WASHINGTON — Vice President-elect Mike Pence and the top Republicans in Congress made clear on Wednesday, more powerfully and explicitly than ever, that they are dead serious about repealing the Affordable Care Act.

How they can uproot a law deeply embedded in the nation’s health care system without hurting some of the 20 million people who have gained coverage through it is not clear. Nor is it yet evident that millions of Americans with pre-existing medical conditions will be fully protected against disruptions in their health coverage.

But a determined Republican president and Congress can gut the Affordable Care Act, and do it quickly: a step-by-step health care revolution in reverse that would undo many of the changes made since the law was signed by President Obama in March 2010.

Step 1: Defang the filibuster

The Senate intends to pass a budget resolution next week that would shield repeal legislation from a Democratic filibuster. If the Senate completes its action, House Republican leaders hope that they, too, can approve a version of the budget resolution next week. Whether they can meet that goal is unclear.