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More than 15 years after the Affordable Care Act was signed into law, it’s more popular than ever: According to new polling by Gallup, 57 percent of Americans approve of Obama’s signature healthcare bill, including 63 percent of independents. Yet Republicans—who failed to stop Obamacare, repeatedly failed to overturn it, and have never managed to unite behind an alternative plan—are once again agitating to relitigate that debate.

Democrats, of course, made the defense of expiring healthcare subsidies the central demand in this fall’s government shutdown fight. And while they lost that battle, they may have already won the larger messaging war. Every day, the clock is ticking toward premium spikes of as much as 114 percent for A.C.A. enrollees in the new year—right at the start of a midterm cycle in which Democrats will be salivating to exploit the issue.

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If anything, Republicans are more divided over healthcare than ever. Some in the conference voted against Obamacare in 2010, or participated in the infamous repeal-and-replace effort of 2017, and remain philosophically opposed to the program as a whole. What’s different now from those previous fights, however, is that a significant number of Republicans want to keep Obamacare in place, at least for the time being, and even extend the enhanced premium subsidies implemented amid the pandemic. I asked California Republican Rep. David Valadao, whose seat has become even more competitive under his state’s redistricting plan, how important it is for Republicans to at the very least hold a vote on healthcare. “For some members, very important,” he told me.

The subsidy debate in particular is pitting centrist members—including vulnerable, swing-district Republicans such as Valadao, Virginia’s Jen Kiggans, New York’s Mike Lawler, and Pennsylvania’s Brian Fitzpatrick—against those adamantly opposed to anything pertaining to the A.C.A. “A lot of people just feel very strongly about how they voted 10 years ago or 15 years ago,” Josh Hawley said of his colleagues. Brendan Buck, a former top aide to Speakers John Boehner and Paul Ryan, offered a similar view. “There are still a very large number of Republicans for whom they have either principled or political objections to the law,” he told me. “And even though it may risk their majority, they’re just not going to come off of that.”

That includes Speaker Mike Johnson, who has accused Democrats of just wanting “to subsidize a broken system”—perhaps inadvertently undermining some of his own swing-district members, whose seats will be critical if Republicans are to have any hope of holding on to the majority past January 2027. Other members of House G.O.P. leadership seem inclined to side with A.C.A. critics, too. House Majority Leader Steve Scalise has said Republicans should address broader healthcare costs, not just those borne by the 22 million-plus Americans who received the enhanced subsidies. “We have been talking about what we can do to lower health premiums for 100 percent of Americans,” Scalise said.

That language echoes what Rep. Andy Harris, the chair of the far-right House Freedom Caucus, told me. “We have to stop talking about the problem of premiums for 7 percent of the American population,” he said, “and start talking about premiums for 100 percent of the American population.” (Worth noting that roughly two out of every five Americans are insured via Medicare or Medicaid.)

Johnson, however, has yet to present a clear path forward. In a meeting Tuesday night, he tried and failed to reach consensus with the leaders of the House Republican factions known as the “five families.” Still, with only six days left in session and facing a self-imposed deadline of holding a healthcare vote by the end of the year, the speaker plunged ahead. This morning, at a closed-door conference meeting, he presented a menu of options without broad member input and offered even less clarity—mostly a list of throwback, tried-and-failed G.O.P. healthcare proposals such as enhanced health savings accounts, cost-sharing reductions, and pharmacy benefit manager reform. “Everyone is mad,” one person close to House Republicans told me of the party’s healthcare dilemma.

Practically the only thing Johnson didn’t include is what the swing-district Republicans actually want: a plan to address the immediate price hikes, like a subsidy extension to give Congress time to make major changes to the A.C.A. Moderate Republicans are further frustrated by the fact that none of the ideas Johnson did offer will get signed into law, especially before the end of the year. Even if the party found consensus in the House, they don’t have 60 votes in the Senate, and there is no bipartisan discussion to forge a plan that could cross that threshold.

In the upper chamber, Republicans are begrudgingly lining up behind a plan by Sens. Bill Cassidy and Mike Crapo, the chairs of the committees overseeing healthcare, to replace the enhanced Obamacare subsidies with payments into health savings accounts, and expand so-called catastrophic health plan options. Over lunch on Tuesday, the participants decided it would be better politically to hold a vote on this destined-to-lose proposal than fail to offer any alternative to the Democrats’ proposed three-year subsidy extension.

In both chambers, all the maneuvering amounts to an effort to make it look like Republicans have ideas. But vulnerable conference members know that voters won’t get any relief from a failed plan. “My idea would be to come together on a bipartisan plan,” said Sen. Susan Collins, who is expected to run for reelection in blue Maine next year. As of right now, though, there isn’t one.

Still, such a plan is theoretically possible if leadership were to commit to it, and there might be just enough House and Senate Republicans who would support a temporary extension to the enhanced A.C.A. subsidies to actually get something passed. There are currently three pieces of Republican-led legislation in the House—including a new discharge petition filed by Fitzpatrick tonight that would bypass the speaker—and at least three in the Senate that would do that. But Trump hasn’t gotten behind an extension of the subsidies, and so leadership won’t either.

The president, after all, has repeatedly demanded that Republicans refrain from working with Democrats, and pass only partisan legislation. But there’s at least some chafing over this dynamic within the conference. “I do not want members of Congress to use the president as a shield here and say, Well, you know, until the president gives me explicit direction, I’m just not going to do anything,” Hawley told me. “I think that’s really dereliction of duty.”

Recall that Republicans have been led to healthcare frustration by the very same president before. In 2017, House Republicans, under then-Speaker Paul Ryan, worked furiously and extensively to come up with a plan to fulfill Trump’s campaign promises to repeal Obamacare and replace it with something “much less expensive and much better.” But the president never defined a healthcare vision himself, and Ryan’s efforts were ultimately derailed when members of the House Freedom Caucus rejected his proposal, insisting it didn’t go far enough in repealing A.C.A. provisions such as requiring that insurance companies cover people with preexisting conditions.

Republicans pretty much gave up on reforming healthcare after that. They were caught flat-footed when Democrats forced the issue, shutting down the government over the expiration of the enhanced Obamacare subsidies and demanding that Congress hold a vote. Now, Republicans are scrambling to throw together ideas—a decade and a half into the Obamacare experiment they opposed. “This is sort of winging it,” Buck said. “This is waking up at the eleventh hour and realizing, Oh, we should probably have a plan.”

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