Eleven days before Donald Trump took office, I wrote a column with the slightly hedged but still hyperbolic headline “Obamacare Repeal Might Have Just Died Tonight.” While the “might” was doing a lot of work, my argument was that the GOP’s clearest and easiest path for repealing Obamacare had fallen short, which would force Republicans to attempt to forge a vastly more difficult path. That is what has happened since, and that is why the cause of repeal has been dying a slow and painful death. John Boehner — Who repeatedly led his party to election victories on the promise that they would repeal Obamacare! — has now admitted repeal is “not going to happen” and “most of the framework of the Affordable Care Act” would remain in place.

Let’s back up and go through how this has happened. As soon as the immediate aftermath of the election, it could be seen that “repeal and delay” gave Republicans the easiest method for destroying Obamacare. The attraction of repeal and delay is that it did not require Republicans to cobble together majorities in both chambers to support any particular alternative plan, which — despite repeated promises and assurances of imminent success — they had failed to do since the legislative debate on health care began in 2009. Repeal and delay merely required finding 218 House Republicans and 50 senators to defund Obamacare on the premise that something, to be determined later, would be better.

But several Republicans expressed reservations about repealing the law without having any clarity about its replacement, if any. By January 9, repeal-and-delay had enough opponents — Republicans could only afford to lose two votes in the Senate — that the party’s leaders would have to scrap the plan, which they did.

The Republicans’ new strategy is to stage a single vote that would repeal Obamacare and simultaneously put replacement measures in place. A group linked to Mitch McConnell is trying to whip up support for this by circulating polling showing that just 17 percent of the public supports repealing Obamacare without an immediate replacement plan. What’s important about this is not the polling result itself — independent pollsters found the same thing since well before the inauguration — but the fact that Republican leaders are now emphasizing it, rather than pretending it’s not true.

Their professed hope is that the replacement plan will give Republican members of Congress something positive to offer in the wake of killing Obamacare. The trouble for them is that attaching a replacement bill to a repeal bill makes the vote much, much harder. Now that their best chance to repeal the law is gone, the remaining options are all fairly desperate.

–Jonathan Chait
Trump’s Health-Care Nightmare Is Only Just Beginning