One year ago, when President Donald Trump delivered his inaugural address, a primary focus was repeal and replace. Trump laid out his agenda to do away with the Affordable Care Act — Obamacare — and replace it with something more consistent with his Republican Party’s philosophy of less government and free markets.

With controlling Republican majorities in the House and Senate, repeal and replace should have been a cinch. One year later, we see it was not so automatic. The ACA remains intact despite numerous attempts by Trump and the Republican-led Congress to unseat it.

Trump didn’t even mention Obamacare on Tuesday in his 2018 State of the Union address. That’s good indication the issue is off the Republican agenda, at least for now.

Two factors loomed large in the durability of Obamacare.

One deciding factor has been the opposition of moderate GOP senators Susan Collins and Lisa Murkowski to every ACA repeal bill put forward in 2017. They represent the slim two-seat Republican majority that narrowed even further in December, when Alabama Democrat Doug Jones upset Judge Roy Moore in a special election for a vacant Senate seat.

The other factor has been Trump himself. His first months in the White House must be characterized as confused, disorganized and distracted. A consummate Washington outsider, Trump had a hard time getting the Republican leadership to work with him, let alone the Democrats.

Other factors are coming into play.

Absent a full repeal, the administration has chipped away at the regulatory underpinnings of Obamacare. The recently passed tax law did away with Obamacare’s individual mandate — meaning, individual Americans won’t face a penalty if they don’t buy health coverage on public exchanges under the ACA. So even without a full-blown repeal, Trump can still claim some victory on the health care front.

Finally, major GOP contributors like the Koch brothers have backed away from the issue of health care reform. And it’s not coincidence that CEOs Jeff Bezos of Amazon, Warren Buffett of Berkshire Hathaway and Jamie Dimon of JPMorgan Chase announced earlier in Tuesday their intention to create a health care program for their own employees.

At least one analyst observed that Tuesday’s address resembled last year’s inaugural speech, only substituting taking out health care reform and substituting immigration reform.

Will Trump be any more successful pushing immigration reform in 2018 than he was pushing repeal and replace in 2017? That will depend on how well he addresses all of the factors that presented hurdles. But most important, Trump’s realization of his objective will depend on how extensively the administration has improved and increased its efficiency and organization — and more than anything else, its focus.