Taking a moment out to be cynical…
What if the GOP planned all along to fail to pass a repeal bill for the ACA in both the House of Representatives and the Senate?
I can think of three very good reasons why they might want that to be the final outcome.
1. The ACA is growing steadily more popular
2. The POTUS made ACA repeal and replacement a centerpiece of his agenda, and the POTUS is unpopular
3. The POTUS promise of better insurance for less money is totally incompatible with giving rich folks a tax cut, if you try to trade the ACA off against tax policy
The GOP is, of course, hopelessly tangled up in a rhetorical cul-de-sac of its own making over the ACA. They have been promising to repeal the ACA since about the time that it was passed, and they have been bloviating and posturing to that end since 2010 (witness the number of votes scheduled in the House to repeal the ACA – up to over 60 the last time I looked).
The GOP cannot suddenly turn around and say “well, it seems that the ACA might not be all bad so let’s not repeal it”. The activist base of the party would be apoplectic with rage, and local pressure groups would immediately look for primary election targets in 2018, picking on representatives who they consider to be traitoriously disloyal. One of the reasons why so many GOP elected representatives make dingbat-crazy public pronouncements is that they are terrified of being primaried. When a representative like Renee Elmers, who was propelled into office by a Tea Party primary insurgency, can be dumped out of office by the same group of primary voters after being accused of being a RINO (a cardinal sin for any GOP political candidate), then nobody in the House from the GOP, no matter how batshit-crazy, is safe.
So, the GOP has been in rock-meet-hard-place territory. If they repeal the ACA, elected representatives fear a tidal wave of voter anger sweeping them out of office in 2018. If they abandon all attempts at a repeal, they fear primary challenges for being “insufficiently conservative” or (gasp) being named as a RINO.
So…what better option exists?
Allow the repeal bills to die due to (just failing) to get enough support.
This would be a classic tactic of virtue signalling, done all the time by politicians who want to appear tough and resolute. The world of politics is replete with examples of politicians proposing cockanamie legislation, having it shelved or voted into oblivion, and then going back to their supporters and saying “look, I tried to get it passed”.
So, the PR spin from Donald Trump that he got really close, is a classic rhetorical sleight of hand that papers over the reality that, in all probability, the majority of GOP senators and house members are glad that ACA repeal has died a death. They still have the option to slowly strangle the ACA by other means of course. That would be a cunning and slow dismantlement of the ACA without having to take ownership for publicly killing it. Think arsenic poisoning instead of shooting.