Here is the problem Republicans face with their opposition to the 2010 health-care law signed by President Barack Obama: Getting rid of it without approving a substitute would increase the federal debt, provide wealthy people with a tax cut and cause as many as 20 million Americans to lose their health care. Although Vice President Mike Pence told CNN last week that “step one is to repeal the taxes and the mandates” in the law known as Obamacare and “at the same time pass a replacement bill,” neither he nor congressional Republicans have provided specifics of a plan.