Forget "little" compromises to let the Republicans come up with an alternative. They've had enough paid staff to have come up with a half dozen alternatives in the years since it was past and if they haven't done it yet they won't do it in three years. They'll delay the repeal three years from now and say they have a few changes that will straighten it out.
Repeal and if that hurts incumbent Republicans, so be it. The majority of them are halfwits and RINOs anyway.
And if the insurance companies don't want to? The way the industry works there isn't a lot of incentive for them to do so.