-to-basics approach: Kill the law now, even if there's no clear picture of what replaces it. On Monday evening the Freedom Caucus made the risky decision to return to pushing the 2015 repeal bill, arguing that it’s already proven it can win majorities in both chambers and clear the Senate’s parliamentary hurdles.
"I think to suggest we could pass it in 2015 but it's more difficult to do it in 2017 makes for a very difficult argument for anyone as to why they changed their position and were willing to vote for it then but not now,” Freedom Caucus Chairman Mark Meadows (R-N.C.) said during a briefing with reporters.
On the Senate side, Kentucky Sen. Rand Paul says he counts five Republicans who agree with the House maniacs. That might be an exaggeration on his part, but he's got at least Utah Sen. Mike Lee and Texas Sen. Ted Cruz (of course) with him. McConnell can't afford to lose even two Republican votes, and he's going to get no help from Democrats.
Another bunch of senators—Politico counts four of them—is pushing hard for Medicaid expansion to stay in place for at least a few years. And another handful wants to make sure that the most popular protections—"allowing people on Obamacare insurance plans to keep them indefinitely until there's a new law; continuing to bar insurers from denying coverage because of pre-existing conditions; and allowing young adults to stay on their parents’ plans until age 26"—remain in effect until there's a replacement plan.
Or forever. Whichever comes first.