Republicans used a consistent tactic against the Affordable Care Act, voting in the House to repeal the Act more than 50 times and passing repeal in the Senate which was met with President Obama's veto. That was a tactic, but was not a policy because the votes were all symbolic. Only the early votes aligned with a policy objective - to repeal the law before sufficient time elapsed so that Americans understood the benefits the law would confer on them. So the stage was set for repeal after election of a Republican president in 2012. Failing that, the scorched earth strategy included challenging the law in the courts, but the Roberts Supreme Court balked on that one.
If HRC had won the presidency, we would now be seeing a focus on further challenges in the courts and, if Republicans had retained control of the Senate, a 4 - 4 deadlocked Supreme Court. Last October Republicans McCain, Cruz and others sent clear signals that even nominating and approving a ninth Justice was optional, not required. Chaffetz in the House would have pursued endless investigations of HRC, thus substantiating the argument - "How can we approve a nominee of a president who is being investigated?"
Now what? The Republicans dubbed the Affordable Care Act "Obamacare" which achieved two tactical objectives - (1) Diverting attention from the goal of the law to prevent lapses in coverage for those without the fortune to have employer health care insurance while making health insurance affordable and effective in the individual market, and (2) tapping into the visceral hatred of Obama of a certain segment of their voters, which happens to a segment that Trump was able to grow by drawing nonvoters into the system.
But the success of those tactics now have an extraordinary impact on policy - "when tactics become policy". Republicans will either
(1) pass a bill that succeeds in cutting taxes on the wealthiest Americans (with the prospect of further tax cuts for the wealthiest with the repeal of the estate tax and, less directly, cuts in corporate taxes) OR
(2) Trump's administration will continue to sabotage the law in order to support the notion that "Obamacare is a disaster!)
Obfuscation, lies, and distractions are not just the tactics of authoritarian regimes. In a democracy, these are the tactics used to confuse voters about policy. And now, seven years later, more than a few of those voters are wising up, which has some impact on the GOP moderates.
McConnell is sure to come back with a revised bill that offers enough of a fig leaf to the Republican moderates while convincing the Paul/Cruz et al faction that the bill is a first step in the destruction of "Obamacare". But in the end, the bill will continue to be opposed by virtually every constituency involved in health care, including insurance companies that are seeing the decimation of the individual insurance market for no better reason that to achieve the goal of repealing "Obamacare".