I had the privilege of presenting to the Trump administration on several occasions leading up to the potential vote on Ryan's healthcare initiative. Our firm also presented to the Obama administration leading into the ACA roll out, although I wasn't present at those meetings. I think it's important to note, whatever people think about any administration in power, they are backed by some of he best minds in any field, issue or topic. Granted, these resources may be handcuffed by party lines, political BS, etc., but they are well aware of the issues with any sort of bill or reform they propose.
Our firm actually thought Trump wouldn't even back Ryan's plan since it was abundantly clear to anyone close to the matter that the bill was an utter disaster. During our initial two sessions, Trump was oddly quiet with the media on the topic and his advisors present at the meetings were in agreement about the massive shortfalls of the bill and the potential catastrophic long term implications. We actually thought he'd let Ryan fall on the sword and maybe get a little egg on the face for having to admit he had no plan for HC, but point to the massive issues with the ACA, potential massive issues with Ryan's plan and the complexities of healthcare as to why they don't have a reasonable plan in place yet, which would ultimately be understandable.
Not sure what changed, but the following week he did finally back the bill and begin pressuring the Republicabs to support it. Ultimately he didn't get it done, but that's a huge win for his administration. The bill was so horrifically bad it would have hung with his name and legacy long after he was gone. Sure, he gets a bit more egg on the face than simply not supporting it by showing he had no plan, which was given no matter what, showing an inability to negotiate/persuade votes, but ultimately those are minor concerns compared to the issues the administration would have faced if it passed.
Ironically, what became unbundently clear was the administrations dealings with Democrats appears to likely pale in comparison to the dealings with the Freedom Caucus members. Sure, there are plenty of spineless, crybaby Democratic officials, but some, possibly many would likely work with Trump on many issues. The Freedom Caucus seems intent on blocking anything and everything unless it derives from one of their own, which Trump is clearly not. That's an interesting group of people to say the least.