The dilemma facing the Republicans is that they have a larger agenda than just health care. Their major agenda is to repeal the ACA, pass tax cuts for the wealthy, and not anger the voters too much and lose seats in Congress.
It is not possible for a conservative health care plan because to do so would force them to get 60 votes as budget reconciliation would not be a possibility. Since the Democrats are not going to play ball (don’t blame them), they must use budget reconciliation which is what they traditionally use to ram through tax cuts.
This is why we have the Frankenstein like bills. They are trying to ram through something that allows them to say they did a repeal and replace and get their tax cuts. It turns out that getting all three of their items is tougher than expected.
The Republican drive to repeal Obamacare is not yet dead, but its state of distress is sufficient to set off recriminations on the right on its presumed failure. The most popular explanation emerging on the right is that Republicans erred by promising Americans too much coverage. “The problem for Republicans,” argues Peter Suderman, “is that they have not yet backed away from universal coverage rhetorically.” Philip Klein laments “a fatal concession made to liberals: the decision to take Obamacare’s approach to pre-existing conditions.” They argue that the party should instead have designed a stingier program, with catastrophic coverage, rather than make commitments they couldn’t carry out. What’s missing from the arguments is any serious analysis of why Republican rhetoric fudged the universal coverage question.