“The old order changeth,” Tennyson wrote in 1912, “yielding place to new.”

For three-quarters of a century, Americans have been debating whether the state should guarantee health coverage for all. With the passage of the Affordable Care Act, the “yes” side seemed at last to have prevailed, or nearly so. Obamacare is not quite a universal health-care program, but it shifted the U.S. closer to that outcome. For seven years, Republicans have vowed to shift it back. Now the moment for reversal has arrived. If Paul Ryan’s version of health-care reform prevails, the speaker will have accomplished something that Ronald Reagan and Margaret Thatcher never could: repeal a fully operational social insurance program.

But it looks increasingly unlikely that Ryan will prevail. Monday’s Congressional Budget Office estimate that 14 million Americans will lose coverage in the first year after repeal—with 7 more to lose it just in time for the 2020 presidential election—must spread panic among already nervous Republicans. Paul Ryan, a true believer, accepts that toll as the price of principle. It seems doubtful that very many other Republican officeholders will long agree.