How to cope with health care is proving a colossal headache for Republicans who have long vowed to “repeal and replace” Obamacare without a consensus on how to do it.

In recent days, the nation has watched out-of-the-loop lawmakers search the Capitol fruitlessly for a secret draft of a possible plan prepared by Republican House leaders and listened as President Donald Trump laid out a path forward that might boost the prospects of a measure touted by Maine’s senior senator.

With many conservatives worried about replacing one big government program with another and many liberals and moderates concerned about the possibility that millions will lose coverage or wind up with a poor substitute, the prospects of any plan trying to split the difference are dim.

Still, several of the key provisions that Trump called for in a speech to Congress — flexibility for states, greater use of tax credits and health savings accounts, and coverage for pre-existing conditions — are among the many elements of the plan put forward by Republican U.S. Sen. Susan Collins in January.

Collins said recently she proposed the measure with U.S. Sen. Bill Cassidy, R-La., because the GOP can’t simply repeal the Affordable Care Act, commonly referred to as Obamacare, “and not have something to replace it.” Her plan, she said, offers a starting point to craft a new approach to health care for many Americans, a process that’s not going to be swift nor easy.

The Cassidy-Collins plan would give states the option of keeping Obamacare, doing nothing, or creating what the senator called a new “better choice” that she anticipates most states would opt for.

Collins said the ACA alternative would maintain consumer protections included in Obamacare, but instead of relying on a mandate for individuals to purchase insurance on health exchanges, it would give states money with the idea that they could tap the cash to create individual health savings accounts for most everyone and pair it with high-deductible insurance and basic pharmaceutical plans.

Topher Spiro, vice president for health policy at the liberal Center for American Progress, recently said Collins’ bill “is not going anywhere” because the Republicans simply can’t agree on what to do. So far, six of the 52 Republican senators have endorsed the Cassidy-Collins approach.

Spiro said House conservatives want to repeal Obamacare and support the 2015 reconciliation language that would do away with Medicaid expansion and the taxes that pay for the ACA without laying out an alternative program.

Spiro said that because Collins’ proposal, which he considers flawed on many levels, “doesn’t gut all the taxes” that provide the funding to pay for health care subsidies, conservatives view it as “totally off limits.”

As times goes on, it is “less and less likely” that the GOP will find a way to muster support for any particular alternative, Spiro said. “There’s many levels of divisions,” he said, with many factions on Capitol Hill along with whatever the Trump administration comes up with.

Collins said, though, that political leaders have to do something because the ACA “is not working well” in many states where insurers are pulling out and premiums growing too costly. They don’t have the option of doing nothing, she said.

Spiro said that Collins is “a key vote here” in preventing the Republicans from repealing the ACA if they don’t have something ready to take its place. “Repeal and delay” — an idea floating around on Capitol Hill to kill Obamacare over the next few years while lawmakers work out an alternative — “is really just repeal,” he said.

“It’s just common sense that you wouldn’t pull the rug out” of a program that’s working for millions without a proposal ready to take its place, Spiro said.

Spiro said that Collins is not the only GOP senator skeptical of simply pulling the plug on Obamacare. He said that Cassidy, Lisa Murkowski of Alaska, Rand Paul of Kentucky and Tennessee’s two senators may help block repeal if there’s nothing at hand to replace the ACA.

The real answer, Spiro said, is for GOP moderates to work across the aisle to pursue “pragmatic, evidence-based solutions” that many lawmakers could support to overhaul the system for the better. Collins could be crucial, he said, if she would act “like a dealmaker” and make it clear she’s ready to talk with Democrats as well as Republicans.

Collins said when she introduced the bill that it was “a work in progress” that she considers “an attempt to put forth a possible solution that would appeal to members on both sides of the aisle.”

Reaching across to Democrats “to fix some of the problems” is the best path forward, Spiro said.

Before the Democrats will consider anything, though, GOP members “need to remove the gun from the head” and end their “partisan rush to repeal,” Spiro said.

Trump, who vowed repeatedly throughout the campaign that he could deliver an Obamacare alternative that would be better and cheaper, last week called “on all Democrats and Republicans in the Congress to work with us to save Americans from this imploding Obamacare disaster.”

“We must act decisively to protect all Americans,” Trump said. “Action is not a choice. It is a necessity.”

U.S. Sen. Susan Collins, R-Maine, and other senators return to their offices on Capitol Hill in Washington on Thursday, March 2, after voting.

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