WASHINGTON – Although House Speaker Paul Ryan, R-Wis., acknowledged Friday that “Obamacare is the law of the land,” its survival or collapse in practical terms now rests with decisions that are in President Donald Trump’s hands. In the coming weeks and months, the White House and a highly conservative health and human services secretary will be faced with a series of choices over whether to shore up insurance marketplaces created under the Affordable Care Act – or let them atrophy.