Trump has the ultimate say on any legislation - he can veto it. (Unless congress can get a 66% majority to re-pass it).
Basically, he’s being petulant and a bully - “do what I say or I will take my baseball and go home and you guys can’t play”. The threat is if they don’t do it his way, in two years congress will go for re-election and all their supporters will say “you promised to repeal Obamacare and reneged on that!”
Congress is like a dog that chases cars. Now that they finally caught one, what do they do with it? they’ve assumed for years they just remove the Obamacare legislation and things go back to the way they were. However, there are people getting Medicaid that weren’t before. There are people getting (subsidized) health care from Exchanges that didn’t get it before. (When you read that premiums went up 25%, 60% or more - many of the people on those exchanges are subsidized because the cost of health care exceeds X% of their income - therefore it only goes up 5% for them, and the government pays the rest.)
Trump was chasing a bunch of fanatics. The “Freedom” caucus does not believe in any government-mandated requirements, so anything he produced that satisfied them would be essentially removing health care options from those 24 million people who are currently covered - mostly poorer people. Open season on pre-existing conditions, no mandatory coverage for emergencies, maternity benefits, prescriptions. No mandatory sign-up. No requirements for employers to provide health care. Get rid of the taxes that pay for Obamacare.
The normal Republicans would like to clean up some of the negatives of Obamacare but not take away too many of the things that are seen as gains from Obamacare - no pre-existing conditions, coverage for children up to 26, subsidies for poor, etc.
He needed 215 votes. Without the “Freedom” wing, he would have to get votes from Democrats. How would he do that? Remove Medicaid expansion? Remove subsidies? Give tax breaks to really rich people? Jack up premiums for older workers? …probably not.
It’s not hard to see that the choices that would persuade Democrats to support a new health care measure are not much different from what’s already in the ACA. The democrats aren’t motivated to support a significant weakening of the current health care laws.
So you have 3 factions that want 3 completely different things and need 2 of them to pass anything. None of them will compromise. The Freebies won’t give, they are fanatics. The other Republicans won’t vote for something that will be held against them badly next election. The Democrats know they are needed to pass anything, so they know they can hold out … and meanwhile what they have stays.
Who will give in first?
I see 2 scenarios:
-admit defeat and call it a victory; pass Obamacare lite, call it repeal.
-pass a really really bigly bad law like the current proposal, but closer to the next election so it doesn’t hurt anyone until after the 2018 election and hope they don’t notice until after the elction and forget by 2020.
Politics used to work by compromise - what can both sides hold their nose and agree on? Unfortunately, politics, like the world, has descended into a mess of people in echo chambers. The Right, particularly, can listen to Fox and Breitbart and chat with each other on their won internet chats and ignore the fact that there are contrary viewpoints. The left is not much better. The politicians who used to compromise are driven out in primaries, where the echo chamber minions organize a minority of like-minded voters to ignore compromise and vote for fanatic candidates, exacerbating the problem - so the compromise-minded types have to adopt a hard-line stance to avoid being replaced.