The GOP problem on Obamacare repeal has always been that b/c they savagely opposed Obamacare and the individual mandate, and everything to the left of that, they left themselves no political room to deliver results on health care, at all.
By opposing the ACA they removed these options from the table:
By opposing subsidies based on income, they made it impossible to help spread the flat cost of health care over an unequal income distribution. This means, any plan they come up with leaves some less wealthy people uncovered, or skimpily covered. Period.
By opposing the individual mandate, they made it impossible for private insurance to offer lower premiums, lower deductibles, and lower co-pays compared to Obamacare. Without the individual mandate, insurers have to price in the risk that only the sick will sign up, and without spreading the risk pool to the healthy, the sick pay much higher premiums. This means any plan the GOP comes up with will have worse coverage or worse costs than the ACA plans. Period.
By opposing the Medicaid expansion, they made it impossible for many lower income Americans to afford care. This is similar to the subsidy issue in that everyone on average has roughly the same health care costs, but income in this society is not equal which means some people have much less (or zero) ability to afford health care. It’s not like the poor can say “well, my liver is only a Toyota liver not a Rolls Royce liver so the upkeep on my liver matches my modest income”. This means that any GOP plan will leave more poor people, including many of their own constituents, without coverage. Period.
In addition to that, the GOP already ruled out all of the solutions to the left of the ACA: single payer, price controls, public option, etc.
So that left the GOP with, in reality, nothing to offer on health care. The fact that the GOP has had 8 years (EIGHT YEARS!) to come up with a viable alternative to the ACA and has miserably failed, just demonstrates this fact.
So I don’t see any way for the GOP to resolve this issue without taking major lumps, in all possible directions. If they leave ACA untouched, they are vulnerable to the attack from the right (the American right does not obey the constraints of a normal politics; there is no “right edge” to the spectrum) and that can easily kill them politically in a primary. If they repeal ACA in any meaningful way, they have no good alternatives so they end up depriving people of coverage. They have absolutely no good options, which is why they’ve been flailing on this for months.
A smarter crew would have made a swift harsh choice early this year (either repeal and weather the loss of coverage storm from the left/center or reject repeal and weather the failure to repeal storm from the right), essentially “ripped off the band-aid” and then proceeded with the rest of their agenda. But too many of the GOP were such true believers in the Power of Conservatism they just assumed there was some good magic market modality that would fix the ACA. And too many of the GOP were narrowly focused on the politics and never studied health care deeply, not even realizing that their attacks on the ACA were exaggerated and misleading, and they had no good alternatives. So they just figured they could magic their way out of the corner they had painted themselves into and now they are going to be trailing paint all over.
