Instead, the House on Wednesday will take up the repeal measure after the Affordable Care Act’s constitutionality was upheld, and amid growing misgivings that relitigating the issue now will make Republicans seem out of touch — especially when party leaders are still without an alternative. “Anytime Republicans are debating taxes and the economy, we’re winning,” said a veteran Republican campaign consultant who spoke on condition of anonymity to avoid publicly crossing his party’s leadership. “Anytime we’re debating health care, they’re winning.” The tally on Wednesday may be largely unchanged from the first full-repeal vote in February 2011, but the run-up to the vote is shaping up as far different. Republicans will keep fanfare to a minimum, while Democrats try to mount the attacks. No doctors in white lab coats will be paraded before the television cameras pleading for repeal. The rhetoric is likely to be less about socialized medicine and government takeovers of health care and more about the health care law’s impact on the real issue driving the election — jobs and the economy. Moreover, divisions are emerging over the wisdom of pulling the law out, root and branch. Some Republicans, facing re-election in swing districts, are openly suggesting that some measures should remain. Others worry that the Republican leadership has yet to detail what the party would replace the health care law with. Representative Nan Hayworth, an ophthalmologist and a freshman Republican from New York, said she and others have a clear framework: bolstered health savings accounts, the option to purchase insurance across state lines, medical malpractice limits and a government-subsidized insurance pool for sick people who cannot buy insurance on their own. But those alternatives have not been broadly aired. “We need to start expressing our principles promptly,” she said. Such concerns are a sharp contrast to the first repeal vote, when a new, vigorous Republican majority was confident that they owed their triumph to voter anger over the health care law. Democrats were on the defensive, with all eyes on which survivors of the 2010 midterm tsunami would switch their votes for the law and embrace repeal. The House voted 245-to-189 to undo President Obama’s signature domestic achievement, with three Democrats joining in. Representative Pete Sessions of Texas, chairman of the National Republican Congressional Committee, said the health care law was passed “with deception at its core” — a penalty for those who fail to purchase insurance has been unmasked by the Supreme Court as a tax on the middle class. He said he was still convinced that the issue would be “probably the biggest driver” ensuring Republican victory in November, outside of the tax increases that could come next year with the expiration of the Bush-era tax cuts. His deputy at the Republican Congressional Committee, Representative Greg Walden of Oregon, was more circumspect. “We’re going to be talking about jobs and economy, but there are lots of elements to that discussion, one of them being health care,” Mr. Walden said. Democrats, on the other hand, say they will be playing offense. The Democratic Congressional Campaign Committee started an advertising campaign Monday morning portraying Republicans as controlled by insurance companies and intent on taking away the popular consumer protections in the law. A series of news conferences are planned that will include real-life families whom Democrats say would be harmed by repeal. But they will also frame the repeal vote as a political stunt, taking Congress’s time away from job-creating legislation. A video to be released Monday will use Speaker John A. Boehner’s oft-repeated phrase, “Mr. President, where are the jobs?” to mock the repeal exercise. “There’s a strong sense that we don’t want to carry on this fight, over and over,” said former Gov. Tim Kaine of Virginia, a Democrat who is running for the Senate. “Let’s move on.” For Republicans in solidly conservative districts — a majority of Republicans in the House — the repeal vote is a no-cost way to energize the base and prove to angry constituents that the fight has not ended. Representative Patrick McHenry, a Republican from western North Carolina, spoke of “fire and passion for repeal” still seething in his district. “Activist and average folks regularly bring up full repeal,” he said. “They’re still keenly aware of it, demand it and understand this law is holding back economic growth.” But Republican campaign consultants are more cautious. Those voters are already energized by the prospect of voting against Mr. Obama in November. How a rehashing of the health care debate will affect independent voters is less clear. Democrats are driving the narrative that voters are ready to move on. Dan Maffei, a former House Democrat from upstate New York who is campaigning to get his seat back, is using the Supreme Court’s decision to push the debate toward improving the health care law he helped pass, not whether it should stay or go. To him, another vote — the 30th this Congress has held to repeal or partially repeal the law — is more evidence of the rut Washington is in. “They’re stuck in this eternal recurrence, rerunning the debate on the bill over and over again instead of moving forward,” Mr. Maffei said.