If Congress can't pass a bill, with or without Democrat support, they'll face similar pressure in two years, perhaps in the midst of a "horrendous fiscal situation."
Despite a high-profile effort and public failure, Republicans aren't finished with healthcare. Or, it might be said, healthcare isn't quite finished with Republicans.
Despite earlier signals that they would move on from healthcare legislation, the Trump administration seems like it wants to try again.
The odds that its next attempt will also fail have to be at least even, so whether that's smart politics are not is arguable.
But Obamacare does need some changes to avoid longer-term ills that include exploding federal deficits, in an economic recession that is sure to come at some point, says Jeff Goldsmith, a national adviser to Navigant's healthcare practice.
Goldsmith, a self-described healthcare futurist and associate professor of Health Sciences at the University of Virginia, says the hundred billion-dollar-plus annual outlays for the as yet unrepealed and unreplaced Affordable Care Act pales by comparison to the trillion dollars a year currently spent on Medicare and Medicaid, which represent an existential threat to the U.S. economy.
"If this process fails, we're right back at it in two years in midst of a horrendous fiscal situation," he says.
That situation would get notably worse should interest rates and recession risks rise, as is expected.
"This is such a morass. Unless that is contained we've got a terrible fiscal problem," he says, noting that he is a fan neither of the ACA or the recently failed Republican alternative.
Goldsmith says the core purpose of the failed bill was not to fix the problem of runaway healthcare costs, but simply to "undo the redistribution of income at the heart of the ACA, which itself was taking money from wealthy and giving to the working poor in clumsy way."
Goldsmith says legislation surrounding healthcare in recent years proves the wry saying attributed to Lewis Carrol's Alice in Wonderland: "If you don't know where you're going, any road will take you there."
"The ACA was a good deed done badly, is the way I've put it to my students," he says. "But the difference in getting it passed was that there was strong and consistent political guidance from the White House."
That guidance included rough agreements reached at various White House summits with interest groups. Each group agreed to broad ideas of what they would give up in return for gaining insurance coverage for millions more Americans through their support, or at least their indifference, to the ACA.
And still, the ACA passed with no Republican support.
Philip Betbeze is the senior leadership editor at HealthLeaders.