Senate conservatives have a bill. House moderates have a bill. The House GOP study group is looking at writing one. So is a group of physicians in the House. Then on Monday, New Hampshire Sen. Judd Gregg put in his own plan.

Republicans have no shortage of ideas about how to tackle the issue of health reform. What they don’t have is agreement — between the Senate and the House or between conservatives and moderates.

Now some in the party are nervous that the array of options might add up to nothing, leaving Republicans without a cohesive strategy as President Barack Obama edges closer to delivering health care reform.

For months after Obama pinpointed health care as a top domestic priority, Republicans were locked in an internal struggle over what kind of health care fix they support — or whether they need to present a competing vision at all.

Two Republican House members — Wisconsin Rep. Paul Ryan and California Rep. Devin Nunes — got tired of waiting. So they teamed up on a proposal with Sen. Tom Coburn (R-Okla.) and Sen. Richard Burr (R-N.C.), complicating life for House GOP leaders who are still hoping to maintain a united front — despite the competing priorities offered by their rank and file.

“We were ready to go” last year, Ryan said of a health care bill he offered back then to overhaul Medicare, Medicaid and Social Security. “It’s health care time. ... It’s important to get our ideas out there.”

The leadership is still trying to develop one plan that could serve as the conference position, but they may end up with something far different. A bill is forthcoming from Rep. Dave Camp of Michigan, the ranking Republican on the House Ways and Means Committee; and yet another one from Rep. Michael Burgess (R-Texas), a physician and founder of the Congressional Health Care Caucus.

The multiple rollouts highlight the growing impatience some Republicans are feeling as Democratic negotiators move closer to producing a bill that has been decades in the making.

“Until the Coburn-Burr-Ryan-Nunes legislation, Republicans had failed to put forth a plan that is cohesive, comprehensive and coherent,” said David Merritt, a health policy expert with Newt Gingrich’s Center for Health Transformation, which consulted on the bill. “Every major Democratic candidate for president had a fairly radical plan to shake things up, and now we’re on the cusp of many of those very proposals being voted on in Congress. The fact that the Republican leadership has not been more proactive is a mystery.”

But House Minority Leader John Boehner (R-Ohio), who typically favors the shotgun approach, said he embraces as many ideas as his members offer up, and he complimented Republicans who have stepped forward with plans.

“President Obama has asked for our ideas and solutions in this area, and — as far as we’re concerned — the more sharp, innovative ideas we offer, the better,” Boehner spokesman Michael Steel said.

Republicans in the House have been far less involved than their Senate counterparts in working with Democrats on a bipartisan health care measure.

Nancy-Ann DeParle, the White House director of health reform, said she has met individually with Republican House members, including an hourlong session before the Memorial Day recess with Rep. Tim Murphy (R-Pa.), during which she promised to visit Children’s Hospital of Pittsburgh.

But though Democratic and Republican offices are working closely in the Senate, DeParle said she cannot recall participating in any bipartisan staff meetings in the House.

“It seems there is a very different dance going on in the House,” DeParle said.

To be sure, Democrats also have their divisions. Liberals want a strong public insurance option, while moderates have been slower to embrace the idea. Still, Democrats remain largely united behind President Barack Obama's approach.

Republicans face a unique dilemma as Congress embarks on its summer health care adventure: Do they need to offer viable solutions? If so, can they do it without attracting unnecessary criticism for those alternatives? Or can they simply wait for Democrats to release their own bill and then criticize it?

The challenge for Republicans is that Democrats have publicly avoided committing to specifics. The strategy allows Democrats to keep all the major interest groups at the table. This has created anxiety among Republicans, who have watched the weeks tick by and wondered if their party was missing an opportunity to define itself.

“Essentially, they are very concerned,” said a congressional GOP aide, who spoke on the condition of anonymity to talk candidly about internal party debate. “There is concern that if there isn’t a clear alternative that empowers individuals, the Republican version will be a cheaper version of whatever [Democratic Sen. Max] Baucus and Obama have put forward.”

Boehner put his former No. 2, Missouri Rep. Roy Blunt, in charge of herding Republicans on the critical issue. Since February, Blunt has organized weekly meetings with outside experts to help educate members on the intimate details of the country’s health care system. In April, his team started crafting the Republicans’ official alternative, with the goal of completing their work before Democrats bring their own comprehensive bill to the floor.

But as the Blunt group continues its work, his peers are stepping into the void and complicating the already treacherous task of bridging deep-seated divides among his fellow Republicans by offering competing plans that have drawn battle lines between moderates and conservatives.

On one side are conservatives, led by Coburn and Ryan, who offered a plan that would drastically revamp Medicaid, provide tax credits to purchase coverage and create state-based insurance exchanges where consumers could compare plans. Critics of their plan say it could disrupt the country’s system of employer-based insurance.

On the other, Pennsylvania Rep. Charlie Dent and Illinois Rep. Mark Kirk introduced legislation that seeks dramatic savings by expanding that employer-based health care system and ending the states’ regulatory monopoly.

Meanwhile, Blunt’s task force presses forward. His group comprises a number of competing personalities with divergent views on the health care issue.

The group includes fiery conservatives, like Georgia Rep. Tom Price and Arizona Rep. John Shadegg; more moderate Republicans, like Pennsylvania Rep. Tim Murphy; and plenty of doctors like Burgess, Louisiana Rep. Charles Boustany and Georgia Rep. Phil Gingrey. Camp is also participating.

Members and aides both acknowledge that it will be difficult for leaders to overcome the egos and ideological divides that dominate the conclave. Making things even more difficult, in their third year out of power, the Republicans’ minority status is still sinking in with some lawmakers who embark on negotiations like they are crafting actual legislation. A number of conservatives are eager to sign onto the Ryan-Nunes bill, but Camp is frustrated with both of them for offering the legislation, as members of his Ways and Means panel, members and aides said immediately after the rollout.

Ryan and Nunes both expect to support whatever the working group produces, and Ryan said he will continue his work with the group.

Kirk, who also began drafting his plan months ago, was a little more explicit in his desire to offer legislation that would appeal to voters’ clear preference to keep their current plans.

“Things are progressing rapidly,” said Burgess, who is working on a plan with several other members and, in April, was critical of his party for not having offered its own ideas. “It’s hard to tell what direction things are moving. There will be more proposals to come.”

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