Sixteen months before those elections, some Republicans cite no need to offer an alternative. "I don't think it's a matter of what we put on the floor right now," said Rep. Greg Walden of Oregon, who heads the party's campaign committee. He added that what is important is "trying to delay Obamacare."
Rep. Fred Upton of Michigan, who leads a committee with jurisdiction over healthcare, said, "If we are successful in ultimately repealing this legislation, then yes, we will have a replacement bill ready to come back with."
Divisions were evident earlier this year, when legislation to make it easier for high-risk individuals to purchase coverage died without a vote. It was sidetracked after conservatives, many of them elected with tea party support, objected to any attempt to improve the current law rather than scuttle it.
With the rank and file growing more conservative, some Republicans acknowledge that without changes, they likely couldn't pass the alternative measure they backed when Democrats won approval for Obama's bill in 2010. Among other provisions, it encouraged employers to sign up their workers for health insurance automatically, so that employees would have to "opt out" of coverage if they didn't want it, and provided federal money for state-run high-risk pools for individuals and for reinsurance in the small group market.
The current state of intentions contrasts sharply with the Pledge to America, the manifesto that Republicans campaigned on in 2010 when they took power away from the Democrats. That included a plan to "repeal and replace" what it termed a government takeover of healthcare.
It promised "common-sense solutions focused on lowering costs and protecting American jobs," including steps to overhaul medical malpractice laws and permit the sale of insurance across state lines. Republicans said they would "empower small businesses with greater purchasing power and create new incentives to save for future healthcare needs." They promised to "protect the doctor-patient relationship, and ensure that those with pre-existing conditions gain access to the coverage they need."
But Rep. Paul Broun, R-Ga., said, "We never did see a repeal and replace bill last time," referring to the 2011-2012 two-year term that followed the Republican landslide. "I hope we can this time, and I'll keep fighting for it."
Broun, running for the Senate from Georgia in 2014 as a conservatives' conservative, has drafted legislation of his own that relies on a series of tax breaks and regulatory changes such as permitting insurance companies to sell coverage across state lines to expand access to healthcare.
Other Republicans are at work on different bills, in the House Energy and Commerce Committee headed by Upton, and elsewhere.
Rep. Steven Scalise of Louisiana, who leads the conservative Republican Study Conference, said the organization is working on legislation to reduce healthcare costs "without the mandates and the taxes" in the current law.
Like others involved with the issue, he provided no timetable and few specifics.
At the same time, the other half of the 2010 pledge to "repeal and replace" is getting a workout.
The House voted last week to delay two requirements, the 38th and 39th time they have gone on record in favor of repealing, reducing or otherwise neutering the system that bears Obama's name.
In the case of one of the rules, a requirement for businesses to provide insurance to their workers, the administration announced a one-year delay earlier this month.
Democrats and even some Republicans say the intense focus on repealing the health law is wide of the mark.
"Every voter knows what Republicans are against. They don't know what they're for" on healthcare, said Rep. Steve Israel of New York, who heads House Democrats' campaign committee. He said the strategy would haunt Republicans next year among moderate and independent voters who want changes, not outright repeal.
The fate of legislation to put more funds into high-risk pools demonstrated a belief among some Republicans that they should advance alternatives. Polling presentations make the same point but are not uniformly persuasive among the rank and file, according to officials, and lawmakers' speeches sometimes make it sound as if the health law is disintegrating on its own.
Yet one prominent conservative, Ramesh Ponnuru, warned recently that it was a "perverse complacency" to do nothing while assuming the health law will implode.
"We can be sure that the Left would respond to any such collapse by making the case for a 'single payer' program in which the federal government directly provides everyone insurance," he wrote on May 30 in National Review Online.
Ponnuru added that in some Republican circles, "the idea that an alternative is necessary is seen as a mark of wimpiness, a weakness for big-government programs that are just slightly" weaker than what Democrats possess.
