While many Capitol Hill Republicans want to avoid a repeat of the Affordable Care Act repeal debate, President Donald Trump keeps promising a health plan that will be "phenomenal" and make the GOP "the party of health care."
Last month, Medicare chief Seema Verma said, "We're actively engaged in conversations" on what to do. Earlier in August, Trump adviser Kellyanne Conway indicated an announcement might come this month.
Behind the pronouncements lies a conundrum: whether to stray beyond efforts underway to improve the nation's health care system -- loosening insurance regulations, talking about drug prices, expanding tax-free health savings accounts -- to develop an overarching plan.
For the White House, it's a fraught decision.
A comprehensive plan could be a lightning rod for opponents. Conversely, not having a plan for replacing some of the most popular parts of Obamacare -- such as its coverage protections for people with preexisting medical conditions -- could leave the GOP flat-footed if an administration-supported lawsuit before the 5th Circuit Court of Appeals invalidates the sweeping health law.
"This is a real conundrum. There is a risk with action or inaction," said Dean Rosen, a Washington, D.C., health policy consultant who often advises Republicans.
No matter how the 5th Circuit rules, its decision, which could come soon, is likely to be stayed while the issue heads to the Supreme Court. Such a delay would give the administration time to flesh out a proposal if the appeals judges throw out the ACA, but it would also ensure that a health care debate is front and center during the presidential campaign.
Right now, polls show the public is focused on health costs, said professor Robert Blendon, who directs the Harvard Opinion Research Program, which studies public knowledge of health care and policy issues. Consumers are concerned about what they pay at the pharmacy counter or the sum of their insurance premiums and deductibles.
"Most voters are not interested in another debate on a new health plan," he said.
But if the 5th Circuit upholds a Texas ruling overturning the entire ACA, "that changes the entire framework," said Blendon. "The administration could not just say, 'Oh, we'll have something great.' They would have to have something outlined."