The Club for Growth plans to directly target party leaders like Mitch McConnell, right, the Senate majority leader, and Paul D. Ryan, left, the House speaker, in a new phase of the campaign to repeal the Affordable Care Act.
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Stephen Crowley/The New York Times
The sudden caution of the Republican Party leadership, as it grapples with the enormously complicated challenge of replacing the Affordable Care Act, has baffled conservatives who have been fighting the health law for years. In the House, Republicans have voted dozens of times to dismantle the law, and it has been a primary issue in congressional races since 2010. Repealing the law, many conservative lawmakers believe, is the one clear mandate they have from voters.
“The reality is, this is existential for Republicans,” said David McIntosh, the president of the Club for Growth, which has been sending emails regularly to its 100,000 members warning that Republicans could be stalling the repeal indefinitely. The group plans to directly target party leaders like Mitch McConnell, the Senate majority leader, and Paul D. Ryan, the House speaker, in a new phase of the campaign.
“If they don’t repeal Obamacare and replace it,” Mr. McIntosh added, “I don’t think they’ll stay in the majority in the next election.”
Implicit in the repeal push is a threat that conservative groups have always wielded over the party when they feel it is not being true to its convictions: primary challenges.
And this early rift between the party’s activist wing and its leadership in Washington could be a taste of what Republicans can expect now that they control the government entirely and are no longer able to blame Democrats for blocking their agenda. After making bold promises over the past few years on issues like overhauling expensive government programs, rewriting the tax code and defunding Planned Parenthood, Republicans face voter demands to follow through.
Republicans remain unable to agree on a health care plan that satisfies both moderates and hard-liners. As President Trump himself acknowledged last week when he tried to explain the delay — “Nobody knew that health care could be so complicated,” he said — it is no easy task to pass a measure that could leave millions uninsured. And polls now show American’s attitudes toward the law are improving as they worry about what could happen if it is suddenly jettisoned.
Democrats, who have been cramming town hall-style meetings to implore Republican lawmakers not to take apart the health law, seem content to let their opponents fight it out in the hope that the divisions will lead to an impasse.
“Their rhetoric that has enabled them to stir up the far right is in collision with the truth,” said Thomas E. Perez, the chairman of the Democratic National Committee.
The repeal effort by the conservative groups is intended to sway members of Congress who may be hesitating because of public pressure back home. That pressure, conservatives said, is no reason to renege.
“This issue has been litigated in four federal elections, and the result has been historic Republican majorities in Congress,” Mr. Phillips of Americans for Prosperity said. “That’s why there is no sympathy when some Republicans talk about contentious town halls or a few hundred calls into their office.”
Americans for Prosperity, which has spent tens of millions of dollars in advertising opposing the Affordable Care Act, is bringing back some of the subjects of its initial ads — ordinary people who spoke about the problems with “government-run medicine” — for its new push. And it is arming activists with supporting evidence — it found, for instance, that 98 percent of Republicans in the Senate, or 51 of the 52, had voted at one point to repeal the law.
“Congressional Republicans have promised an Obamacare repeal in unequivocal terms,” Mr. Phillips said. “It’s time for them to keep their promise.”
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