WASHINGTON — Congressional Republicans, who once promised to "repeal and replace" President Obama's healthcare law, for now have all but given up pushing alternatives to the sweeping legislation the president signed in 2010.
In the last year and a half, House Republicans have sent the Senate just one 36-page bill designed to limit medical malpractice lawsuits, despite pledging to develop detailed legislation to slow rising healthcare costs, help Americans keep their health plans and broaden access to insurance.
And as the House prepares to take its 33rd vote to repeal all or part of the Affordable Care Act, senior Republicans say they will not try to move a replacement plan until 2013 at the earliest. "There might be a chance for us to do this next year," House Rules Committee Chairman David Dreier (R-San Dimas) said Tuesday.
At the same time, GOP lawmakers are rejecting the notion that any replacement legislation should expand health coverage as much as the current law.
"Conservatives cannot allow themselves to be browbeaten for failing to provide the same coverage numbers as Obamacare," Sen. Orrin G. Hatch (R-Utah) told a gathering at the conservative American Enterprise Institute this week.
Many Republicans say it makes little sense to write replacement legislation when they can't get a repeal bill through the Democratic Senate. "I'm perplexed by this obsession with the replace part when the repeal hasn't occurred," said House Republican Policy Committee Chairman Tom Price (R-Ga.).
But the retreat from a central 2010 campaign promise to deal with the nation's healthcare problems has prompted even some conservative healthcare experts to say Republicans owe voters more detail about how they would control costs and protect sick and poor Americans.
"One of the big questions that the public needs to ask Republicans who are so focused on repeal is what will come in its place," said Gail Wilensky, who headed the Medicare and Medicaid programs under President George H.W. Bush and advised Sen. John McCain (R-Ariz.) during his 2008 presidential campaign.
Tom Miller, resident fellow at the American Enterprise Institute, said it wasn't enough for the GOP to simply talk about limiting government and empowering markets. "We need to swap some myths and miracles for real progress," he said.
Republican lawmakers say they have been clear about their broad principles for healthcare, including controlling costs, giving patients more choices and limiting government involvement.
"I just don't think government does big things well," said Sen. John Barrasso (R-Wyo.), a physician and leading critic of the Affordable Care Act.
Individual GOP lawmakers also have sponsored numerous healthcare bills that would reduce state regulations on insurance companies, encourage small businesses to pool together to buy health plans and change the way that insurance is treated under the tax code.
And conservative policy experts at the Heritage Foundation and elsewhere have outlined comprehensive plans to address rising healthcare costs while ensuring broad protections for the poor and the sick.
But Republican leaders have not brought any of these proposals to a vote.
That has shielded the party's ideas from close scrutiny by independent analysts, a politically risky process that could highlight legislation's costs and its impact on consumers and others.
Such scrutiny proved embarrassing for House Republicans in 2009, when they proposed a detailed alternative to the healthcare legislation that Democrats were developing at the time.
The nonpartisan Congressional Budget Office concluded the GOP proposal would have left more than 50 million Americans without health insurance and reduced costs for healthy people while raising them for the sick.
Similar study of the House Republicans' 2011 budget plan indicated that a proposal to make Medicare beneficiaries shop for commercial insurance with a government voucher would leave seniors paying thousands of dollars more for their healthcare.
Former Massachusetts Gov. Mitt Romney, the presumptive GOP presidential nominee, speaks only generally about how he would replace the current healthcare law. His campaign has repeatedly declined to provide details about knotty challenges such as affordably protecting millions of Americans with preexisting medical conditions.
In response to questions, Romney spokeswoman Andrea Saul said, "Gov. Romney's plan is to strengthen America's healthcare system and ensure that all Americans have access to insurance coverage and the care they need."
But the lack of specifics contrasts sharply with Republican rhetoric from two years ago, when the party swept into control of the House amid promises to fully replace the law.
"Repeal is the first, not the last step," five House GOP committee chairmen said in a USA Today op-ed on June 20, 2011, the day of their first repeal vote. "Compassionate, innovative and job-creating healthcare reform is what's next."
That same day, the House passed a resolution instructing the chairmen to develop legislation that accomplished 12 goals, including "lower healthcare premiums," "preserve a patients' ability to keep his or her health plan," "provide people with preexisting medical conditions access to affordable health coverage" and "increase the number of insured Americans."
A year and a half later, Rep. Kevin McCarthy of Bakersfield, the No. 3 Republican in the House, has a detailed list of the 32 floor votes House Republicans have taken to repeal all or part of the 2010 healthcare law.
His office has not kept track of bills to replace the Affordable Care Act, a spokeswoman said.