With just hours to go until a series of votes that are supposed to culminate in a new bill to repeal part of Obamacare, Republican lawmakers are pressing ahead with plans to overhaul the Affordable Care Act, despite not knowing what the final legislation will look like. The result, so far, has been confusion: the chaotic effort to unwind Barack Obama’s signature health-care law took another tortuous twist Wednesday as seven Republicans and every Democrat voted against a “clean” repeal vote with the goal of crafting a replacement plan within two years. The 44-55 vote came just a day after Mitch McConnell suffered another defeat on a modified version of his bill, which would repeal and replace Obamacare at the same time, with nine dissident Republicans declining to fall in line.

The failure of both options has highlighted the deep divide running through the G.O.P. caucus, which is at an impasse over reforming the country’s $3 trillion heath-care system. After seven years of blasting Obama’s own reforms, they are now faced with the disagreeable realization that legislating is harder than obstruction, and implementation will take more work than blind opposition. Caught in the middle are some 20 million Americans who gained health insurance coverage under Obamacare, and now face the terrifying prospect of seeing that coverage stripped away. And some Republicans, grappling with the political and electoral consequences of unwinding those benefits, are beginning to lose their nerve.

Donald Trump has done his utmost to publicly shame those lawmakers having second thoughts, attacking Lisa Murkowski, one of two Republicans who voted against even opening the debate on Tuesday, for “[letting] the Republicans and our country, down yesterday.” But it is unclear how much capital the president still has to cajole Congress into taking tough votes on his behalf, after a months-long process that has proved he has little interest in the specifics of debate beyond being able to credibly claim some kind of win. That possibility, however, already seems to have slipped away. Having failed to agree on a plan to replace Obamacare, or to fully repeal it, Republicans appear to be settling on some sort of compromise that might allow them to declare a symbolic, if hollow, victory. Senate Republicans need to aim for the “lowest common denominator” to keep the repeal effort alive, Health and Human Services Secretary Tom Price told CNBC on Wednesday. “What gets us to 50 votes so that we can move forward on a health-care reform legislation . . . that’s what needs to happen.”

It’s hardly an inspiring message for the voters who bought into Trump’s promise to replace Obamacare with “something great.” The latest “lowest common denominator” that Republicans are aiming for is a so-called “skinny repeal” bill, which the Senate is expected to vote on as soon as Thursday afternoon. The bill would eliminate some of the unpopular parts of Obamacare, including the mandate requiring all Americans to have health insurance or pay a penalty, but has been met with bipartisan skepticism. Ten governors—five Democrats and five Republicans—released a letter Wednesday urging the Senate to reject the measure, which experts say could create a “death spiral” of rising premiums in the non-group insurance market. Their concerns were echoed by the Blue Cross Blue Shield Association, which also warned the Senate about the economic consequences of such a bill. “A system that allows people to purchase coverage only when they need it drives up costs for everyone,” the insurance trade group explained.

“Skinny repeal” is far from Trump’s initial lofty vision. But if at least 50 senators could agree to it, with Vice President Mike Pence there to break a tie if necessary, the bill would at least keep Republicans’ flailing effort afloat. Indeed, the point of the skinny measure would not be to actually enact it. Instead, the bill is effectively a Trojan horse that Republicans could use to jump-start conference negotiations with the House. “What a skinny repeal does is it gets it to a conference committee,” said Senator Mike Rounds of South Dakota. “At that stage, then we can begin the process of rebuilding again as one option.”

The unappealing option is apparently meeting little tangible G.O.P. resistance, despite the fact that McConnell is currently drafting his slimmed-down bill in secret, with little outside input. “There is no definition to any of it right now,” Murkowski said Wednesday. “This is like a car crash,” one senior G.O.P. aide told Axios. “Everyone will slow down to look at the carnage but no one will get out to help.” Republican Senator Bob Corker was more forthright: “I think people would look at it not necessarily on its content, but as a forcing mechanism to cause two sides of the building to solve it together.”

Insiders are skeptical that a conference committee could come up with a bill that can pass the Senate, considering the senators have proved unable to do it themselves. “Obamacare replace policy is not making it through the United States Senate at this step of the process,” one senior Republican aide e-mailed Axios’s Caitlin Owens, wryly dubbing the bill a “Corpsicle.” Moving through its ironically pontifical rhythm of death and resurrection, for now, it looks like it’s back to the drawing board for the G.O.P.