House leaders predict the chamber will approve a measure before President-elect Donald Trump’s inauguration to enable a swift repeal of Obamacare, but their confidence belies the deep confusion and skepticism among Republicans about the risky path to enacting a replacement.

“This is the first of several steps that we will be taking to deliver relief to Americans who are struggling under this law,” House Speaker Paul Ryan told reporters Thursday.

There were still some doubts about whether the measure would advance, with several Republicans saying they intended to oppose the budget resolution—legislation that allows a repeal bill to evade a filibuster in the Senate. With all Democrats likely to oppose the measure, Republicans can afford to lose fewer than two dozen Republicans in the House.

But the narrow 51-48 Senate vote to adopt the budget resolution early Thursday morning intensified the pressure on House Republican holdouts to begin delivering on something the party has been promising for the past seven years.

“We spent 2010, 2012, 2014, 2016 talking about ‘repeal and replace.’ So, no one really wants to stop the momentum on that,” Representative Warren Davidson of Ohio said Thursday.

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Trump has also put added pressure on Republicans to act swiftly, and his pronouncements have scrambled GOP leaders’ plans to delay a replacement for as long as two or three years. Trump this week called for a replacement to occur "simultaneously, essentially," prompting Ryan to insist that congressional leaders are “in sync” with Trump.

“Without getting into all of the legislative mumbo-jumbo, we want to do this at the same time and, in some cases, in the same bill," Ryan said Thursday night during a town-hall meeting on CNN.

Davidson may end up voting for the resolution, but he said he still has concerns about "the way we’re being forced to go about this," since they have yet to lay out any specifics about their replacement plan. Even so, he said he is confident that, ultimately, "we are going to land a good replacement plan."

Representative Richard Hudson of North Carolina said Friday there is "a lot of angst in our state" and that he participated in a telephone town-hall with 12,000 people a day earlier.

"My constituents are freaking out about commercials they are seeing on TV about how they are going to lose their healthcare," he said. Hudson said he tells constituents regarding Republican efforts to devise a replacement plan, "If Obamacare is working for you, we want to hear you say that, too."

Some conservatives, including Representative Tom Massie of Kentucky, say they will vote against the resolution, echoing fiscal concerns that had been voiced by Senator Rand Paul. They are unhappy that the underlying budget envisions adding trillions of dollars to the deficit in the next decade, even though leaders insist the numbers are just placeholders.

Others, including Representative Dave Brat of Virginia, question why Ryan and other Republican leaders haven’t provided a "fuller" description of what the replacement plan will be, and how it will improve the deficit.

Budget Chairman Diane Black of Tennessee on Thursday presented various potential replacement plans during a Rules Committee meeting, but members haven’t coalesced around any of them.

Freedom Caucus Chairman Mark Meadows of North Carolina wouldn’t say how many of the group’s members will oppose the bill, or whether he will. But he has been lobbied heavily by Republican leaders.

"What I’ve been told is there will be a replacement bill plan that gets voted on at the same time we vote on repeal—by same time, plus or minus a week or so," he said. "So, that would mean they are going on parallel tracks, not necessarily the same vehicle, but on two separate vehicles, it appears." That likely means some of the plan will be outside of the reconciliation bill, and could face a filibuster in the Senate.

He said he believes that a repeal could still happen in February, but that it could also bleed over into March.

"Do I believe we can get consensus in the Senate? Not very optimistic that we could get 60 votes in the Senate," he said.

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Among the questions Republicans are struggling to resolve are how to treat states that expanded Medicaid under Obamacare and whether to immediately repeal all of the Obamacare taxes or keep some of them in place for now to ensure funding for a robust replacement.

"The American people are saying, slow down and let’s figure out what’s going on here," said Brat.

"What’s the rush?" said Representative Glenn Thompson of Pennsylvania.

Adding to the angst is the conflicting language used by Ryan and other leaders to explain the strategy.

In his press conference Thursday, Ryan said Republicans are trying to "deliver relief as soon as possible" for a system that is "collapsing." At the same time, he said he envisioned "a thoughtful, step-by-step process."

"That’s going to take time," he added.

And while Ryan promised work on the replacement plan will be a "bottom-up" process using congressional committees, he also said much can be accomplished through executive action by the incoming Trump administration.

Tom Price, the president-elect’s pick to run the Health and Human Services Department, faces a hearing next week in front of the Senate’s health committee, although the key hearing for his confirmation hasn’t yet been scheduled. His confirmation could be delayed well into February.

Democrats, meanwhile, are lining up against the GOP tactics. Representative Jim McGovern of Massachusetts says that by moving forward without telling members what their replacement plan is, Republican leaders are "running the House of Representatives like a Kremlin." He joked that "the plan is to take two tax breaks and call me in the morning."

"Quite frankly I am disappointed in some Republicans who said they did not want to repeal until they see a replacement," McGovern said. "Apparently they are caving, and, you know, that is tantamount to being a cheap date."

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