Being against things is easy; governing is harder. That was the explanation of Paul Ryan, speaker of the United States House of Representatives, and arguably the third most powerful person in Washington, after his Republican Party, along with President Donald Trump, pulled their health care reform bill from consideration by Congress. The move is a stunning defeat for the new president and his party, one with ramifications far beyond the provision of health care in the U.S. or domestic politics in the country.

Since the Affordable Care Act (ACA, but usually called Obamacare) was passed in 2010, Republicans have insisted that repealing that legislation was their top priority and would be their first act upon reclaiming the White House. They passed repeal legislation under President Barack Obama, but he understandably vetoed those efforts to erase his signature domestic initiative. Trump's election last year was supposed to allow the realization of that long-frustrated ambition.

But, as Ryan ruefully noted, governing is harder than opposing. As Republican legislators contemplated their options, they realized that repeal, while theoretically easy, would not suffice. The prospect of depriving 24 million people of health care was not a winning strategy (and denying the validity of those projections did not make the potential costs go away.) The party could not agree on a replacement plan, however. Hard-line conservatives stuck to their ideological position, arguing that the provision of any care was a betrayal of their principles and complaining about the cost of any residual health care services provided by the federal government. Moderates sought to preserve some of the popular features of the ACA, but they would cost money and undermine the claim that Obamacare had truly been repealed.