Vice President Mike Pence spoke at Senator Joni Ernst’s (R-IA) fundraiser, urging lawmakers to repeal and replace Obamacare.

Pence declared, “Iowa is facing a healthcare crisis under Obamacare and it’s high time we take action.”

“That’s why Congress must come together under the leadership of President Donald Trump and relieve Iowa and relieve America and repeal and replace Obamacare,” Pence added.

Medica, a major Obamacare insurer in Iowa, announced in May that it may pull out of Iowa’s Obamacare exchange. Aetna and Wellmark Blue Cross Blue announced this year it will exit the marketplace in 2018.

“We’re going to give states like Iowa the flexibility you need to care for the most vulnerable in this state — the Iowa way,” the vice president remarked.

Some establishment Republicans doubt whether the Senate can repeal Obamacare by the end of the summer, arguing that a lack of Republican consensus will prevent a fast repeal process.

Senator Richard Burr (R-NC) said last week that he believes a health care deal will not pass through the Senate this year.

“It’s unlikely that we will get a health-care deal,” Burr admitted. The North Carolina senator said that the House-passed GOP health plan was “dead on arrival,” and that “I don’t see a comprehensive health care plan this year.”

Majority Leader Mitch McConnell told Reuters recently, “I don’t know how we get to 50 at the moment.”

The Senate’s working group on health care will bear the burden of drafting a Republican health care bill. Members of the working group include Sens. Mitch McConnell, Bob Portman (R-OH), John Cornyn (R-TX), John Thune (R-SD), Mike Enzi (R-WY), Orrin Hatch (R-UT), Lamar Alexander (R-TN), Tom Cotton (R-AR), Cory Gardner (R-CO), Ted Cruz (R-TX), John Barrasso (R-WY), and Pat Toomey (R-PA).

Senate Republicans will consider adding state waivers for Obamacare regulations, similar to the House’s American Health Care Act (AHCA). The Congressional Budget Office (CBO) reported that the AHCA’s state waivers for Obamacare regulations such as community ratings and essential health benefits would reduce health premiums substantially.

The CBO’s report estimates that states that repeal some of Obamacare’s regulations would experience 20 percent lower premiums over the next ten years. States that repeal all of Obamacare’s essential health benefits and community ratings would experience the lowest average premiums compared to states that retain all or some of Obamacare’s regulations. The CBO also projected that young and healthy Americans would experience substantially lower average health premiums through the state waivers.

Moderate senators such as Sen. Bill Cassidy lead another camp that wants to auto-enroll Americans without health insurance into a basic, catastrophic health care plan, paid for by an individual’s federal tax credit. Cassidy’s camp argues that this would force more healthy people into the Obamacare exchanges to balance out the costs of sick and older American.

The Louisiana senator explained, “Your best way to lower premiums is to expand the risk pool.… Auto-enrollment would allow expansion of the risk pools.”

Despite the Senate’s deliberations, Pence told Fox News host Sean Hannity that he remains “cautiously optimistic” that an Obamacare replacement could pass before 2018.

“I’m cautiously optimistic that could come the end of this year, we’re going to deliver on repealing and replacing Obamacare; we’re going to pass tax cuts and you’re going to see an economy roaring and continue to grow under a president who is fighting every day for the forgotten men and women of America,” he said.