I have said this entire time that Trump winning the election would be worse for the GOP than Trump losing. #accolades
In the case of Ryan, it doesn't make a big difference. If the GOP keeps its majority and the freedom caucus blocks Ryan, I think that Democrats should work out a deal with him: They vote for Ryan as Speaker, and in return the Hillary administration gets some legislation passed. Ryan could really be forced to do that, as electoral-vote.com in this report just yesterday suggested. It would be fun.
The ACA will have to be reformed before it collapses. A "House Sanity Caucus," plus a Democratic Senate, plus President HRC could take the best GOP ideas (interstate insurance market, liberalized health savings accounts), and add in assurances that the best Obamacare features (coverage of pre-existing conditions, subsidized insurance for those who don't get through employment) remain.
HRC: I saved everyone's insurance!!
GOP: We killed Obamacare!!
Paul Ryan: I made it all happen!!
Win, win, win.