(Bloomberg) -- President Donald Trump and Republican lawmakers are grasping for ideas on a new party-line package aimed at blunting criticism of rising health care and other costs of living, as spiking premiums bedevil the party and affordability becomes the defining issue of next year’s pivotal midterm elections.

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GOP lawmakers, bruised by an off-year election in which the party sustained losses, are struggling to present an alternative to Democrats’ push to renew expiring health care subsidies as a spike in insurance premiums looms for more than 20 million Americans.

Republicans in the House and Senate at this stage seem to be talking past one another as they debate the path forward. Many are waiting for clearer direction from the president, who has offered vague support for a policy that would funnel financial support directly to individuals instead of subsidizing insurance premiums.

“I think that’s going to be necessary to get us to coalesce around any single proposal,” Republican Senator John Cornyn said.

In the Senate, centrists in competitive states, such as Susan Collins of Maine, have pushed for a short-term extension of Obamacare subsidies with additional limits, such as an income cap on who qualifies for insurance premium tax credits. Finding a compromise along those lines is likely the simplest pathway to 60 votes in the Senate, but with Trump’s opposition its prospects are dim.

Now, Republicans are flirting with the possibility of going it alone with a GOP-only sequel to Trump’s multi-trillion-dollar tax and spending bill signed into law this summer.

The Senate Budget Committee has asked Republican offices to compile ideas, including on health affordability, that could be included in a partisan bill by mid-December, people familiar with the matter said. White House Deputy Chief of Staff James Blair raised the possibility of a Republican-only health care bill if bipartisan negotiations fail at a Bloomberg Government event on Tuesday.

“We’ve got to see how it works out and if not, if that path is foreclosed, there is the partisan path of reconciliation as well,” Blair said.

It’s still unclear whether there’s an appetite among congressional Republicans for an intra-party debate over health care during a midterm election cycle, even if the White House is eager to advance policy focused on affordability. Health care has traditionally been a weak issue for Republicans, and the ghost of the Trump’s first-term failed Obamacare repeal-and-replace effort still haunts Republican leaders.

One skeptic is Senate Finance Chair Mike Crapo, who said on Thursday that he’s currently focused on bipartisan ideas on health care, not Republican-only legislation.

Senator Bill Cassidy, chairman of the Health, Education, Labor and Pensions Committee, is pitching an alternative approach that would devote the roughly $23 billion it would cost to extend the enhanced subsidies for a year to instead go to federally funded health savings accounts for people who enroll in the lowest level of insurance coverage possible under Obamacare.

Cassidy envisions a two-year program with a plan to pass a another health care package later aimed at lowering underlying costs. The money put into the HSAs could be used to pay out-of-pocket expenses and deductibles, but not monthly premiums, he said.

The lower-level insurance plans typically have higher deductibles, higher co-pays and cover fewer medical services.

Senator Rick Scott of Florida introduced his own version of a health plan to funnel money to “HSA-style Trump Freedom Accounts” with restrictions on the funds from being used for abortion services.

But with millions of Americans facing their Obamacare premiums doubling or tripling starting Jan. 1, the HSA proposal doesn’t solve many voters’ most immediate concern. On Thursday, Senate Democratic leader Chuck Schumer called the HSA plan “woefully insufficient.”

In the House, the focus so far has been drafting a package that would target the underlying cost of health care. House Majority Leader Steve Scalise, who’s been charged with coming up with a GOP plan, dismissed Cassidy’s proposal as too amorphous, saying he is focused on “actual bills,” like provisions left out of the GOP’s earlier tax and spending package.

At a Wednesday hearing on health affordability, Democrats argued for at least a short-term extension of the Obamacare subsidies because there isn’t time to hatch a brand-new health plan before premiums rise.

“We don’t have time,” Senator Peter Welch, a Democrat from Vermont, said. “We have one option only and that is to extend the credits, otherwise millions are going to go without health care.”

Republicans leaders, however, have argued that extending the subsidies would just be a temporary fix to a broken marketplace. That stance has trickled down to many of the rank-and-file, even those who previously backed a short-term extension.

New York Republican Representative Nick LaLota, who had signed on to a one-year extension bill, said lawmakers need to shift focus to a plan with a better chance of passage.

“I just don’t have any hope it’ll ever pass the Senate,” LaLota said of the temporary extension. The focus should instead be on a package that would send money directly to enrollees, as Trump and Cassidy have pushed, he added.

Cassidy said if the president favors a proposal, it’s more likely to get a vote in the House.

“The guy at 1600 Pennsylvania Avenue has a lot of sway,” Cassidy told reporters Wednesday.

--With assistance from Erin Durkin and Erik Wasson.

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