WASHINGTON -- Republicans have said repeatedly that the landmark health care reform law, upheld as constitutional by the Supreme Court last week, must be repealed and replaced. But the GOP leader in the U.S. Senate gave a surprising answer on "Fox News Sunday" when asked how Republicans would provide health care coverage to 30 million uninsured Americans.

"That is not the issue," Sen. Mitch McConnell said. "The question is how to go step by step to improve the American health care system. It is already the finest health care system in the world."

"Fox News Sunday" host Chris Wallace interrupted, "You don't think 30 million uninsured is an issue?"

"We're not going to turn the American health care system into a western European system," McConnell said. "That's exactly what is at the heart of Obamacare. They want to ... have the federal government take over all American health care. The federal government can't handle Medicare or Medicaid."

Wallace pressed McConnell, noting that the Affordable Care Act will prohibit insurance companies from not offering plans to individuals with pre-existing health conditions. "If you repeal Obamacare, how will you protect those people with pre-existing conditions?"

"Over the half of the states have high-risk pools that deal with that issue," McConnell said, assuring Wallace that the state programs could cover the tens of millions of uninsured Americans who have pre-existing health conditions.

Thirty-five states now have high-risk pools, covering about 208,000 people. Those policies are open to individuals with pre-existing health issues but often come with high premiums, waiting periods and coverage exclusions for certain conditions.

The Affordable Care Act included a new federal high-risk pool (modeled on the state plans) called the Pre-Existing Condition Insurance Plan. So far, only 67,000 Americans have enrolled. The program will be phased out in 2014 when the law's broader provisions kick in.

Don Stewart, a spokesman for McConnell, offered some additional information about Senate Republican leader's position on health care insurance.

"If you watched the interview, it was clear that the Leader believes we need to focus on lowering costs, first and foremost," Stewart said in an email. "That is the best way to help the 250 million Americans who have insurance today, and to help the 47 million who do not. We need to make it affordable, but Obamacare -- in its rush to expand coverage to everyone -- actually drives up health care costs by $300 billion. If health care is more affordable, more of the uninsured can find coverage."

There are as many as 25 million Americans who lack insurance and have pre-existing conditions, and all together 50 million people are uninsured, according to government estimates. The White House expects 30 million Americans to gain insurance coverage as a result of the new law.

This story has been updated to include comment from Don Stewart, a spokesman for Senate Republican leader Mitch McConnell, and additional details about the number of people uninsured.

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  • 1912

    Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House. (Photo by Topical Press Agency/Getty Images)

  • 1935

    President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first. (Photo by Keystone/Getty Images)

  • 1942

    Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk. (Photo by Hulton Archive/Getty Images)

  • 1945

    President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere. (Photo by Keystone/Getty Images)

  • 1960

    John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. (Photo by Keystone/Getty Images)

  • 1965

    President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor. (AFP/AFP/Getty Images)

  • 1974

    President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes. (Photo by Keystone/Getty Images)

  • 1976

    President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside. (Photo by Central Press/Getty Images)

  • 1986

    President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost. (MIKE SARGENT/AFP/Getty Images)

  • 1988

    Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year. (TIM SLOAN/AFP/Getty Images)

  • 1993

    President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate. (PAUL J. RICHARDS/AFP/Getty Images)

  • 1997

    Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. (JAMAL A. WILSON/AFP/Getty Images)

  • 2003

    President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people. (STEPHEN JAFFE/AFP/Getty Images)

  • 2008

    Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan. (PAUL RICHARDS/AFP/Getty Images)

  • 2009

    President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance. (Alex Wong/Getty Images)

  • 2010

    With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare." (Mark Wilson/Getty Images)

  • 2012

    On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care." (BRENDAN SMIALOWSKI/AFP/Getty Images)