Now, a third "R" word is creating heartburn for GOP leaders: "Repair."

Republicans in Congress are currently drafting legislation to repeal significant chunks of the Affordable Care Act and mapping out ways to replace what they eventually roll back. But increasingly, top lawmakers are tempering their rhetoric as they confront the monumental challenge of dismantling a law that covers 20 million people.

At a House subcommittee hearing Thursday morning to debate health care draft legislation, Republican Rep. Leonard Lance stressed that the party wants to "repair the ACA."

"We want to repair the ACA and I have never favored its repeal without a replacement," Lance said. "I think it needs to be repaired and we are trying to focus on repairing it and that is why we're conducting this hearing along with other hearings."

Those comments echoed those of Republican Sen. Orrin Hatch and others from earlier in the week. Hatch, the top Republican on the Senate Finance Committee that has significant jurisdiction over health care, told CNN that his party should "try and repair the law."

"I'm for repealing it and starting over, but you can certainly look at the good things that may be part of the law. There are some good things that we would put in any bill," he said.

That notable shift in rhetoric among his colleagues had House Speaker Paul Ryan on the defensive on Thursday.

At a news conference, Ryan insisted that for all the talk about repairing President Barack Obama's legacy health care law, the GOP still fully intends to "repeal and replace" Obamacare.

"There's just a miscommunication or misinterpretation of what we're trying to say. Our job is to repair the American health care system and rescue it from the collapse that it's in," Ryan said. "And the best way to repair our health care system is to repeal and replace Obamacare. It's not an either-or."

Ryan's explanation is unlikely to appease Democrats across the political aisle, who are eager to point out the GOP's shifting messaging.

House Minority Leader Nancy Pelosi said that there has been a "vocabulary" change among Republicans recently.

"I think that some of their vocabulary is changing on the subject. They're using words like 'rebuild' or those kinds of words," Pelosi told reporters. "You'll hear less and less of 'repeal.'"

She laughed off the explanation from Ryan that Republicans are simply referring to repairing the health care system -- not the health care law.

"The health care system is what it is," Pelosi said. "They have had seven years to come up with (a plan) and so far we hear vocabulary changes and the rest."

Other Republicans, like Sen. Rob Portman, downplayed the significance of the word "repair" on Thursday and insisted that the party's overarching goal remains the same.

"I use 'fix,' I use 'repair,' I use 'replace.' I think they all mean the same thing to me," Portman said.

The Ohio Republican pointed to the pre-existing conditions piece of Obamacare as an example of a part of the law that even Republicans support preserving.

"You could say that's 'continuing' or that's 'fixed' or 'replaced' or whatever," Portman said. "There are aspects of the Affordable Care Act that some of us have all along said are necessary."