WASHINGTON — As they race to repeal large parts of the Affordable Care Act, President-elect Donald Trump and congressional Republicans are leaving behind nearly everyone but their base voters and a handful of conservative activists.
Not a single major organization representing patients, physicians, hospitals or others who work in the nation's health care system backs the GOP's Obamacare strategy.
New polls also show far more Americans would like to expand or keep the health care law, rather than repeal it.
Even many conservative health policy experts caution that the emerging Republican plan, which calls for a vote in January to roll back insurance coverage followed by a lengthy period to develop a replacement, could be disastrous.
Intensifying the political risks for Republicans, a growing number of patient groups are warning that millions of Americans are in danger of losing vital health protections and that Republicans need to agree on a replacement plan before they uproot the current system.
"When people get cancer, they have to know that they are going to have insurance," said Chris Hansen, president of the American Cancer Society's advocacy arm. "There have been and are problems with the ACA, but we have to make sure that what is done and the way it is done is not going to leave people who have cancer or who may get cancer ... in the lurch."
The American Cancer Society Cancer Action Network last week sent a letter to congressional leaders urging them not to repeal large parts of the health care law without first developing replacement legislation that guarantees patients the same protections.
GOP leaders, who have repeatedly promised their core voters that they would repeal Obamacare, oppose any delay in a vote, despite the risk that Republicans may be held responsible for any ensuing turmoil.
They are pushing to pass a bill early next year that would repeal many key provisions of the law. That would include the money that has allowed states to expand their Medicaid safety nets and the billions of dollars in federal funds that have provided subsidies to low- and middle-income Americans to help with the cost of insurance premiums. More than 20 million Americans who previously lacked insurance have gained coverage under the law.
"We have to bring relief to Obamacare as quickly as possible so that it stops doing damage, not just to the health care system but to the families of America who need affordable health insurance," House Speaker Paul Ryan, R-Wis., told reporters at the Capitol last week.
To minimize disruptions, senior Republicans want to delay when the cuts would take effect. The idea is to buy time to allow the party to develop an alternative — something that GOP lawmakers have been unable to agree on in the six years since the law passed.
That approach has won praise from several conservative think tanks, including the Heritage Foundation, which said the so-called repeal-and-delay strategy could deliver "a seamless and successful repeal of Obamacare."
Most independent experts are more skeptical.
Last week, the American Academy of Actuaries warned in a letter to House lawmakers that many insurers are likely to pull back from state marketplaces even if the effective date of a repeal is delayed.
"Significant market disruption could result, leading to millions of Americans losing their health insurance," the group said.
Similar warnings have come from the Republican insurance commissioner of Iowa and some leading conservative critics of the current law, such as James Capretta of the American Enterprise Institute and John Goodman of the Texas-based Goodman Institute.
Goodman, who has been working with a group of GOP lawmakers on an Obamacare alternative, cautioned that the current repeal plans would eliminate the taxes that provide hundreds of billions of dollars to fund coverage.
Ryan has said the GOP's eventual plan would preserve coverage for the millions of people who depend on the current law. Without those taxes, however, Republicans would not have a clear way to do that unless they find some other source of revenue, something that conservative lawmakers repeatedly have balked at.
"If all Obamacare goes away, including its funding sources, where does the money come from to continue the insurance for the 20 million newly insured under the Affordable Care Act?" Goodman wrote in a recent Forbes column.
Neither Trump nor his congressional allies have indicated how they would answer that question.
That is adding to anxiety among major patient and medical groups, who fear that Republicans may never be able to enact an alternative, given their inability to develop one despite years of promises to do so.
"Any new reform proposal should not cause individuals currently covered to become uninsured," cautioned Dr. Andrew W. Gurman, president of the American Medical Assn., the nation's largest physicians' group.
In 2009 and 2010, the AMA was among the key groups in the health care debate, along with the American Hospital Assn., the American College of Physicians, AARP and other patient advocates, who supported the law and its promise of extending health protections to millions of Americans.
Many of these groups would like to see changes made to the law, which even supporters say needs revision.
None has backed the GOP "repeal and delay" strategy.
Even major industry groups that have been most vocal with complaints about Obamacare and opposed it when it was enacted, including the main health insurance trade association, America's Health Insurance Plans, are not backing the repeal campaign.
The health insurance group has suggested a number of steps to minimize potential disruptions should Republicans move ahead with legislation to roll back the law.
The reticence is mirrored in public views of the GOP repeal campaign.
Although Republicans strongly support it, most Americans do not, according to recent polls.
Just 39 percent of respondents in a national survey conducted over the first days of December by the Pew Research Center said that Congress should repeal the law, compared with 55 percent who said Congress should expand it or leave it as is.
Support for repeal predictably was weakest among Democrats, but even among independents, just 35 percent said Congress should roll back the law, and 61 percent said the law should be expanded or left alone.
Those findings track with another national survey conducted in mid-November by the nonprofit Kaiser Family Foundation, which found that just a quarter of Americans want to repeal the law.
That was down from a third who backed repeal in October.