President Trump shakes hands with House Speaker Paul D. Ryan (R-Wis.) during Republican congressional retreat on Jan. 26 in Philadelphia. Trump’s remarks on sensitive policy matters have often bewildered the lawmakers, including Ryan, who are trying to enact his agenda. (Alex Wong/Getty Images)

When President Trump told Fox News Channel host Bill O’Reilly recently that the rollout of a Republican health-care plan would “maybe . . . take till sometime into next year,” he contradicted many congressional Republicans who have promised a swift repeal of the Affordable Care Act.

And they followed what has become an uncomfortably common routine: making sense of his words, figuring out how they mesh with their own promises — and getting back to work.

“I don’t really know what he’s referring to in terms of a year,” said Sen. John Cornyn (R-Tex.), the No. 2 Senate leader. “Hopefully we will get our replacement plan in place well before that.”

Said Sen. John Thune (R-S.D.), the Republican conference chairman: “When I heard that timeline, I was like, ‘Okay, well, that’s — that’s another timeline.’ We’ll factor that in.”

Said Rep. Patrick J. Tiberi (R-Ohio), chairman of a key subcommittee assembling the health plan: “He doesn’t know what he doesn’t know, with respect to the legislative process.”

(Obtained by The Washington Post)

It was only the latest example of Trump making an off-the-cuff statement on a sensitive policy matter that has bewildered the Republican lawmakers on Capitol Hill who are working to implement his — and their — agenda.

In the case of health care, Trump has frustrated GOP leaders who have been struggling to keep their party together on a complicated and potentially disruptive plan to replace the Affordable Care Act (ACA) — only to watch Trump seem to overpromise and step on their carefully crafted messaging.

There are significant policy disagreements among Republicans on health care and other issues, but Trump’s musings have often served to heighten those conflicts, to GOP leaders’ dismay.

Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) went to the Senate floor Monday to lash out at “an obsession with advancing a narrative of a deeply divided Republican majority.”

“Sure, there are details that need to be worked out, both on the process and the substance on things like tax reform, trade and, of course, health-care reform,” he said. “But, by and large, Republicans all have the same ultimate goals for these key areas.”

Although the goals may be similar, their language has often diverged. During the presidential transition, Republican lawmakers began speaking about their health-care plans in terms of “universal access” — a positive-sounding alternative to the universal-coverage aims of the ACA.

But in a Jan. 15 interview with The Washington Post, Trump promised “insurance for everybody” — a phrase that evokes the single-payer system Republicans detest rather than the free-market-oriented solutions they have tended to favor.

Trump also, in that interview, warned Congress not to “get cold feet because the people will not let that happen” and said he has a health-care plan “very much formulated down to the final strokes.”

“We haven’t put it in quite yet, but we’re going to be doing it soon,” he said.

The sense of urgency was reflected in a three-pronged plan party leaders presented to the GOP rank and file at a retreat in Philadelphia last month. In laying out a 200-day congressional agenda, House Speaker Paul D. Ryan (Wis.) said that a blueprint would be rolled out within weeks, and that the House would pass a special fast-track bill repealing the ACA and beginning the replacement process no later than the end of March.

Meanwhile, Ryan and other leaders said, the Trump administration would be moving to undo federal regulations tied to the ACA and advancing other pieces of the replacement through congressional committees.

Trump’s remarks to O’Reilly, aired to an unusually large audience before the Super Bowl broadcast Sunday on Fox, seemed to extend that timeline by months.

“Maybe it’ll take till sometime into next year, but we’re certainly going to be in the process,” he said, adding: “I think that, yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year,” he said.

As with Trump’s previous comments on a number of issues including health care, border security and immigration, GOP congressional leaders moved to shoehorn what he had said into their plans.

“I think there’s a little confusion here,” Ryan told reporters Tuesday, suggesting that Trump was referring to the transition period necessary to implement the GOP health-care plan. “As far as legislating is concerned, we’re going to do our legislating this year.”

White House press secretary Sean Spicer endorsed that reading later Tuesday: “I think we can have this done legislatively sooner rather than later. But I think the implementation of a lot of the pieces may take a little bit longer.”

A similar dynamic has played out on tax reform, another politically hairy endeavor that has been the subject of intense behind-the-scenes talks between the Trump administration and congressional leaders.

Ryan and other House leaders have pushed a corporate tax model known as “border adjustment,” where companies can deduct the costs of exported goods but not imported goods from their taxable income, as an alternative to the border tariff that Trump has frequently threatened to level on U.S. companies that move production overseas.

On the evening of Jan. 9, Vice President Pence and key Trump advisers including Chief of Staff Reince Priebus and Stephen K. Bannon, the president’s chief strategist, spent more than two hours in the speaker’s office as Ryan made the case for border adjustment. Ryan and aides left the meeting thinking that Trump would come around to the idea.

But a week later, Trump blindsided Ryan and other House leaders when he told the Wall Street Journal that he found the proposal “too complicated.”

“Anytime I hear border adjustment, I don’t love it,” he said. “Because usually it means we’re going to get adjusted into a bad deal. That’s what happens.”

Since then, however, Trump appears to have softened somewhat. The next week, he delivered remarks at the GOP retreat promising a tax reform bill “that will reduce our trade deficits, increase American exports and will generate revenue from Mexico.”

Ryan’s aides pointed to those comments — as well as remarks that day from Spicer pointing to a plan “using comprehensive tax reform as a means to tax imports from countries that we have a trade deficit from” — as evidence that Trump has endorsed border adjustment.

Several Republicans shrugged off Trump’s most recent remarks as the imprecision of a political novice.

Sen. John Barrasso (Wyo.), a key player in health-care discussions, said he plans to rely on personal interactions he has had with Trump, Pence and their aides to guide legislation rather than Trump’s public pronouncements. “I continue to use that as the basis for my plan,” he said.

Said Rep. Roger Williams (Tex.): “He’s the president, and he’s got maybe a calendar he’s looking at, but I can tell you: It’s our job. I think the emphasis should be on getting this thing done now, because that’s what the American people want.”

Tiberi, chairman of the Ways and Means subcommittee on health, said Trump may not be aware of the political implications of pushing the health-care issue into 2018 — that is, just ahead of the midterm elections.

“There’s a lot of anxiety already out there. I think the longer we wait, the more difficult it becomes, so I think we’d rather do it sooner rather than later,” he said. “Obviously, he’s the president, but you kind of put it in perspective: He’s only in his second full week, and he hasn’t been around this process for very long.”