Republicans in Congress have insisted the only way to fix Obamacare is to repeal it. But with Barack Obama about to leave the White House, several Republicans sound willing to tweak it rather than kill it.

These Republicans suggest that a Hillary Clinton presidency could shift the debate over the Affordable Care Act just enough to work on improvements with someone who isn’t the law’s namesake.

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