GOP infighting over health care, other issues belies victory

WASHINGTON (AP) — Less than 24 hours after Donald Trump had won the White House, House Speaker Paul Ryan triumphantly proclaimed the start of a new era of Republican leadership that would "hit the ground running."

Six weeks into Trump's administration, Republicans are running — just in different directions.

As congressional leaders move forward with efforts to undo former President Barack Obama's health care law, conservative activists and GOP lawmakers are slamming the proposal as "Obamacare lite," ''Obamacare 2.0" and "RINOcare" — RINO standing for Republicans In Name Only, a term of derision.

Swing state senators worry that their sickest and poorest constituents could lose access to health care. Republican governors fear that millions of people now covered by Medicaid could be dropped, a step the governors warn could hurt GOP candidates in their states.

"We've said all along, 'Work with the governors,'" said Gov. Brian Sandoval, R-Nev. "Well, they came out with their own bill, which doesn't include anything that the governors have talked about."

Republican leaders hoped unified control of Washington would unite the party around years of campaign promises to dismantle the Affordable Care Act, cut taxes and slash regulations.

Instead, the celebratory weeks that followed Trump's victory seem to have been little more than a temporary cease-fire in a yearslong GOP civil war.

"There are people who haven't adjusted to the fact that we have a Republican president," said Michael Steel, a former top adviser to onetime Speaker John Boehner, R-Ohio, who frequently tangled with tea party-aligned lawmakers. "These guys could wind up leading the cavalry charge straight into machine-gun fire."

The health care battle is probably the first of many intraparty clashes to come. Already, plans to overhaul tax laws have Republicans tied in knots. Budget hawks are skeptical about Trump's $1 trillion infrastructure plan and senior GOP lawmakers have rejected major pieces of his upcoming budget proposal.

The White House realizes that it must win over many of the objectors. With Democratic voters demanding nothing short of complete resistance to Trump, congressional passage of the Republican agenda will depend largely on party-line votes. That leaves limited room for GOP defections.

In a Wednesday meeting with the leaders of conservative groups, Trump positioned himself as the good cop in the conflict, taking what one participant described as a series of veiled shots at Ryan. The president argued that his team was at least meeting with conservative activists, according to the participant, who spoke on the condition of anonymity to describe private discussions.

Trump also reminded the activists of his strong support among the conservative base and said he planned to campaign in states he won, in an effort to pressure their unsupportive lawmakers.

"I want to be as helpful to the Trump administration as I can. I'm very supportive of the president. I support him, I want to help him. But respect has to go up and down the street, it's got to go both ways," said Rep. Gary Palmer, R-Ala., a member of the hard-line House Freedom Caucus.

At least one conservative group is already running digital ads against the GOP health care plan, arguing that the tax credits in the bill essentially replace one federal entitlement with another. Activists plan to swarm Capitol Hill to demand Congress pass a repeal bill that would completely erase all trace of Obama's signature domestic achievement.

"This is not something that is easy for us to say, 'OK, we'll take half a loaf,'" said Adam Brandon, head of the conservative activist group FreedomWorks. "What Senate Leader Mitch McConnell promised when he was on the campaign trail was we're going to repeal Obamacare root and branch. So what we're asking him to do is repeal — root and branch."

Republican leaders attribute some of the discord to inexperience. Just one-quarter of House Republicans ever served in the majority with a Republican president, meaning the vast majority of their members have spent their congressional careers focused solely on blocking a Democratic administration's agenda and fighting their own leadership.

During the Obama years, conservative lawmakers ousted incumbent Republicans, brought down a House speaker and pushed presidential candidates to the right.

"When you have a president of another party you can freelance all you want to but now we have an actual chance to change the country," said McConnell, R-Ky., speaking at a breakfast hosted by Politico. "We need to get into a governing mode and start thinking about actually achieving something rather than just sparring."

Shifting public opinion has also complicated the calculus for Republicans, increasing the political risk of giving into conservative demands for a total rollback of the health law.

Since Trump's election, polls show the law gaining in popularity. Over the congressional recess last month, GOP lawmakers faced raucous town halls and furious protesters demanding to keep their coverage.

If the GOP is unable to make good on seven years of election promises to repeal the law, they risk entering the 2018 elections without a tangible achievement and angering a Republican base that spent years fighting to get rid of the Affordable Care Act.

But if millions lose access to health coverage as a result of the GOP bill, it could expose members in swing districts to fierce attacks.

"Governing is tough," says Robert Blendon, an expert on public attitudes about health care at Harvard University. "Some Republicans didn't think through the politics of taking away coverage for 21 million people who now have it."

Beaumont reported from Des Moines, Iowa.

Associated Press writer Julie Bykowicz contributed to this report.