My guess is that this whole stunt is a way for Paul Ryan to not really have to repeal the ACA. The entire republican machine since 2009 has been defined by the idea that national health is un-American and anti-freedom. To replace the ACA with anything is to concede that it isn't, and to repeal it without replacement is to solidify your party's place as the minority party for many years. They can't win. So Ryan figured out that he just has to propose a law that is repugnant enough to all of his members who love freedom that they will never vote for it. That way, he can say he tried, but that the political will just isn't there. If we learned anything in the 2016 election it's that Paul Ryan will do literally anything he thinks is politically expedient, without regard for or second thought of his own professed ideology. (Except maybe I'm wrong. Maybe his confessed ideology is that he has no other allegiance than to himself--isn't that the whole point of 'objectivism' to being with? In that case, this and his behavior last year would be in perfect lock goose step with his creedo.)