The challenges Republicans have faced in repealing Obamacare have been long and legion, beginning with the basic fact that they are incapable of creating a plan that covers as many people. They've faced massive dissension within their own ranks. They've faced the fact that they can't pay for some of the things they have thought up because they won't raise taxes. Now they face maybe the biggest challenge of all: popular vote loser Donald Trump.
Whether the White House can repeal and replace the law this spring—as Capitol Hill leaders say is the goal—largely depends on the president's ability to focus and outline the specifics of what he would like, while convincing reluctant GOP members to back a plan. So far, his rhetoric has been all over the place, offering differing timelines and ideas, depending on the venue and the person he's speaking with.
"Nobody knew that health care could be so complicated," Trump said Monday morning. He added to the GOP's nervousness by refreshing the idea that Republicans should maybe just let Obamacare collapse under the weight of rising premiums and volatile exchanges—though he claimed it wasn't an idea he would pursue.
"Let it be a disaster, because we can blame that on the Dems that are in our room—and we can blame that on the Democrats and President Obama," Trump told Republican governors. "But we have to do what's right, because Obamacare is a failed disaster." […]
He has seemed, at times, to not understand the intricacies of policy, according to friends, associates and others who have spoken with him, while at other times asking sharp questions. These people say Trump is acutely attuned to the potential for political damage and wants to be careful—and make sure Democrats are blamed if there is any fallout. Trump, who decries polls as "fake news," also closely follows them and has noticed the law's popularity ticking up.
The "let it be a disaster" thing could actually be emerging as a real option, because with avowed Obamacare hater Tom Price installed as secretary of Health and Human Services, Trump's administration is in a position to severely undercut the law.
They've already created enough disruption that health insurers—who have to decide very soon whether they're going to be participating in the 2018 plan year—are feeling the chaos. The part of the equation that Trump can't make happen, though, is having the blame fall on Democrats and President Obama. That ship sailed the minute Republicans gained the House, Senate, and White House.
But House Republicans feel the pressure from their base to follow through on the repeal promise, and are hoping that Trump will let them lead the way even though they really don't have that replacement part figured out. The dismantling part—making themselves hugely unpopular and in a position to take all the blame—that part is nailed down. The replacing part, not so much. Meanwhile, Ryan is doing his level best to get the word out that he's got this, he's in control. That will last until the next time Trump opens his mouth.