Republicans in Congress haveinsisted the only way to fix Obamacare is to repeal it. But withBarack Obama about to leave the White House, several Republicanssound willing to tweak it rather than kill it.

These Republicans suggest that a Hillary Clinton presidencycould shift the debate over the Affordable Care Act justenough to work on improvements with someone who isn’t thelaw’s namesake.

And it’s not just politics: Last week’s decision by one of thenation’s largest insurers, Aetna Inc., to withdraw almost entirelyfrom the program’s insurance exchanges is the latest warning signthat Washington may have to act to prevent the law from unraveling.Many of the areas most affected by a potential loss of coverage arerepresented by Republicans.

Representative Scott DesJarlais, a Tennessee Republican and adoctor who has strongly backed Donald Trump, said his party would"certainly" consider a Clinton plan to revise a law he says is in adeath spiral.

"She would be able to to look at what has failed," he said in aninterview. "Obviously, we wouldn’t be closed-minded. The bottomline is, how do we take care of people and make it affordable forthem?"

Pete Sessions, a Texas Republican who runs the influentialHouse Rules Committee, said he remains opposed tothe health-care law, but he also conceded that it’s unlikely,for both political and financial reasons, that the law could berepealed outright.

Obama’s departure, he said in an interview, will be "anopportunity to see there are other ideas, not just that there’s acontinual battleground."

Most Republicans still insist Obamacare must go, and aTrump presidency would all but guarantee much bigger change becausehe too has called for its repeal.

But faced with a Democratic president and a possible DemocraticSenate, some Republicans see an opening to make the law more totheir liking, particularly because the party has never coalescedaround a replacement.

More than half a decade after Democrats passed the health lawwithout any Republican votes, Obamacare is showing its seams.Enrollment in coverage sold through new government-run insuranceexchanges has lagged expectations. The nation’s largest commercialinsurer by market value, UnitedHealth Group Inc., has joined Aetnaand several smaller companies in retreating from the program.Insurers that remain complain that patients are sicker and costlierthan they expected, and that provisions in the law intended to prodyoung people to sign up are toothless or haven’t been enforced.

Related: Will the GOP negotiate with Clinton on theACA?

Little consensus

Fixing the law won’t be easy, as there’s little consensus onwhat should be changed.

Many of the insurance industry’s top suggestions, such aslowering premiums for young people and raising prices for oldercustomers, are opposed by consumer advocacy groups. The possibilitylooms large that any legislation could become mired in the samepartisan warfare that almost halted the Affordable Care Actitself.

But Clinton may succeed at convincing Congress to act by virtueof not being named Obama. The tactics the president employed topass the health law, including passage of a companion bill underprocedures that prevented a Senate filibuster, enraged andalienated Republicans, preventing him from negotiating anymeaningful changes later.

AshLee Strong, a spokeswoman for House Speaker Paul Ryan, aWisconsin Republican, said that a plan to repeal and replace theAffordable Care Act -- included in the six-part House Republicanagenda that Ryan calls "A Better Way" -- remains the party’sposition. But she added: "The speaker has said we’re a party ofideas."

Ryan has endorsed Trump for president. Clinton, however, holdsabout a seven percentage-point lead on Trump in an average ofnational polls maintained by the Pollster.com website.

Related: Aetna CEO threatened to abandon ACA in response toblocked merger

Clinton’s proposals

Clinton has proposed changes to the Affordable Care Act,including more generous subsidies to offset rising premiums and anew tax credit for deductibles, co-payments and other out-of-pocketexpenses, the subject of frequent complaints by patients,notes Jesse Ferguson, a spokesman for Clinton’s campaign. Shealso supports creating a new government-run insurer, known as the"public option," to increase consumers’ choices in areas whereprivate plans have withdrawn.

In negotiations with Congress, though, Clinton would have tonavigate both Republican demands that she may find unpalatable andthe conflicts between insurers and consumer advocates.

"Compromise is not really that bad of a word. But to continue tosimply do nothing is bad," Representative Dennis Ross, a FloridaRepublican, said in an interview. "Just continuing this standoff,just leaving it alone, is going to make it worse for the Americanpeople."

Demanding concessions

Republicans may demand concessions from Democrats in exchangefor agreeing to Clinton’s amendments to the law. A likely targetwould be the law’s unpopular requirement that most Americans carryinsurance and that most employers provide it.

"The individual mandate doesn’t work," said Joe Antos, ahealth-care economist with the American Enterprise Institute whoopposed passage of the health law but now supports fixing it,rather than repeal. "If it did, most of these problems wouldn’texist."

Sessions introduced legislation in May with Senator BillCassidy, a Louisiana Republican, that would repeal only theAffordable Care Act’s individual and employer mandates, whilesetting up an alternative system of insurance subsidies thatSessions says could co-exist with Obamacare.

Clinton would probably regard the Sessions-Cassidy legislation,titled the World’s Greatest Health Care Act of 2016, as little morethan a stealthy attempt to undermine the Affordable Care Act.Nonetheless, "I think she would want to call us," Sessions said inan interview.

Insurers’ problems

Insurers, meanwhile, want Washington to make it easier for themto turn a profit on Obamacare plans. On top of charging youngercustomers less and older ones more, the industry would like to beallowed to offer cheaper plans with less generous benefits, and itwants the government to crack down on people who try to sign up forcoverage outside of the law’s annual enrollment periods, who arethought to often be sick and in immediate need of expensivehealth-care services.

Such customers may be "buying insurance when the house is onfire," Karen Ignagni, the president and chief executive officer ofEmblemHealth, New York’s largest insurer, said in an interview.

She said her company and others also want revisions to a programcalled "risk adjustment" that requires insurers who sign upObamacare customers who are relatively healthy to pay money toplans with relatively sicker patients. The program has at timesresulted in smaller insurers owing millions of dollars to largercompetitors.

Related: Insurer exits from Obamacare turn few choices intonone

"I can’t recall a law being passed that isn’t after a few yearsadjusted and modified to fit circumstances as they develop,"Ignagni said. She previously led America’s Health Insurance Plans,the industry’s Washington lobbying group.

But some of the industry’s proposals will run into opposition byconsumer advocates that strongly support Obamacare and expressskepticism that insurers are in much distress.

"I don’t believe we have a crisis, notwithstanding the latestnews about Aetna," Ron Pollack, the executive director of theconsumer advocacy group Families USA, said in an interview. "Ithink it is essential that we use whatever dollars that areavailable as effectively as possible. Padding insurance companyprofits does not fit within that concept."

Pollack said his group supports "improvements to the health-caresystem," including many of Clinton’s proposals. He’d also like tosee the government require insurers to offer standard plans in theexchanges that would be easier for customers to understand andcompare. "The most pressing item right now relates toaffordability," he said.

Conservative opposition

Any major overhaul of Obamacare would face obstacles inCongress. Importantly, even if Republican leaders were receptive,they and Clinton would have to contend with conservativeRepublicans in the House who have led the repeal-and-replacerefrain.

It’s also unclear who would lead negotiations. Fred Upton ofMichigan, the current chairman of the House Energy and CommerceCommittee, which has jurisdiction over much of Obamacare, faces aterm limit in that post. Unless he receives a waiver, the panelwill have a new leader next year, perhaps John Shimkus of Illinoisor Greg Walden of Oregon.

House Budget Committee Chairman Tom Price of Georgia, a medicaldoctor, refused to speculate about whether congressionalRepublicans might have to find some way to work with a Democraticpresident next year to fix the health-care law.

"It needs to be repealed, not the least of which is because thepremise is the federal government knows best on health care," hesaid in an interview. "That’s just a step in the wrong directionout of the chute."

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