Here are the political realities:
Conservatives will push for a repeal-only bill next. Unlike Senate Majority Leader Mitch McConnell, conservative groups were thrilled when President Trump tweeted that the Senate should try the repeal-first strategy. Vice President Mike Pence backed up that view on Rush Limbaugh's show yesterday: "We ought to just repeal only" if the Senate bill fails.
In the conservative groups' view, nearly all congressional Republicans already voted for a 2015 budget bill that repeals most of the Affordable Care Act — so they should just pass that again. (In reality, the only way McConnell is likely to put that vote on the floor is to end the issue, even if it fails.)
If that vote doesn't happen, they'll hammer GOP leaders for not living up to their repeal promises — and if moderate Republicans don't vote for it, they'll get an earful, too. "They'd have to explain why they're damned liars" after campaigning on repeal for seven years, said Jason Pye, vice president of legislative affairs for FreedomWorks.
The individual insurance market will still need help. It's not as if it's healthy right now. The Centers for Medicare and Medicaid Services reported yesterday that there was a 38 percent drop in the number of health insurers who filed to offer Affordable Care Act health insurance next year.
The fate of insurer subsidies still has to be resolved. The Trump administration won't want to keep paying for the cost-sharing subsidies for low-income customers without funding from Congress. So Congress would have to decide whether to fund the subsidies on its own.
The ACA will be run by an administration that hates it. By now, HHS Secretary Tom Price and CMS administrator Seema Verma have spent so much time promoting the law's failures that they'd have trouble switching gears and trying to make the law work.
Any bipartisan talks will be small ball. Even if moderate Democrats agree to start negotiating a "repair bill" with Republicans, the only ideas they've mentioned so far are relatively narrow, like Sen. Tim Kaine's proposal to create a permanent reinsurance program for the individual market.
