Ryan's really stuck between a rock and a hard place on this. After six years of anti-ACA rhetoric, the house has to put forward some kind of bill. The conservative wing of the party believes the government should spend less money subsidizing health care. There's no way to do that that doesn't result in higher premiums or lost coverage. That's going to be unpopular. If he had a president who could speak to policy nuances and trade-offs, *maybe* they could sell it to the general public (I tend to think it would still be a very tall task). I'm pretty sure the only real point of this bill is to fail as quickly as possible so Ryan can throw up his hands and say "well, we tried".