Republicans are coalescing around a plan to quickly pass nextyear a delayed repeal of Obamacare to give them two or three years tocraft an alternative.

But that plan, designed to create a “cliff” that according tolawmakers and aides would push Congress to get its act together,comes with significant perils.

“We’re going to begin immediately to repeal Obamacare and reconciliation is the onlyway to do it. And I believe we will have 51 Republican senators or52 to vote for that,” Senator Lamar Alexander of Tennessee, whochairs the health committee, told reporters Thursday.

Senate Majority Leader Mitch McConnell “has said it will be twoor three years before the repeal takes effect,” Alexander said,urging his party to provide “clear signals” about a replacementplan before the vote.

Privately, Republicans are engaging in frantic efforts to find away forward and fulfill that promise, now that they’ve won controlof the White House and Congress. They’ve been unable to agree on ahealth care alternative ever since the 2010 law was enacted overtheir objections. GOP lawmakers and policy aides describe it as atop priority next year under President-elect Donald Trump.

After a closed-door meeting of House Republicans on Friday,Representative Blake Farenthold of Texas said the earliest actionon a repeal will probably come in February because of proceduralrules.

"The idea is to repeal immediately, and act on a replacement assoon as possible," he said. A replacement will require Democraticvotes in the Senate and work has to be done with insurancecompanies, Farenthold said.

"Leadership doesn’t want to over-promise," he said.

Senator John Cornyn, the Republican majority whip, said heexpects a repeal to move forward in the first 100 days of the Trumpadministration, even if the Senate is "jammed up" withconfirmations of appointments by the new president.

But undoing President Barack Obama’s signature law is easiersaid than done. There are at least five major obstacles the GOPmust overcome.

No party-wide consensus

Congressional Republicans have held dozens of votes to repeal ordismantle the 2010 law, but haven’t been able to push through adetailed replacement plan in either chamber. A scattershot ofreplacement proposals -- including one from House Budget ChairmanTom Price, Trump’s pick to run the Department of Health and HumanServices -- have failed to gain traction within the party.

“It’ll take a while, and nobody should think that on day onewe’re going to repeal and replace it,” said Republican Senator JeffFlake of Arizona.

One reason is that many Republicans are unable to agree on whatto do about the estimated 22 million people who would stand to losetheir health insurance, according to the nonpartisan CongressionalBudget Office, if the law is repealed.

“I am of the view that we can’t pull the rug out from underpeople who have been, in many instances, forced into Obamacare,”said Senator Jerry Moran of Kansas. “So this will take some time tomake certain that we protect people and their health care.”

Ideologically, conservative opposition to regulations andspending creates a dilemma. Before Obamacare’s new rules, insurershad more discretion to deny coverage to sicker Americans. And manyRepublicans oppose using taxpayer money to subsidize health carefor the poor, which limits the options for extending coverage.

Popular pieces tied to unpopular ones

Republicans -- including Trump and House Speaker Paul Ryan --say they want to keep popular components of the law, such as thecoverage guarantee for people regardless of their medicalhistory.

Sixty-nine percent of Americans support the pre-existingcondition provision, including majorities of Republicans, Democratsand independents, according to a Kaiser Family Foundation pollreleased Thursday.

Yet only 35 percent support the individual mandate to buyinsurance or pay a tax penalty.

That disconnect will be tough to reconcile. The mandate is seenby many health policy experts -- as well as the insurance industry-- as inextricable from the pre-existing conditions guarantee, asit increases participation of healthier people to defray the highcosts of caring for sick customers.

“That’s certainly the challenge. How do you create a process bywhich you can get your pre-existing conditions covered?” Moransaid.

“I’m beginning to think it can be accomplished,” he said, but hewasn’t sure how.

The survey found that majorities of Democrats, Republicans andindependents also support provisions in Obamacare that let peopleunder 27 stay on a parent’s insurance plan, guarantee preventiveservices without out-of-pocket costs, subsidize costs forlower-income Americans and expand Medicaid.

Industry opposition

Health insurers and hospitals have shifted their businesses overthe last half-decade to adjust to the Affordable Care Act, andthey’re warning against any sudden moves that could hurt patients,or their businesses.

The American Hospital Association, for instance, said in a Nov.30 letter to Trump that any repeal of the ACA should also include areplacement plan. “We urge you not to make any abrupt changes thatcould lead to significant instability for patients, providers,insurers and others,” the group said.

Already, Trump’s talk of repealing the ACA threatens todestabilize the law’s markets. That’s because insurers are countingon more people to sign up for coverage during the currentenrollment period, while the rhetoric and uncertainty may actuallydepress sign-ups.

“It’s possible that some people are going to say, ‘Why bother tosign up? I’ll wait and see what the new one is,’” Michael Neidorff,chief executive officer of health insurer Centene Corp., which hasa major business selling ACA plans, said on Nov. 10.

Medicare time bomb

The ACA cut $700 billion from Medicare reimbursements toproviders, helping extend the solvency of the program from aninitially projected date of 2016 to 2026, according to itstrustees.

Repealing the law and restoring those expenses could create animminent solvency problem for Medicare, which many SenateRepublicans say is a conversation they’re not ready to dealwith.

Democratic opposition

Republican aides argue privately that a “cliff” for repeal wouldforce Democrats to come to the table and work with them on a healthcare replacement.

Republican Representative Daniel Webster of Florida said Fridaythe plan is for the Senate to move first on a budget resolution inJanuary that then would go to the House.

Alexander argued that the law could be repealed with 51 votesunder the “budget reconciliation” process, but a replacement wouldneed 60 votes. That means winning over at least eight Democrats --and for now, Democrats are not in a giving mood and would prefer tojam Republicans.

“There’s no way to keep those good things without keeping someof the other things in the ACA. And so they’re stuck, and that’swhy they don’t have a solution,” said Senator Chuck Schumer of NewYork, the incoming Democratic leader.

It’s a risky bet, but after winning the election someRepublicans are prepared to roll the dice.

"If we do an outright repeal, we’d be better off," said SenatorRichard Shelby of Alabama. "And then we’ll replace it with what wewant. Something better."

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