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In fact, the Affordable Care Act brought the rate of uninsured Americans to a record low 9 percent in 2015. It’s the major achievement of the controversial health care law and one the Obama administration likes to tout whenever it can.

Health and Human Services Secretary Sylvia Burwell did just that in an interview with NPR on Tuesday.

“We have the lowest uninsured rate in the nation’s history,” Burwell said. “Twenty million Americans have insurance that didn’t have insurance before the Affordable Care Act. For many people they consider it just a basic part of their health care.”

But many of those surveyed in a new NPR/Ipsos poll got it wrong. About half believed that the number of people without insurance had increased or stayed the same, or they said they didn’t know what the law’s effect has been on insurance coverage.

That was a failure of communication on the part of the Obama Administration, says Bill Pierce, a senior director at APCO Worldwide, who advises health care companies on strategic communications.

“They needed to use the president more,” said Pierce. “If this was his number one achievement, and something he was proud of doing, it was the kind of thing that he needed to be out there and talking about all the time.”

Democrats were better informed than Republicans, with 54 percent of Democrats saying the law had reduced the number of people without insurance, compared to 41 percent of Republicans.

Pierce said one problem is that the law was passed in 2010 but didn’t go fully into effect for years. In that the time, the web site that housed the insurance exchange, the most public part of the program, failed.

“By the time they insurance rate started to fall, a lot of minds were already set,” he said.

NPR’s poll was designed to gauge the public’s knowledge of some basic aspects of the U.S. health care system. The results come as Republicans on Capitol Hill are working to repeal the law. A Senate was expected as soon as Thursday on an interim step toward repeal.

While many people in the poll were misinformed about the big picture when it comes to Obamacare, they had stronger knowledge about the details of the law.

The majority of those surveyed know that the ACA protects people with pre-existing conditions from being refused coverage and that it requires insurance companies to pay for preventive care.

However, the heated debate during the 2008 presidential race over so-called “death panels” left a mark.

About a third of those surveyed believed Obamacare places limits on end-of-life medical care and another half were not sure. Only 18 percent correctly said that no such limits exist under the law.

Beyond Obamacare, many people had a good grasp of the overall quality of the U.S. health care system.

The majority were aware that Americans generally pay more for health care than people in other countries and that even so, health care outcomes in the U.S. does not have “the best results in the world.”

The poll also reiterated findings from a separate survey from the Kaiser Family Foundation last week that showed that people are about evenly split on their view of the Affordable Care Act.

Still, most people don’t want lawmakers to repeal the law until they have a replacement plan in place. Only 14 percent favor repeal without a replacement plan.

That message seems to have gotten through to lawmakers. Earlier this month, Republican leaders in the House and Senate were advocating an immediate Obamacare repeal, with a slow phase out while they consider ways to replace the law so people who have insurance can still get it.

But many lawmakers walked those plans back this week in statements and via Twitter. Some, including President-elect Donald Trump, said they did not want to see a repeal until a replacement is ready.

“We’re going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously,” Trump said in a news conference Wednesday.

The poll surveyed 1,011 adults on January 4 and 5, 2017.

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Abra and Matt Schultz, both 32, recently built a house in a middle class neighborhood in Pottsville, Pa. Matt works as a carpenter foreman for a construction company. He and Abra, his wife, are right in Trump’s wheelhouse — Republicans in Republican Schuylkill County.

The couple spent December trying to decide whether to buy health insurance or skip it for 2017. They voted for Trump because they were fed up with how much they are paying for health insurance.

In mid-December in the couple’s kitchen, Abra was sizing up their health insurance options. She showed off a thick notebook, along with a file folder with policy document and notes piled as high as a stack of pancakes. “Don’t touch my paperwork — don’t even try to touch it,” Abra joked to Matt. “I get so stressed out about it. I’ll not pick one until the very last minute, like that deadline day.”

Matt makes good money but he usually gets laid off in the winter when construction slows down. For the last few years, he and Abra have bought coverage on HealthCare.gov, the Affordable Care Act exchange.

But they’re in a tough spot. They make too much money to get a subsidy to help them pay for insurance. Subsidies are available only to those who make under 400 percent of poverty or about $97,000 for a family of four. But while the Schultzes don’t qualify for help, paying full price for health insurance stretches their budget to the limit.

Two years ago, when they first signed up for insurance on the exchange, Abra says they were paying $530 a month for a plan they liked. The price rose a little for 2016, but the options for 2017 went up a lot — about 30 percent on average in Pennsylvania.

“We have one for $881, one for $938, one for $984, like the deductibles are — look, these are insane,” Abra said, as she checked the exchange website for monthly premiums. “The one that we would be stuck with would be the silver. This is $881.50, and our deductible would be $7,000.”

It’s frustrating, she said, because she and her husband are relatively healthy and haven’t needed that much care. Add to that the cost of a separate partially subsidized insurance policy for their two children, and the family is expecting to pay at least $14,000 in health premiums.

Abra Schultz resented the mandate to buy health insurance from the beginning. And she liked what Trump he said about the Affordable Care Act on campaign stops, like one in King of Prussia in November, just before the election.

“Obamacare has to be replaced, and we will do it and we will do it very, very quickly,” Trump said in his speech. “It is a catastrophe.”

Abra said she wouldn’t mind being in health insurance limbo while Trump and lawmakers debate the future of Obamacare.

Larry Levitt with the Kaiser Family Foundation said he understands her frustration with the law. “These are people who are playing by the rules, and doing the right thing, and they feel like they’re getting the shaft,” he said.

No one likes higher and higher premiums, he says, but there’s a trade-off. “Before the ACA, to get insurance on your own, you had to fill out a medical questionnaire, and an insurer would only take you if you were reasonably healthy,” Leavitt said. “That kept premiums down, but it’s because sick people were excluded from the market altogether.”

Levitt said the law’s goal was to to get insurance to a point where premiums only increase slightly every year while everyone can still get coverage, no matter their preexisting condition. And he says, any replacement plan devised by Republicans will have upsides and downsides, just like the Affordable Care Act. “If this were easy, it already would have happened,” he said.

Abra said she understands the broader picture, but she needs to focus on what’s best for her family — affordable health insurance.

“[Trump] just wants to fix what needs to be fixed, which I think is wonderful news,” she says.

Abra did decide on a policy for her and her husband — she selected the plan that costs $938 a month because she wants to keep her current doctor. But if lawmakers eliminate the penalty for people who don’t get insurance, she might take a risk and drop the coverage.

This story is part of a reporting partnership with NPR, WITF’s Transforming Health project and Kaiser Health News.

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Darlene Hawes lost her health insurance about a year after her husband died in 2012.

Hawes, 55, is from Charlotte, N.C. She ended up going without insurance for a few years, but in 2015 she bought coverage on HealthCare.gov, the Affordable Care Act marketplace, with the help of a big subsidy.

“I was born with heart trouble and I also had, in 2003, open-heart surgery,” she says. “I had breast-cancer surgery. I have a lot of medical conditions, so I needed insurance badly.”

After the results of the 2016 election came in, she was scared she’d lose her insurance immediately. For years, Republicans have vowed to scrap the health care law. The new Congress is already working on a plan to undo the Affordable Care Act. But they have not settled on how to replace the health care structure that Obamacare set up.

Hawes is one of about 550,000 North Carolinians who relies on the Obamacare marketplace for health insurance. She was relieved after she talked with an enrollment specialist last month who told her she can renew her policy for 2017.

“And I’m like, ‘Oh my Lord, did she just say that?’ ” Hawes asks with a laugh. “It’s just like a whole load of burdens just fell off of my back because all the years I haven’t been covered since my husband passed away — I don’t want to be sad again. I was very sad.”

Most health care researchers and policy analysts agree not much is likely to change in 2017.

“Even the Republican Congress in one of their most recent bills to repeal it, they put in a two-year transition period, so that the premium subsidies and the other provisions of the law that are fundamental wouldn’t be repealed for a couple of years,” says Sabrina Corlette, a research professor at Georgetown University’s.

Some Republican leaders say repeal should happen immediately with a transition period to come up with a replacement.

Still, the CEO of HealthCare.gov, Kevin Counihan, says he can’t guarantee coverage will remain. “It’s not my place to promise anything about a new administration,” he says. “But what I can tell you is not only are we moving forward, but our enrollment is higher than expected.”

At the end of 2016, enrollment for 2017 plans spiked and as of the end of December, North Carolina has the third-highest enrollment for 2017 plans among states using HealthCare.gov.

Julieanne Taylor with Legal Services of Southern Piedmont is helping people sign up. She says about a third of them have asked about the election.

“But generally when we’re calling, people are really excited to have their appointment and come in and look at the plans for 2017,” she says. “I think they’re mostly interested in how much they’re going to be paying.”

In some ways, North Carolina is in tough shape. Premiums are going up and insurance companies have dropped out, leaving Blue Cross Blue Shield of North Carolina as the only insurer in 95 percent of the state.

Blue Cross actuary Brian Tajlili says it’s simply an expensive market that has older, sicker people who cost more to cover.

“There is continuing demand for services and continuing high utilization within this block of business,” he says.

What he calls “this block of business” means the customers who buy insurance on the exchange. It’s a small slice of the overall health insurance market, because most people are covered through work or Medicare. The overwhelming majority of consumers who buy coverage on the exchange get federal subsidies that greatly reduce what they pay.

Still, it’s been a turbulent market for consumers and insurers. Over the past two years, Blue Cross has lost $400 million in North Carolina on that part of its business.

Amid the post-election uncertainty, Tajlili says Blue Cross is committed to offering plans in 2017.

“2017 will be another pivotal year for us as we look at the individual market,” he says.

One of Blue Cross’ new customers will be Sara Kelly Jones, 46, who works at Letty’s restaurant in Charlotte, N.C. She recognizes Obamacare isn’t perfect. But before the law, health insurance was a financial vise that kept tightening on her.

“I could not afford it at all,” she says. “Every year it was going up $100 to $120, $150 a month. It got to the point where it was going to be at least $200 more a month than my mortgage.”

But under Obamacare, Jones qualifies for a subsidy. Her premium will go up with Blue Cross, but she says she can afford it with that help.

Jones says the political debate over the law ignores people like her.

“I’m terrified,” she says. She’s worried about the Republican Congress’ pledge to scrap and replace Obamacare without presenting a detailed proposal. “If there had been any plan outlined that wasn’t just some vague, ‘We’re going to replace it with something awesome,’ ” she says she’d rest easier. “They have no plan! What on Earth are you going to do with all these people, myself included, that are counting on this?”

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News. You can follow Michael Tomsic on Twitter: @michaeltomsic.

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By many standards, Mireille Kamariza is at the top of the world.

She’s a graduate student at one of the world’s top universities, working on her Ph.D. with one of the world’s top chemists. And she’s tackling a tough problem — tuberculosis — that sickens nearly 10 million people a year.

Earlier this year, 27-year-old Kamariza and her adviser unveiled a potential breakthrough in fighting TB: a way to detect the culprit bacteria faster and more accurately.

But for Kamariza, the fight against TB is not just about scientific progress and prestige. It’s personal.

Kamariza grew up in the small African country of Burundi, where many around her were stricken with TB. A close relative lived with the disease for years — and eventually died from it. It was common for people in her town to get sick with TB and “wait to see if you’d die — and if you survived, you’d just kind of live with it.”

A World Health Organization report released in October states that an estimated 10.4 million people were infected with TB in 2015, up from previous years — and 1.8 million died from the disease.

TB is still a stigmatized disease in Burundi, so Kamariza doesn’t want to be specific about her relative’s identity. But, she says, he most likely didn’t get treated “because he didn’t know you could be treated, and even if he did know, [treatment] was far from where he was — and expensive.”

Kamariza’s journey hasn’t been easy. In Burundi, it’s rare for girls to attend college — not to mention work with world-class scientists.

“Science was something that Europeans and Americans did,” she says. “It was for other people — not for me.” When she was in high school, she didn’t have a clue about science careers. Neither did her parents.

“I never dreamed [Kamariza] would become a scientist because it is a career path that is unknown in Burundi,” says Denise Sinankwa, Kamariza’s mother.

Sinankwa had her hands full when Kamariza was young. She and her husband were raising four kids during a bloody civil war. Nearly 300,000 civilians were killed. The family moved a lot, and Sinankwa often worked multiple jobs to feed the family.

But Sinankwa still pushed Kamariza to do well in school. She wanted her daughter to land a good-paying job and be able to support herself.

Kamariza considers herself lucky. She attended a government-managed Catholic school, where “things were more rigorous” than other public schools. The “nuns’ school” instilled a mindset most of her peers lacked because generally girls “were raised to be a wife,” she says.

Kamariza wanted to pursue studies in the U.S., where her second-oldest brother had already landed. So, when she was 17, Kamariza packed up her belongings and traveled with her third brother half way around the world. She went to San Diego in the fall of 2006 and moved into a tiny studio apartment with her brothers. The four worked various jobs at grocery stores, restaurants, retail shops — “whatever we could get to pay the bills,” Kamariza says. Their earnings also paid for classes at a junior college.

Then Kamariza’s hard work started to pay off.

At San Diego Mesa College, she found a life-changing mentor. Her chemistry teacher, Saloua Saidane, was a fellow French-speaking African. Born to illiterate parents in Tunisia, Saidane was one of 12 children and knew what it was like to be a poor immigrant kid pouring herself into school as the only way to a better future.

“Kamariza was serene yet determined,” Saidane says. “She worked hard. She saw the opportunity to have a good life, a life different from what she left behind.”

Saidane started Kamariza’s journey into science. “She really pushed me and kept motivating me and telling me I should aim high. Whatever she told me, I did,” Kamariza says.

After quitting her job at Safeway to focus on school, Kamariza got into the University of California, San Diego, and began undergraduate studies. Through a National Institutes of Health diversity scholarship, Kamariza spent summers doing biology research. In 2012, she joined Carolyn Bertozzi‘s lab — then at the University of California, Berkeley, now at Stanford University — as a graduate student.

Kamariza wanted to focus on infectious disease. So she started brainstorming with another graduate student to figure out a quicker, better way to diagnose TB.

They eventually came up with a new test that recognizes a sugar, called trehalose, that is uniquely found in TB bacteria. In the presence of a special substance, TB bacteria cells glow green, making the microbes easy to spot on microscope slides of an infected person’s mucus or saliva.

Current TB tests are laborious and not very sensitive — some infections are missed. TB cultures are more reliable but take six weeks to produce a result. Kamariza — and other researchers elsewhere — are creating methods that could make TB diagnoses simpler and more accurate.

Kamariza’s method looked promising this year when she and her colleagues tested it on a small batch of samples from patients in South Africa. But the tools are still in the developmental phase. Larger, more rigorous studies are needed for the method to be considered for use in clinics.

Though unfinished, the research drew heavy crowds when Kamariza presented her data on a poster at a TB conference in September in Paris. Considering her improbable journey — from a child witnessing the tragedy of this disease to a young researcher contributing toward its eradication — “the whole experience is surreal,” Kamariza says.

“A lot of hard work, a bit of luck, perseverance and relentless support from friends and family are what got me here,” says Kamariza, She hopes her experience can “encourage others like me to pursue their passions, no matter the obstacles.”

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The halls of the Kiambu County Hospital just outside Nairobi are empty. This is normally a bustling place but on Thursday entire wings are closed.

Only in the emergency room are there a scattering of patients. Moms with babies sit languidly on metal chairs. Men with broken bones and some with serious injuries are just hoping to be treated.

But they probably won’t be seen by doctors. A doctor’s strike that began last month in Kenya has now entered its second month. Physicians at public hospitals want more money and better medical equipment, but the government says it can’t afford to meet their demands.

The strike has left millions of Kenyans without proper health care and has also overwhelmed some of the country’s private hospitals.

The nurses at the public hospitals are not on strike, so they’re doing whatever they can. They’re the ones running the ER. But a patient who needs complicated care and can’t afford a private hospital is out of luck.

The only doctor I found at the Kiambu hospital is David Kariuki, who is on strike but showed up to perform his administrative duties.

“The current strike is about better working conditions for doctors, especially those within the public health sector,” he said.

A doctor right out of school in Kenya makes about $10,000 a year in the public health system. To earn more money, many of them are lured abroad or into the private hospitals that many Kenyans can’t afford.

That means, Kariuki said, that “the public health care system continues to be strained, because you have fewer doctors to see a growing population, so everyone would get overworked” and more stressed out.

And it’s not like there were a lot of doctors on duty before the strike: 5,000 physicians in the public sector serve a population of nearly 50 million.

In the emergency room, I find Masa Mawili, who came to the hospital because of his foot. It was so swollen that it hardly fit in his sandal, and the swelling extended all the way to his calf. He doesn’t know what caused the swelling.

He said he had already seen the nurses but they couldn’t tell him what was wrong with his foot. So he sat and waited hours in the hope that a doctor would show up — some of them have been working despite the strike.

On Wednesday, Kenyan President Uhuru Kenyatta met with the Kenya Medical Practitioners, Pharmacists and Dentists Union for hours. Late at night, his government put out an offer: Some doctors would get a more than 100 percent raise, others significantly less.

The doctors are supposed to respond by Friday, but they seem determined to hold out for the 300 percent raise that the government agreed to in a 2013 collective bargaining agreement but has since walked away from.

But it’s not just about the money.

“The CBA [collective bargaining agreement] once signed will make sure more doctors are trained to improve on service delivery,” the union tweeted.

At the hospital I visited, some patients sided with the doctors but others took the government’s side.

Paul Kagiri, whose college-age son was given the OK to go to college after a physical at the hospital, said that what the doctors are asking for is “very, very, very high.”

The government can’t afford to pay them. And there are reports of people who sought help at public hospitals and ended up dying. Right now, he said, it’s time to think about the wanjiku — the ordinary people.

“Only the wanjiku right now is suffering a lot,” Kagiri said. “And instead of wanjiku suffering why [don’t the doctors give back to the public?”

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President Obama and Vice President-elect Mike Pence were both on Capitol Hill Wednesday, making competing cases for and against Obama’s signature health care law. Republicans have promised to make repeal of the Affordable Care Act their first order of business, once they control both Congress and the White House.

Obama is urging his fellow Democrats to do what they can to preserve the law. If that fails, Democrats plan to hold Republicans accountable for any disruption the repeal may trigger. Both sides are trying to position themselves as the protectors of Americans’ health care, while branding the other party as a dangerous threat.

As usual, the truth may be somewhere in between. Here we take a closer look at some of the claims being floated by both parties:

President-elect Trump got the ball rolling with a pre-dawn tweet, cautioning that “Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases……”

Republican House Speaker Paul Ryan echoed Trump. “This law has failed,” Ryan told reporters. “We know that things are only getting worse under Obamacare. This is about people paying higher premiums every year and feeling powerless to stop it. It’s about families paying deductibles that are so high it doesn’t even feel like you have health insurance in the first place. And in so many parts of the country, as you’ve always heard, even if you want to look for better coverage, you’re stuck with one option. One choice is not a choice. It is a monopoly. The health care system has been ruined, dismantled under Obamacare.”

CLAIM: Obamacare suffers from “massive premium increases”

FACT CHECK: True in some cases, but it’s also relative. Obamacare is also actually cheaper on average than the typical employer-provided plan.

Many people shopping for health insurance on the government-run exchanges set up by Obamacare have seen double-digit premium increases this year.

The average cost of a benchmark plan rose 25 percent nationwide, but there was considerable variation from state to state. Premiums in Arizona jumped an average of 116 percent, while premiums in Indiana and Massachusetts actually went down. Most people buying insurance on the exchanges receive a government subsidy, which helps defray the cost.

A study by the Urban Institute last year found that even without the subsidy, insurance policies sold on the exchanges cost about 10 percent less than the typical employer-provided plan. Exchange policies might seem more expensive, because part of the cost of workplace plans is typically paid by employers, and thus largely invisible to the employee.

CLAIM: “You’re stuck with one option” under Obamacare

FACT CHECK: Not true for the majority, but it has increasingly become the case.

Obamacare insurance exchanges have grown less competitive, as some insurance companies have lost money and left the market. One in five customers on the exchanges had just one insurance company to choose from this year (up from 2 percent in 2016). Nearly 6 in 10 customers have a choice of three or more companies. The lack of competition, which can lead to higher prices, tends to be worse in rural areas and the South.

Insurance companies have struggled, in part, because fewer young, healthy people have signed up for coverage than forecast. Backers of the Affordable Care Act say that could be remedied with more generous subsidies to encourage sign-ups or bigger penalties for those who fail to enroll. Obama also renewed the idea of a public insurance option to supplement private offerings.

CLAIM: “The health care system has been ruined, dismantled under Obamacare”

FACT CHECK: Prices were going up at faster rates before Obamacare.

Most Americans under age 65 still get health insurance through an employer, although the percentage has been slowly dropping. The cost of employer-provided coverage has gone up since passage of the ACA. But the annual price hikes were considerably larger in the decade before the law was passed. Some of the savings from slower premium growth have been offset by higher deductibles.

While Republicans highlight the shortcomings of the Affordable Care Act, Democrats warn that repeal would be much worse.

“Instead of working to further ensure affordable care for all Americans, [Republicans] seek to rip health care away from millions of Americans, creating chaos in our entire economy,” Democratic Senate leader Chuck Schumer said Wednesday. He and his fellow Democrats offered a mocking slogan for the GOP: “Make America Sick Again.”

Schumer also suggested that repealing Obamacare would hurt rural hospitals, “right in their heartlands. The minute they enact this repeal, [hospitals] are going to suffer dramatically,” he said.

CLAIM: ACA repeal would “rip health care away from millions”

FACT CHECK: True, if Republicans don’t protect them or replace ACA with something that provides coverage.

The Affordable Care Act has expanded health care coverage to some 20 million Americans through a combination of subsidized individual policies, expanded Medicaid, and allowing young adults to stay on their parents’ plans. The uninsured rate has fallen to an all-time low of around 10 percent. Coverage would be higher still if 19 states had not refused to expand Medicaid.

If the Republican-controlled Congress repeals the Affordable Care Act, many of those newly insured Americans would be at risk of losing coverage. In addition, millions more who buy individual insurance policies off the exchanges could be at risk, if that market is disrupted. The Urban Institute estimates as many as 30 million people in all could lose their health care coverage, doubling the uninsured rate.

Republicans have promised an orderly transition as they work toward a replacement for Obamacare, and it’s possible the effective date for any repeal could be delayed for a number of years. Insurance companies, however, may be reluctant to participate once it’s clear Obamacare’s individual market is being phased out.

CLAIM: Rural hospitals are going to suffer

FACT CHECK: True, if repealed outright, but it’s also because of the way the ACA was structured in the first place.

The concern for hospitals reflects a trade-off when the ACA was passed seven years ago. The government scaled back what it pays hospitals for treating Medicare patients and the indigent, with the expectation that would be offset by payments from millions of newly insured.

Hospitals worry that if repeal of the law cuts insurance coverage, but doesn’t restore other payments, they could be left with a mountain of unpaid bills. The American Hospital Association and the Federation of American Hospitals urged Congress and the incoming Trump administration to either protect insurance coverage or replace the hospital payments.

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Congress is back in session on Tuesday, and leaders of both houses say their first order of business will be to repeal Obamacare.

If they do that, it will be a slap in the face to President Barack Obama just three weeks before he leaves the White House. The Affordable Care is the outgoing president’s signature achievement, marked by an elaborate signing ceremony in March 2010 at the White House, with lofty speeches from the vice president and Obama himself.

“Today, after almost a century of trying, today after over a year of debate, today, after all the votes have been tallied, health insurance reform becomes law in the United States of America,” Obama said that day, to long applause from the assembled crowd.

And Joe Biden famously leaned over to remind the president that it was “a big ***ing deal.”

But Republicans have been vowing to repeal the law since the day it passed, and they’ll soon have a sympathetic president in the White House to sign whatever bill they send him.

“We will repeal the disaster known as Obamacare and create new health care, all sorts of reforms that work for you and your family,” President-elect Donald Trump vowed last month in Orlando.

That new health care plan hasn’t been fleshed out yet by Trump or his allies in Congress. So they say they’ll vote to get rid of Obamacare, but delay its demise until they come up with a replacement that will cover the millions of people who have insurance thanks to the law.

But insurance companies and health care analysts are worried.

“I don’t see how you talk to any [insurance] carrier and give them any desire to hang around to see what they replace it with,” says Dr. Kavita Patel, an internist at Johns Hopkins University Hospital and senior fellow at the Brookings Institution. “Why would you stick around for that?”

Patel worked in the White House and helped create the Affordable Care Act. But she’s not alone in her concern.

Last month the health insurance trade group America’s Health Insurance Plans sent a letter to lawmakers asking them to keep in place many of the financial incentives that are central to the law — including subsidies for patients to help them buy insurance and cover copayments, and a provision that eliminates some taxes on insurers.

The American Academy of Actuaries also warned in its own letter that a repeal of the ACA without replacing it would be dangerous to the long-term health of the insurance market.

Still, Republicans appear determined to move ahead with the vote as soon as this week.

Some history:

Democrats rammed the Affordable Care Act through Congress in 2010 with no Republican support.

It was a huge, complicated law and, like most legislation, it was flawed. Over the subsequent six years, Republicans, who were angry at the way the Affordable Care Act was passed, refused to cooperate in any actions that would be seen as helping it succeed. Instead, they promised in speeches and television interviews to repeal it entirely. In fact, the House has voted more than 60 times over the years to do just that.

“There’s no getting around the fact that lots of Republicans campaigned hard against the ACA and a lot of them won, including the person at the top of the ticket,” says James Capretta, a scholar at the conservative American Enterprise Institute.

But even with control of both chambers of Congress and with Trump in the White House, Republicans can’t simply repeal Obamacare. They would need the help of at least a handful of Democrats to overcome a filibuster.

Democrats can’t, however, filibuster budget bills. So Republican leaders have decided to defund Obamacare, eliminating the tax penalties for those who don’t buy insurance and the subsidies to help people pay their premiums. Essentially, that guts the law’s main elements.

The problem for Republicans is that today, an estimated 20 million people get their insurance through Obamacare. About 10 million buy policies through the exchanges set up by state and federal governments, and most of those patients get subsidies to help pay the premiums.

And millions more are covered because the law allows states to expand the number of people who are eligible for Medicaid, the health insurance program for the poor.

So people who had pre-existing conditions that shut them out of the insurance market before the ACA passed, or people who had reached insurer-imposed lifetime benefit limits, generally like the law.

But, then there are people like Will Denecke, who is mad because his insurance costs have gone up since Obamacare passed. Before the law was enacted, he spent about $340 a month on health insurance.

“Incredibly, we got a notice from my health care company, Moda, which has been having financial problems, that my premium was going up to $930,” he said last October.

He’s a self-employed urban planning consultant in Portland, Ore., and, unlike most people in Obamacare, he makes too much money to qualify for government subsidies.

“I’ve had health insurance my whole life, but it’s just offensive in principle to think of spending $1,000 a month on health care insurance when there is a good chance I won’t need it,” he said.

He was considering just letting his coverage lapse.

And, on the other side, you’ve got people like Leigh Kvetko of Dallas. She takes 10 medications every day because she’s had two organ transplant procedures, and the drugs are part of her daily regimen to survive. After Obamacare passed, she was able quit her job at a big company and start a business with her husband, because she could finally get individual insurance.

“This particular plan, the fact that they cannot discriminate against me because of how I was born, was a lifesaver, literally,” she says.

House Ways and Means Committee Chairman Kevin Brady told the Washington Times last month that consumers needn’t worry. “We can assure the American public that the plan they’re in right now, the Obamacare plans, will not end on Jan. 20, that we’re going to be prepared and ready with new options tailored for them,” he said.

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