U.S. senators unveiled two opposing visions of a healthcare system in the United States on Wednesday - leading liberals advocating government insurance for all and several Republicans proposing an eleventh-hour repeal of Obamacare to replace it with programs run by the states.
Neither plan was thought likely to succeed in a Congress exhausted with fighting over the issue, raising questions over whether lawmakers would instead prop up the health benefits offered under former President Barack Obama's healthcare law.
Independent Senator Bernie Sanders, a 2016 Democratic Party presidential candidate, held a campaign-style gathering at which enthusiasts applauded as he proposed extending the federal Medicare health insurance program for seniors to include everyone.
"The American people want to know what we are going to do to fix a dysfunctional healthcare system which costs us twice as much per person as any other country and yet leaves 28 million people uninsured, and even more underinsured," Sanders declared.
Senator Elizabeth Warren, one of 16 Democratic co-sponsors for Sanders' proposal, told the gathering it was time to go a step beyond Obamacare, the 2010 law officially called the Affordable Care Act that expanded health coverage to 20 million Americans.
"We will say that in this country everyone gets a basic right to healthcare," Warren said.
But in an office building nearby, Republican senators announced they were offering a "last chance" to repeal Obamacare, before a parliamentary procedure allowing them to pass it with a simple majority, instead of a three-fifths majority like most Senate legislation, expires at the end of September.
They proposed replacing the law with a program that would give states money in the form of block grants to run their own healthcare programs.
Senator Lindsey Graham of South Carolina, one of the plan's authors, said he was not ready to give up the long-held Republican goal of repealing Obamacare despite a stunning failure to muster enough votes within the party this summer to kill the law.
"The idea that the Republican party has done its best to repeal and replace Obamacare is a joke," said Graham, who was joined by fellow Republican Bill Cassidy in the effort.
A system of U.S. government-run healthcare for all is anathema to many Republicans, who think the hybrid Obamacare system in which government subsidizes private health insurance already was a step too far.
Republicans' last attempt in July to overturn Obamacare fell one vote short in the Senate in a humiliating defeat for President Donald Trump and Senate Majority Leader Mitch McConnell.
In addition to the Sanders and Graham-Cassidy proposals, a bipartisan effort is under way in the Senate health committee to repair Obamacare without repealing it, by protecting subsidies that are paid to insurance companies to help offset discounts under the program.
McConnell this week declined to comment on either the Cassidy-Graham bill or the bipartisan health committee effort, saying the way forward was not clear. The Republican leader is not expected to bring Sanders' proposal to the Senate floor for a vote.
Trump applauded Graham and Cassidy, saying he hoped the senators "have found a way to address the Obamacare crisis."
Trump has frequently complained that Obamacare is in crisis. Democrats dispute this but many admit there is room for improvement. A greater than expected mixture of sick and healthy customers hampered Obamacare from the start, leading to large premium increases and many counties have just one insurer.
(Reporting by Susan Cornwell; editing by Grant McCool)