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WASHINGTON Sen. Ben Sasse, R-Neb., vented his frustration Wednesday as a handful of his Republican colleagues lined up against the same kind of health care repeal language that they supported less than two years ago.

How can you possibly explain that to people with any intellectual integrity? Sasse said in an interview with The World-Herald.

As Senate Republicans struggle this week to unify behind a replacement for the Affordable Care Act, Sasse highlighted Wednesdays vote to repeal significant parts of former President Barack Obamas health care law with a two-year delay. GOP senators had approved such a plan in 2015 only to see it vetoed by Obama.

Since President Donald Trump would presumably sign the repeal legislation, Sasse said, voting against it now when it counts amounts to a breathtaking flip.

All four GOP senators from Nebraska and Iowa voted for the repeal proposal Wednesday, but it attracted only 45 votes, with 55 against, including seven Republicans. Six of those Republicans had voted for the similar plan under Obama.

There was a lot of show voting going on here 15 months ago, Sasse said.

Nebraska Democrats blasted senators support for the proposal, saying it would leave people without coverage.

Sasse made repealing and replacing the Affordable Care Act a centerpiece of his 2014 campaign, although he has avoided the public spotlight for much of the recent Senate health care discussion. In the interview, Sasse said that he has been working for months behind closed doors to build support for repeal-and-replace, with a particular emphasis on promoting insurance portability.

The main GOP proposal to simultaneously repeal and replace was rejected earlier this week, despite the support of all four Midlands senators.

While Sasse said that bill had its shortcomings, he also praised language from Sen. Ted Cruz, R-Texas, that would have opened the door for insurers to again sell skimpier catastrophic plans.

Sasse said theres no interest group that makes money off those plans or lobbies for them, but many Americans would like to have that option.

Nobodys ever going to come and do a demonstration sit-in, screaming in your office: I want a catastrophic plan, Sasse said. But thats actually what you hear lots and lots in Nebraska.

It remains to be seen how the rest of this weeks health care debate will play out. Sasse has repeatedly pushed the idea of first repealing the Affordable Care Act and then keeping Congress in town as long as necessary to agree on a replacement.

He said that approach, which Trump has supported at times, would bring Democrats to the table.

Sasse often invokes the need for portability in a replacement health care law, drawing parallels to the shift from defined-benefit pensions to 401(k) retirement plans that workers can carry over from job to job and state to state. Allowing people to keep their health care benefits as they move or change jobs would address some of the problems with the current health care system.

We used to have the same problem with pensions and we fixed it, Sasse said.

Republicans dont have a well-developed theory of what is necessary to address problems in the health care system today, Sasse said, and they should keep working on it until they do.

I know what I believe should happen in health care, Sasse said. But so far, he said, there isnt a majority in Congress in support of his approach.

It cant compel a majority vote, he said. So, we should be debating harder and longer about replace.

joe.morton@owh.com, twitter.com/MortonOWH

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Sen. Ben Sasse rebukes Republican colleagues who voted against health care repeal legislation - Omaha World-Herald