I don't think the Republicans expected to be in the position they are in -- controlling both houses of Congress and the White House. They have voted over 40 times to repeal Obamacare (the Affordable Care Act), but that was just political theater. They knew the White House would never agree to it, and they were just playing to their ignorant base for their own political well-being.
But now they are in a position where they must actually do something (i.e., live up to all their anti-Obamacare rhetoric). And Donald Trump has appointed a new head of HHS that will increase that pressure. Rep. Tom Price of Georgia is Trump's pick. Price has been one of the loudest anti-Obamacare voices, even to the point of writing several of the repeal attempts.
This means Obamacare (and those who depend on it for health insurance) are now in a lot of trouble. I still doubt that Congress can completely repeal Obamacare, since Senate Democrats have the numbers to filibuster to death such an effort. But the GOP Congress can use budget reconciliation (which can't be filibustered) to defund many of the aspects of Obamacare (including the subsidizing of insurance premiums and funding for Medicaid expansion). If they follow through, then millions of Americans will lose their health insurance.
Even if they don't use budget reconciliation to destroy Obamacare, having Price as the head of HHS could mean serious damage to Obamacare could be done without any congressional action. And there is no reason to believe that won't happen. Having an avid Obamacare hater in charge of the program can't result in any good.
But the health care problems don't stop there. Trump has appointed Seema Verma to oversee Medicare and Medicaid. She and Price are both opponents of Medicare and Medicaid, and both support the privatization of Medicare and turning Medicaid into a block grant program (giving states full authority to ignore the health needs of the poor).
Privatization of Medicare will be a disaster. The private health insurance companies don't want to have to insure seniors. Seniors are, in general, sicker than the rest of the population -- and you can be sure those companies will make insurance premiums for seniors sky-high (far more than the subsidies proposed to help them buy insurance).
The charts below (from the Kaiser Family Foundation) show what would happen if Medicare is privatized (under the current plan by Speaker Paul Ryan) -- and they are the best-case scenarios. It could be far worse. Seniors will be paying significantly more for health care, and it will eat up a lot more of their Social Security checks.
With these two picks, Donald Trump hasn't just put the foxes in charge of the henhouse -- he has given them the deed to that henhouse. The poor, the working class, and seniors will find getting health care much more difficult if the Republicans get their way -- and it will be very difficult to stop them.
Even if no congressional action is taken, seniors can expect to pay a lot more for Medicare starting in 2018, the poor can expect no further Medicaid expansion, and insurance premiums will continue to rise for the working class (while subsidies won't).