I wonder how much blame should be placed on the Senate for not doing a clean Repeal. Had they unequivocally announced that a clean Repeal could be done with 51 Senate votes under Reconciliation — because the Senate Parliamentarian had ruled it could — then Ryan would have had no excuse to try RyanCare.
If Ted Cruz was majority leader in the senate, they would do that.
Gorsuch would probably have been confirmed by now too.