Republican House Republican Senate Republican President.
Pretty clear cut who is at fault continuing the status quo.
The Freedom Caucus cost conservatives their best shot at addressing the Medicaid expansion through block grants to the states. That was the real stealth conservative reform at the heat of the AHCA - the first attempt ever to change a big federal entitlement program from a defined benefit to a defined contribution model.
The Medicaid expansion will remain, and the ObamaCare subsidies will remain. Congrats, Freedom Caucus, you did good.
As for the individual and employer mandates, it is not acceptable for Trump merely to "not enforce" these taxes. I can't counsel my client to dismantle its reporting apparatus on that basis. Employers cannot simply ignore the law. The mandates must be repealed.
I think they can, although Trump's message should be at this point to move on to general tax reform. But as part of tax reform, I'd think it might be possible to simply repeal the mandates in exchange for allowing insurance companies to punish free riders with higher rates, while keeping the rest of the ACA intact.
That will have some interesting consequences. First and foremost, small to medium-sized employers will be freed of the regulatory and reporting burdens of the mandate, and can start hiring again. The subsidies will remain in place for comprehensive individual policies that cover the range of "essential benefits" required by the ACA, but the end of the individual mandate should allow insurers to market more stripped down products that can be purchased by consumers without penalty. Can a robust free market develop for such products?