Republicans are serious about reviving attempts to repeal and replace the Affordable Care Act, and providers and industry groups are already getting nervous.

During an early morning tweetstorm on Monday, President Donald Trump said "Repeal and Replace" is "getting done," despite several failed attempts last year.

....We had Repeal & Replace done (and the saving to our country of one trillion dollars) except for one person, but it is getting done anyway. Individual Mandate is gone and great, less expensive plans will be announced this month. Drug prices coming down & Right to Try! — Donald J. Trump (@realDonaldTrump) June 4, 2018

Early premium filings in several states indicate consumers may be facing double-digit premium increases in 2019. Insurers have blamed uncertainty around the ACA and the repeal of the individual mandate specifically as the reason for those increases. The Center for American Progress estimates Trump administration policies changes will account for an average increase of $1,000 on ACA plans.

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Despite those early filings blaming GOP-led policy changes, it appears some congressional Republicans are still itching for a complete repeal.

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Trump's tweet follows a whitepaper (PDF) released by Sen. Bill Cassidy, R-La., last week that outlines changes to the healthcare system, including proposals similar to last year's Graham-Cassidy that would have converted Medicaid to a block grant system in some states.

Last year's bill received nearly unanimous condemnation from healthcare groups who said it would lead to loss of coverage and reduced payments to providers.

Sen. Lindsey Graham, R-S.C., has also said he is working on an updated version of the bill alongside conservative groups including the Heritage Foundation. The Washington Examiner reported that policy recommendations from the groups could be released as early as this month.

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Congressional Republicans have much less wiggle room than last year to try to repeal the ACA, following the loss of both a Senate and House seat. The GOP currently holds the Senate 51-49 as Sen. Susan Collins, a critical holdout vote in last year's failed attempts, has already indicated she is not looking for a Graham-Cassidy 2.0.

Susan Collins answers simply “no” when reporter asks if she wants to try graham cassidy again — Peter Sullivan (@PeterSullivan4) June 4, 2018

Despite the GOP's steep climb, providers and advocacy groups aren't taking repeal talks lightly.

"This is a serious effort that needs to be taken seriously," Dan Mendelson, CEO at Avalere Health, told FierceHealthcare. "They will likely run into the same problems as last time, but that won't stop them from trying."

He added that even if discussions don't lead to passed legislation, providers could still feel the impact.

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"Every time repeal is proposed, it weakens the exchanges due to market confusion," he added. "If consumers think the marketplace is in danger they'll likely bypass the system, possibly going without care. It becomes harder for providers to operate not knowing the future of coverage or regulations."

The Centers for Medicare Advocacy said it's hard to predict how Congress will approach introducing such legislation before the midterms.

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"All threats to healthcare and coverage protections should be taken seriously, especially any proposals that would likely raise costs and limit access to coverage," David Lipschutz, a senior policy attorney for the group, told FierceHealthcare.

"Given how the ACA repeal efforts played out last year, it is difficult to make predictions about what Congress might do next."