The Republican Party has been determined to kill the Affordable Care Act since the law's inception, holding dozens of ineffectual repeal votes in the years since. But with Donald Trump soon to occupy the White House, and the GOP in control of both houses of Congress, they are moving full speed ahead, despite having no agreement on a replacement to offer people who would lose their healthcare in a repeal.

Congressional Republicans have made repealing the Affordable Care Act a pillar of their agenda, fighting against its passage and voting more than 60 times to erase it from the law books. And President-elect Donald Trump put repealing Obamacare front and center in his campaign, stating in his platform, “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

Vice President-elect Mike Pence has already made a trip to Capitol Hill to strategize with Congressional Republicans on a repeal, working as liaison between the incoming Trump White House and the GOP caucus to enact this centerpiece of their radical agenda.

But as my colleague Melissa McEwan recently noted, some Republicans may be getting cold feet when forced to confront the grim realities, both political and moral, that repealing the landmark health insurance reform would bring. And rightly so:

It is not just a theoretical proposal discussed by grandstanders in the abstract anymore. Now it is a real possibility, with real people who will lose their healthcare coverage with a repeal — and whose lives may hang in the balance as a result.

As they say: Be careful what you wish for. Republicans now face the prospect of getting what they have long claimed to want — the chance to repeal Obamacare. But if they do it, they will face the wrath of voters who value their health insurance made possible by Obamacare. And if they do not do it, they will face valid accusations of breaking promises they have been making for six years.

Further, despite the phrase “repeal and replace” having been tossed around for years, the Republicans truly have no worthwhile replacement plan to offer.

As Bloomberg Politics reports, at least a few of them are starting to openly admit this failure, and are trying to warn their colleagues about the problematic path down which they are heading:

A fourth Republican senator has voiced strong doubts about the party’s current strategy to repeal Obamacare without detailing a replacement, more than enough to scuttle efforts to deliver swiftly on a central promise from President-elect Donald Trump.

Bob Corker of Tennessee told reporters Friday morning that he wanted a different approach.

“Repeal and replacement should take place simultaneously,” he said.

Corker is joined in his stance by Senator Susan Collins (R-ME), Senator Rand Paul (R-KY), and Senator Tom Cotton (R-AR). Paul met with Tom Price, a vehement opponent of the ACA and Trump’s nominee for Health and Human Services Secretary, to push the need for a fully-formed replacement plan.

But, as noted in the Bloomberg article, the Republicans “have yet to coalesce on any one replacement plan,” which Senate Majority Leader Mitch McConnell brushed off by insisting they would get around to that “in manageable pieces” later in the year. He also admitted there would be “bumps along the way.”

That is a stunningly heartless way to view the uncertainty and upheaval this scenario will wreak among the millions of people who have greatly benefited from Obamacare’s provisions, including Medicaid expansion, coverage for pre-existing conditions, equal coverage and cost for men and women, and government subsidies to help offset premium costs.

Those people’s lives are not “bumps.” The GOP talk about repeal in dollars and numbers and abstract turns of phrase, rather than centering the human beings who deserve to have their health and livelihoods prioritized by their elected officials over partisan posturing.

As Bloomberg Politics put it, “If Obamacare collapses after a standalone repeal, [Republicans] could be faced with the prospect of explaining to constituents why they’re losing health care they obtained when a Democrat was in the White House.”

And that Democrat himself has been vocal about the dangers and detriment of destroying the law without a substitute waiting in the wings.

In an incisive and thoughtful article for The New England Journal of Medicine — titled, plainly and pointedly, “Repealing the ACA Without a Replacement: The Risks to American Health Care” — President Obama made the case that repeal, especially without a replacement plan, is incredibly reckless:

What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless. Rather than jeopardize financial security and access to care for tens of millions of Americans, policymakers should develop a plan to build on what works before they unravel what is in place.

[…]

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately.

Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in health care costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving health care that may no longer be affordable or accessible.

[…]

Given that Republicans have yet to craft a replacement plan, and that unforeseen events might overtake their planned agenda, there might never be a second vote on a plan to replace the ACA if it is repealed. And if a second vote does not happen, tens of millions of Americans will be harmed.

Obama closes his article with a plea to Republican policymakers to heed the physician’s oath: “First, do no harm.”

But it is a sad and frightening reality that many in the GOP, including the president-elect and many in his incoming cabinet, are entirely unconcerned with the harm they will surely do by repealing the law with nothing ready to take its place.

Along with their patriotism, we are left to wonder where the collective conscience of the Republican Party has gone, and just how high a price will the rest of us pay for its absence.