Between intra-party disagreement and blowback from Democrats and independents, Republicans were already struggling to deliver on their ambitious legislative agenda. They have yet to act on their commitment to repeal and replace Obamacare, though they have signaled they will release separate bills to reduce Medicaid funding and roll back Obamacare tax provisions this week.

Among their core health care problems: Republican governors and Congressional moderates want to prevent millions of Americans from losing health insurance they got under Obamacare, but GOP conservatives oppose measures that would help do so, on the grounds they would establishment a new entitlement that amounts to “Obamacare-lite.” Even Trump himself has said he would not support reductions in insurance coverage.

Republican senators have made clear they oppose major elements of the House approach on both health care and tax reform. But they have not advanced plans of their own.

For now, House Speaker Paul Ryan aims to kick-start momentum by beginning the legislative process on health-care, whatever the ultimate destination. As one Ryan friend told me, the speaker’s principal motivation at this stage is holding his Republican caucus together while political storms swirl around him.

That’s what Ryan’s predecessor John Boehner tried to do before conservative dissidents forced him out.


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