Tom Price, the Georgia Congressman who is President Trump’s nominee to be Secretary of Health and Human Services went before the Senate Finance Committee today—and the grilling he underwent at his confirmation hearing only underlined how hard it will be for Republicans to keep their promise to swiftly repeal and replace the Affordable Care Act, aka Obamacare.

Right now, all is confusion. Congress has set in motion the process of repeal, and on his first day in office, Mr Trump, signed an executive order, directing government agencies to “minimise” the costs of implementing Obamacare. Taken literally, the order could threaten the individual mandate – the requirement that Americans purchase coverage or face a tax penalty for not doing so – and throw health insurance markets into chaos.

That might be acceptable, if Republicans had a ready-made plan to replace Obamacare. But despite voting some 60 times to repeal the ACA since it became law in 2010, they don’t. Mr Trump has declared that a plan was all but ready and would be unveiled once his nominee was confirmed. But Mr Price, who spent most of his time avoiding direct answers, said nothing to bear that out – prompting one Democratic Senator to ask if the president had told a lie. Mr Price ducked that question as well.

The central problems for Republicans are two. First, key provisions of Obama are so popular their removal would cause uproar. These notably include the right of children to stay on their parents’ insurance until the age of 26, and a ban on insurance companies refusing to cover people with pre-existing conditions.

Thousands attend Women's March on Washington Show all 18 1 /18 Thousands attend Women's March on Washington Thousands attend Women's March on Washington Protesters gather outside the White House at the finish of the Women's March on Washington on January 21, 2017 in Washington, DC. Large crowds attended the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Getty Thousands attend Women's March on Washington Protesters hold up signage near the Washington Monument during the Women's March on Washington January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Drew Angerer/Getty Thousands attend Women's March on Washington Protesters gather during the Women's March on Washington January 21, 2017 in Washington, DC. The march is expected to draw thousands from across the country to protest newly inaugurated President Donald Trump. Aaron P. Bernstein/Getty Thousands attend Women's March on Washington Protesters arrive at the Capital South Metro station for the Women's March on Washington on January 21, 2017 in Washington, DC. Following the inauguration of Donald Trump as the 45th president of the United States, the Women's March has spread to be a global march calling on all concerned citizens to stand up for equality, diversity and inclusion and for women's rights to be recognised around the world as human rights. Jessica Kourkounis/Getty Thousands attend Women's March on Washington Protesters arrive on the platform at the Capital South Metro station for the Women's March on Washington on January 21, 2017 in Washington, DC. Following the inauguration of Donald Trump as the 45th president of the United States, the Women's March has spread to be a global march calling on all concerned citizens to stand up for equality, diversity and inclusion and for women's rights to be recognised around the world as human rights. Jessica Kourkounis/Getty Thousands attend Women's March on Washington Demonstrators protest during the Women's March along Pennsylvania Avenue January 21, 2017 in Washington, DC. Hundreds of thousands of protesters spearheaded by women's rights groups demonstrated across the US to send a defiant message to US President Donald Trump. Joshua Lott/AFP/Getty Images Thousands attend Women's March on Washington WASHINGTON, DC - JANUARY 21: Protesters attend the Women's March on Washington on January 21, 2017 in Washington, DC. Following the inauguration of Donald Trump as the 45th president of the United States, the Women's March has spread to be a global march calling on all concerned citizens to stand up for equality, diversity and inclusion and for women's rights to be recognised around the world as human rights. Jessica Kourkounis/Getty Thousands attend Women's March on Washington A marcher holds a sign during the Women's March on Washington January 21, 2017 in Washington, DC. The march is expected to draw thousands from across the country to protest newly inaugurated President Donald Trump. Aaron P. Bernstein/Getty Thousands attend Women's March on Washington A woman chants while attending the Women's March on Washington on January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Mario Tama/Getty Thousands attend Women's March on Washington Protesters attend the Women's March on Washington on January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Mario Tama/Getty Thousands attend Women's March on Washington Protesters march in Washington, DC, during the Women's March on January 21, 2017. Hundreds of thousands of people flooded US cities Saturday in a day of women's rights protests to mark President Donald Trump's first full day in office. Robyn Beck/AFP/Getty Images Thousands attend Women's March on Washington A protester gestures toward the White House on the Ellipse near the South Lawn of the White House during the Women's March on Washington January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Drew Angerer/Getty Thousands attend Women's March on Washington A protester, holding a Donald Trump doll wearing a pink cap, marches in Washington, DC, during the Womens March on January 21, 2017. Hundreds of thousands of people flooded US cities Saturday in a day of women's rights protests to mark President Donald Trump's first full day in office. Robyn Beck/AFP/Getty Images Thousands attend Women's March on Washington Protesters take to the National Mall to demonstrate against the presidency of Donald Trump Washington, DC on January 21, 2017. Hundreds of thousands of protesters spearheaded by women's rights groups demonstrated across the US to send a defiant message to US President Donald Trump. Dominick Reuter/AFP/Getty Images Thousands attend Women's March on Washington Protesters march during the Women's March on Washington on January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. Mario Tama/Getty Thousands attend Women's March on Washington Demonstrators gather on The Ellipse during the Women's March on Washington January 21, 2017 in Washington, DC. Hundreds of thousands of protesters spearheaded by women's rights groups demonstrated across the US to send a defiant message to US President Donald Trump. Zach Gibson/AFP/Getty Images Thousands attend Women's March on Washington Demonstrators march down Pennsylvania Avenue during the Women's March on Washington January 21, 2017 in Washington, DC. Hundreds of thousands of protesters spearheaded by women's rights groups demonstrated across the US to send a defiant message to US President Donald Trump. Zach Gibson/AFP/Getty Images Thousands attend Women's March on Washington Protester's signs are left near the White House during the Women's March on Washington on January 21, 2017 in Washington, DC. Large crowds are attending the anti-Trump rally a day after U.S. President Donald Trump was sworn in as the 45th U.S. president. (Photo by Mario Tama/Getty Images) Mario Tama/Getty

Second, Republicans have promised a system that offers improved benefits, maintains Obamacare coverage but costs less. Squaring that circle is all but impossible. The only specific Republicans agree on is that the replacement should be less bureaucratic and more “patient-friendly.”

To achieve this they pin their faith in the magic of the markets – that improved choice and greater competition between health care providers and drug and insurance companies will increase options and drive prices down. That however rests on the dubious proposition that health care is a market like any other.

Then there is the Medicaid problem. Expansion of Medicaid—the health care coverage programme for the poor brought in by President Lyndon Johnson in 1965—accounts for 11m of the 20m people who have gained coverage under Obama, thus reducing the rate of uninsured to the lowest point in US history.

Right now this expansion is paid for directly by the federal government. Mr Trump and most Republicans however want to replace this system with one of block grants from Washington to individual states. But there is near-universal agreement that this will sooner or later lead to big cuts in in government-subsidised coverage for the poor.

Among Democrats moreover lurks a deeper suspicion: that changes to Medicaid would be but the opening salvo in a grand plan to rein in spending on Medicaid and its sister programme Medicare for the elderly, in part by privatisation.

Republicans of course will not say, repeating their mantra that they want to offer “access” or “opportunity of access” to coverage to all Americans. Whatever that might mean. As Bernie Sanders, the populist challenger to Hillary Clinton for the Democratic nomination, put it at a separate Price confirmation hearing last week, “I have ‘access’ to buying a $10m home, I don’t have the money to do that.”

No wonder Republicans, beyond their non-stop vilification of Obamacare, are so split on what to do. Some want to repeal it at once and let the chips fall where they may. Others insist that the ACA must stay until a comprehensive replacement is settled and ready to go. Some want to allow individual states to keep Obamacare if they wish.