If the gop didn’t have to work around the reconciliation rules they might pass a real repeal of o-care, but the Dems will get at least 56 votes, so the only way to pass real repeal is the nuclear option.
They cant get 50 so they cant change the rules and they cant repass the 2015 bill that gutted O-care that Obama vetoed.
The only way they can pass it is more seats.
Obama had 60 in the Senate and passed the first version Obama signed with all 60, then the second version mods with 57 losing three,
Dems won lots of new seats in 2008, GOP lost seats in 2016 giving them no room for losing Senators.