House Republican leaders are proceeding cautiously on a rewrite of Democrats’ health care law amid skepticism that any plan can pass muster in a conference with widely differing ideas about how to move forward.  

Several members said this week that they realize the public relations problems Republicans have in repealing and replacing the Affordable Care Act five years after it was passed . So leaders are building the bill out from the message, in order to convince their members the endeavor is worthwhile and to show the electorate that their ideas merit control of both chambers of Congress.  

“There’s still a lot of work to be done,” said GOP Conference Chairwoman Cathy McMorris Rodgers of Washington. “We want to have the policy solutions as well as the communications strategy so that America knows that Republicans are committed to quality affordable health care.”  

McMorris Rodgers and Majority Whip Kevin McCarthy of California hosted a group of roughly 30 members in the whip’s office on Wednesday, where they discussed, how to sell a bill to the conference.  

One plan, according to members in the meeting, is to take the message on the road with pie charts and bar graphs explaining how GOP alternatives can supersede President Barack Obama’s law — similar to how Budget Chairman Paul D. Ryan, R-Wis., won support for his budget ideas.  

“We really need to go out there and sell the ideas,” said Rep. John Fleming, R-La., who is a doctor by trade and attended the meeting. “Why do we go out there with legislation when we haven’t really convinced America we have the better ideas?”  

Later Wednesday evening, McCarthy dined with a smaller group of members, where they continued to discuss their strategy. Rep. Phil Roe, R-Tenn., who attended the dinner, said the main question is what form the bill should take.  

“That’s the biggest hurdle,” he said. “There is a big debate going on: small ball vs. comprehensive. And I’ll just tell you right now, that has not been decided.”  

Roe is one of a trio of Republican doctors in Congress who have separately released legislation that would repeal and replace the law. The conservative Republican Study Committee endorses his plan. But Rep. Tom Price, R-Ga., who is influential in conservative circles, wrote legislation as well. Adding to that, Rep. Paul Broun, R-Ga., introduced a bill that has been endorsed by tea party group FreedomWorks.  

Rep. Joe L. Barton, R-Texas, who was ranking member of the Energy and Commerce Committee when Democrats passed a health care overhaul in 2009, said he too will put forth a bill in the coming weeks. Leaders are also looking at their alternative from 2009 for guidance, as well as a Senate alternative released last month.  

Most of the members who put forward broad legislation to replace the law said they would prefer a comprehensive approach.  

“Obviously it’s much more difficult to move a comprehensive bill,” Barton said. “But if we’re trying to educate the American people and assume we’ll take the Senate in the next election, then a comprehensive bill is good to have out there because you cover all the bases.”  

Others, however, want to move smaller, targeted bills on areas where there is broad agreement in the conference, for instance allowing insurance portability across state lines and medical liability reform. A comprehensive bill, critics say, could also open up the party to attacks of hypocrisy, because they derided Democrats for the grand scale of their 2009 legislation.  

Another GOP doctor, Rep. Michael C. Burgess of Texas, said he favors a more minimal approach because approval ratings show that the public does not trust Congress, and any legislation on the matter would be doomed anyway once it reached Senate Majority Leader Harry Reid, D-Nev.  

“We’ve got an approval rating of 8 percent in aggregate. No one believes we can do those kinds of things,” Burgess said. “If I ran the zoo, yeah we would do the right thing. But at the end of the day, we don’t have an election until November. You don’t have a [Republican] Senate. If we get there, you don’t have a new Senate for almost a year, and then even at that you have the same president. So maybe Harry Reid isn’t blocking for him anymore, but he’s got his veto pen.”  

Even if they decide on an approach, the differing policy ideas will make it hard to find a common Republican position, said Rep. Devin Nunes, R-Calif., a member of the GOP whip team.  

“It’s going to be very difficult to come up with legislation everyone agrees on. And then it’s going to be very tough to pass it,” he said.  

On Friday morning, Majority Leader Eric Cantor, R-Va., met with top leaders and committee chairmen in his office to discuss the slate of proposals and how they can harvest the most popular ideas from each. Members emerged from the meeting saying the process is just beginning and nothing has been decided.