While Republicans have projected confidence about repealing and replacing Obamacare since the election, they have yet to agree on a common framework for the system that should replace the status quo, largely because many Republicans, including President Trump, are loathe to support legislation that might jeopardize the coverage that more than 20 million Americans now rely on.

Trump as well as many GOP members of Congress have said they want to maintain popular provisions of the law, such as the prohibition on insurers discriminating based on pre-existing conditions and the ability for adults to remain on their parents' insurance until 26. Similarly, many Republicans from states that have expanded Medicaid want to maintain the federally-funded coverage that many of their constituents now rely on.

However, a sizeable chunk of conservative hardliners in the Republican caucus say they will settle for nothing short of a full Obamacare repeal. They are against maintaining the Medicaid expansion and some have also signaled opposition to proposals for a health plan that would include refundable tax credits aimed at helping low-income people purchase private plans.

How Congressional leaders will be able to reconcile these conflicting views within the party remains unclear. Ryan and others have only said that they are in the process of drafting legislation but have not made public what the bill will look like. Sen. Rand Paul, R-Ky., an outspoken supporter of a full repeal of the ACA, ridiculed party leaders last week, accusing them of hiding the draft in a locked room in the basement of the U.S. Capitol. 

Trump himself has appeared to dither on what to do about the ACA and when it should be done. He has publicly suggested on occasion that the GOP should simply let Obamacare "fall of its own weight" to avoid receiving blame from voters, while other times he has insisted that the party repeal and replace the legislation.