A greater Republican division on the issue of health care reform than originally thought in addition to the Democrats’ determination to not repeal the Affordable Care Act, led to the failure of health care reform efforts thus far, according to a special report recently published in The New England Journal of Medicine.

“Fundamental divisions among Republicans point to an underlying reason why Republicans in Congress had such difficulty agreeing on a single repeal and replace plan. These divisions were not helped by the fact that President Donald Trump’s role in the debate was seen so poorly by the general public,” Robert J. Blendon, ScD, and John M. Benson, MA, of the Harvard T.H. Chan School of Public Health, wrote.