At the same time, the health department is setting limits on how far states can go with their experiments: Idaho recently proposed a scheme to allow insurers to sell plans that do not comply with all of Obamacare’s regulations, with the goal of creating a market for less expensive, less robust coverage, but last week the department rejected the plan as illegal (Gov. Butch Otter didn’t see it as a rejection but as an invitation to “continue discussing the specifics”). And while the Trump administration approved a request to add work requirements to Medicaid in Arkansas, it has held off on approving a rollback in enrollment.

There are practical virtues in some of these initiatives: Efforts to expand the availability of cheaper, less regulated plans, for example, can provide alternatives to Obamacare’s ever-rising premiums. But there are risks as well. Thanks to the way the health law’s subsidies are structured, Mr. Trump’s decision to cut off subsidy payments is likely to increase overall federal spending. The design of the cost-control board was legally questionable, but it represented an effort to cap the growth of America’s largest entitlement program, and Republicans replaced it with nothing.

And at times, the tweaks and fixes seem to be at war with one another. Those same short-term plans are likely to pull healthy people out of the exchanges, further destabilizing the markets and creating pressure to prop them up with subsidies and stabilization funds, which cost the government money.

Supporters of the health care law might describe many of these changes as sabotage, and it’s certainly true that many of them are not being made out of love for the law. But the changes also suggest that Republicans are belatedly engaging with the particulars of the law and its operation, cobbling together a not entirely coherent replacement on the fly.

Having failed in their repeal effort, Republicans are now in something of an arranged marriage with the health care law. These alterations are being made in a predictably haphazard fashion, with little in the way of guiding theory, but the cumulative effect is to turn Obamacare into a law that they can, if not love, at least learn to live with.

To be sure, the embrace is not without reservation. A group of conservative states recently unleashed another legal challenge to the law. Senator Orrin Hatch of Utah recently called it the “stupidest dumbass bill that I’ve ever seen.” But in arranged marriages, love often grows over time.