In an interview with reporters on Capitol Hill, Alexander said the goal of Republicans was to "be the rescue party instead of the party that pushes millions of Americans who are hanging by the edge of their fingernails over the cliff."
Alexander, the chair of the Health, Education, Labor and Pensions Committee that will play a central role in repealing and replacing Obamacare, signaled that the process will have to be incremental rather than rapid if Republicans want their plan to succeed.
Since Donald Trump was elected last week, Republicans have been clear that getting rid of Obamacare is a high priority. But actually following through may take some more time.
"Eventually, we'll need 60 votes to complete the process of replacing Obamacare and repealing it because Obamacare was not passed by reconciliation it was passed by 60 votes. And it was cleaned up by reconciliation because Scott Brown won his election," Alexander said. "Before the process is over, we'll need a consensus to complete it, and I imagine this will take several years to completely make that sort of transition to make sure we do no harm, create a good health care system that everyone has access to and that we repeal the parts of Obamacare that need to be repealed."
Alexander's comments offer insight into what is sure to be a complicated and politically fraught process, but he remained vague on details. Alexander said he sees major problems with the Obamacare exchanges, but assured reporters that he agreed with President-elect Trump's position that people with pre-existing conditions should still be protected under the law.
"The exchanges are the first problem, they need to be repealed, the individual mandate needs to be repealed. There are a number of things that need to be repealed, but I think what we need to focus on first is what would we replace it with and what are the steps that it would take to do that?" he said. "Preexisting conditions will stay. There is no way the Congress is going to repeal preexisting conditions. it might take a different form, but people with preexisting conditions are going to be able to buy insurance in any replacement plan Republicans put forward."
Alexander's outlook is that senators should take time to move forward. Alexander has experience taking things slow. He led the overhaul of No Child Left Behind Act with bipartisan support. It took six years.
While some Republicans have talked about moving quickly in January to have a reconciliation bill ready on Trump's desk when he is sworn in, Alexander argued that reconciliation will still take time.
"A reconciliation package only gives instructions to committees to go to work to solve the problem. A reconciliation package by itself doesn't repeal anything," he said. "It gives you months to go to work to solve the problem."
In Alexander's view, Republicans should be very careful with how they approach the replace side of the equation.
"I've argued since 2010 that I'm skeptical of comprehensive decisions from Washington," he said. " I used to say that if they're expecting somebody to roll a wheel barrel in with McConnellcare on it to replace Obamacare, that they're gonna be disappointed."
Republicans overall have remained vague about how they plan to repeal and replace Obamacare and how fast it will happen now that they are in a position to actually have a Republican president in the Oval Office to sign it.
"What I would like to see us do is think of a way to make fewer decisions about health care in Washington, D.C. ... Let the states make more of those decisions and let consumers have more choices of low-cost insurance," Alexander said. "That's a pretty simple formula, and if we can think of a way to replace what we have now, step by step, with a formula with fewer decisions in Washington, more by states and more by patients and consumers then we will be on the road toward rebuilding our health care system."