President Trump and Speaker Ryan were unable to get a majority of House Republicans to agree on a bill to dump Obamacare and replace it with the AHCA, aka Ryancare. The bill was pulled from consideration by the Speaker this afternoon.
The failure makes Ryan look ineffective, Trump is a bit bruised too, and widely reviled Obamacare remains the law of the land for the foreseeable future. It will continue until it collapses when the last insurers bail out.
President Trump has indicated when that happens, when Obamacare dies a natural death, everybody in both parties will have a motive to fix the problem. Until then, he has moved on to other issues.
Whether Ryan can survive as Speaker is separate question, one to which the answer is unknown at this juncture. Similar intra-party disunity caused the resignation of Speaker Boehner, Ryan's predecessor. Verdict: a party's big tent can be too big to function.