Speaker Mike Johnson said Tuesday that Republicans would embark on a “massive reform” of the Affordable Care Act if former President Donald J. Trump is elected again, putting an unpopular policy position back in the spotlight just days before the election.

“Health care reform’s going to be a big part of the agenda,” Mr. Johnson said, speaking at a campaign stop in Pennsylvania and describing what Republicans would do with their first 100 days in office if they are successful in keeping control of the House.

“No Obamacare?” a voter called out.

“No Obamacare,” Mr. Johnson responded. “The A.C.A. is so deeply ingrained, we need massive reform to make this work, and we’ve got a lot of ideas on how to do that.”

Mr. Johnson added that there was a “docs caucus” made up of Republican physicians who serve in the House who have “a menu of options” they were reviewing, including a sweeping overhaul.

“We want to take a blowtorch to the regulatory state,” Mr. Johnson said. His comments were first reported by NBC News.

Mr. Trump’s campaign quickly disavowed the statement, which a spokeswoman said was “not President Trump’s policy position.” But it signaled that, should he win the presidency and Republicans take both houses of Congress, there would be major pressure from some corners of the party to make major changes to former President Barack Obama’s signature domestic policy achievement.

Nearly 50 million Americans have been covered by health insurance plans through the Affordable Care Act’s marketplaces since they opened a decade ago, and Vice President Kamala Harris has promised to expand enrollment in the popular program if she is elected. She has repeatedly warned voters that Mr. Trump would try to repeal the law if he was elected.

Mr. Trump and an all-Republican Congress already tried unsuccessfully to repeal the law, and the fierce backlash to those efforts helped Democrats win control of the House in 2018. In 2020, the Justice Department under Mr. Trump asked the Supreme Court to overturn the law. After threatening a renewed repeal push late last year, Mr. Trump has kept his position vague, a sign of what a political liability the issue has become for his campaign.

“We’re going to keep the Affordable Care Act, unless we can do something much better,” Mr. Trump said in August. “We’ll keep it. It stinks. It’s not good. If we can do something better, we’re going to do something with it if we can do better, meaning less expensive and better health care for you.”

During the sole debate between Mr. Trump and Ms. Harris, the former president said he had “concepts of a plan” when it came to replacing the Affordable Care Act.

The Harris campaign seized on Mr. Johnson’s comment as an example of a top Republican saying the quiet part out loud.

“Speaker Mike Johnson is making it clear — if Donald Trump wins, he and his Project 2025 allies in Congress will make sure there is ‘no Obamacare,’” Sarafina Chitika, a spokeswoman for the Harris campaign, said in a statement. “That means higher health care costs for millions of families and ripping away protections from Americans with preexisting conditions like diabetes, asthma, or cancer.”

Mr. Johnson’s allies insisted that the Harris campaign was trying to distort his remarks. They noted that Mr. Johnson made no definitive statement about what the “massive reforms” he described would entail. And they said he was merely repeating back an audience member’s words when he said, “No Obamacare.”

Taylor Haulsee, a spokesman for Mr. Johnson, said in a statement that Ms. Harris was “lying” about the remarks out of “desperation.”

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