In it, but not of it. TPM DC

Are Republicans Bending On 'Obamacare'?

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Rep. Allen West (R-FL), a tea party darling, told ThinkProgress that he supports preserving three popular provisions of the Affordable Care Act -- the same three that his party's leaders are reportedly considering.

"You've got to replace it with something," West said. "If people want to keep their kid on insurance at 26, fine. We've got to make sure no American gets turned back for pre-existing conditions, that's fine. Keep the doughnut hole closed, that's fine. But what I just talked to you about -- maybe 20, 25 pages of legislation."

This underscores the GOP's no-win predicament and helps explain why the party has no replacement plan years after promising one. If they successfully gut "Obamacare" and leave it at that, they'll face the blame for snatching away its popular benefits. But if they push to keep parts of the law, they'll face the wrath of powerful conservative groups, which have repeatedly proven their clout at purging Republican lawmakers who buck the right's demands.

"We would be very concerned about bills to resurrect parts of Obamacare," said Dean Clancy, the top health care advocate for the influential conservative group FreedomWorks.

A Republican health care aide said members of his party recognize the dilemma.

"I do think some Republicans are finally starting to realize they could be the dog that caught the car," the aide said.

The deeper problem with the GOP's fall-back plan is that guaranteeing coverage regardless of pre-existing conditions is economically infeasible without a requirement, like the Affordable Care Act's unpopular individual mandate, to bring young and healthy people into the insurance system. The idea is to spread risk and prevent costs from spiraling upward.

Health policy experts overwhelmingly accept this reality. And laws regarding pre-existing conditions without an individual mandate would infuriate the insurance industry. That's why some of the policy-savvy Republicans recognize that supporting the pre-existing condition guarantee would not jibe with their promise of repeal.

"It's a terrible idea," No. 5 Republican Rep. Tom Price (GA) told Politico recently.

A Supreme Court decision on whether the health care law passes constitutional muster is expected by the end of June. If it's struck down, President Obama and Democrats will face an enormous setback but can run against an activist conservative court in the November elections. For Republicans, the political reality is far trickier if they get what they want.