After demanding for six years that the Affordable Care Act be gutted, Republican leaders refused Wednesday to outline concrete steps to repeal and replace it, even as members of their party voiced growing reservations about rolling the law back without a viable alternative.
Neither President-elect Donald Trump nor Vice President-elect Mike Pence, who met with House and Senate Republicans at the Capitol, offered lawmakers details about their repeal plan — a centerpiece of their winning campaign — short of vague promises that Trump would take executive action after he assumes office in just over two weeks.
And GOP congressional leaders would not say how they will proceed or even how long they will take to develop a replacement for the current law, widely known as Obamacare.
"This is going to take a little time," Texas Sen. John Cornyn, the No. 2 Republican in the Senate, said after the meeting with Pence.
The lack of detail underscored the complexities of undoing the biggest expansion of the social safety net in decades without interfering with healthcare for tens of millions of Americans. Republicans' wavering just a day after the start of a new Congress also may give opponents additional time to shore up support for preserving Obamacare in some form.
Cornyn and other Republican leaders repeated assurances Wednesday that consumers would not lose coverage while Republicans work to develop an alternative to the law.
More than 20 million Americans have gained coverage through the law and many more depend on its key protections, including a guarantee that people can get coverage even if they are sick and limits on how much patients can be forced to pay out of their pocket for medical care.
"We don't want to pull the rug out from anybody," said House Speaker Paul D. Ryan (R-Wis.). "We don't want people to be caught with nothing."
After meeting with Senate Republicans, Pence told reporters at the Capitol that Trump's executive orders would "ensure that there is an orderly transition during the period after we repeal Obamacare to a market-based healthcare economy in America."
The assurances have not convinced patient advocates, leading medical groups or even many conservative health policy experts, who are urging the GOP not to roll back the law without first developing an alternative. Many are skeptical Republicans can craft one; they have failed to do so for more than six years.
This week alone, leading physician groups, including the American Medical Assn., joined the push to slow the repeal campaign. Others urging caution include the American Diabetes Assn. and the advocacy arm of the American Cancer Society.
A growing number of Republican senators are also voicing reservations about the lack of a clear plan, jeopardizing GOP leaders' vision for swift repeal in a chamber where just three Republican defections could torpedo legislation.
"We're not sure exactly what direction we're going to go to have a full and careful transition period," said West Virginia Sen. Shelley Moore Capito, whose state has seen a dramatic drop its uninsured rate thanks to Obamacare.
Sen. Susan Collins (R-Maine), a centrist who is being closely watched, urged party leaders to make more progress on an alternative to the current law before voting to scrap it.
"It would be far better to have a detailed framework of what replacement is going to include as we are moving toward repealing," Collins said.
On Wednesday, Sen. Rand Paul (R-Ky.), who has publicly criticized the repeal push, joined Democrats in voting against a motion to start debating a resolution that would set the stage for repeal.
Outside Washington, state Republican officials are raising concerns about repealing Obamacare as well.
Michigan Gov. Rick Snyder, who was among the first Republican governors to expand Medicaid coverage through the healthcare law, called his state's expansion a national model in an interview with the Detroit News.
Under Republicans' current repeal plan, the House and Senate over the next couple weeks would pass a budget resolution directing Congress to develop a repeal bill through a process called budget reconciliation.
The House would then craft the repeal legislation, pass it and send it to the Senate. Under budget rules, Republicans, who have a 52-48 edge in the Senate, would need only a simple majority to pass the bill and send it to Trump.
Senate Majority Leader Mitch McConnell (R-Ky.) said Wednesday that the repeal package, which congressional committees are to draw up by Jan. 27, would hew closely to repeal legislation that Republicans developed in 2015 and sent to President Obama a year ago. Obama vetoed it.
That bill removed the unpopular insurance mandates in the law that require Americans to have health insurance or pay a fine. It also rolled back federal aid for Medicaid, scrapped federal insurance subsidies for low- and moderate-income consumers and eliminated a Medicare surtax on high-income households and other taxes on medical device makers and health insurance companies that go toward funding the law.
To allow Republicans time to develop an alternative, the bill delayed implementation of the repeal for two years.
If congressional Republicans stick to this repeal-and-delay strategy, Trump could take steps through executive action that might help stabilize insurance markets while a replacement is being developed, said Larry Levitt, an insurance market expert at the nonprofit Kaiser Family Foundation.
These steps might include tightening rules on when people could sign up for coverage in Obamacare marketplaces or even loosening requirements on what benefits insurers must offer, which could lower premiums though would likely leave consumers with fewer protections.
But in case those steps prove inadequate, Republicans appear to be laying the groundwork to shift blame back to Democrats.
Trump said Wednesday that the current healthcare law would will "fall of its own weight."
And Pence outlined for lawmakers plans for the new president to barnstorm the country attacking Obamacare and keeping up momentum for the repeal-and-replace push.
"I'm promising you, you will not be doing it alone," Pence told House Republicans, according to a source in the closed-door meeting, which was described as more of a pep rally than a strategy session. "We'll be making the case all around the country."
Democrats, meanwhile, are working on their own political campaign, which is designed to capitalize on growing reservations in Republican ranks and polls showing public unease over repeal.
After meeting separately in the Capitol with Obama, Democratic leaders warned that the GOP was risking chaos by unraveling Obamacare.
"They seek to rip healthcare away from millions of Americans — creating chaos for our entire economy," warned Senate Minority Leader Charles E. Schumer (D-N.Y.). "It is their obligation — they are voting for repeal — it is their obligation to come with replace."
In a twist on Trump's campaign slogan, Democrats warned that Republicans want to "make America sick again."
Times staff writer Michael A. Memoli contributed to this report.