WASHINGTON — Republicans are rarely as exercised as when they are fighting with themselves.
And as the House debates how to best dismantle the Affordable Care Act, a familiar array of interest groups with deep pockets, incensed talk radio hosts and online agitators is again assuming its posture of aggression toward the House Republican leadership.
“Swampcare,” the writer and radio personality Erick Erickson scoffed at the new American Health Care Act, the culmination of seven years of promises to repeal and replace President Barack Obama’s signature domestic achievement. “Obamacare 2.0,” declared Breitbart.com. “RINOCARE,” Mark Levin wrote on Twitter, using the acronym for Republican in Name Only.
Political groups backed by the billionaire brothers Charles and David Koch and other powerful players on the right, such as Club for Growth and Heritage Action for America, have come out quickly and strongly against the bill. Some have threatened to punish lawmakers by docking their conservative ratings on the influential “scorecards” they distribute to voters. Activists are already swarming Capitol Hill and demanding that Congress take a harder line and pass a repeal measure that would leave no trace of the Affordable Care Act.
“I feel lied to,” said Anna Beavon Gravely, the deputy state director of the North Carolina chapter of Americans for Prosperity, a Koch-backed group that is funding a grass-roots push against Republicans in Congress who want to stop short of an outright repeal.
“We trusted you because you said you were going to do something about this. And this is not it. Not even close,” she added as she prepared to set out for the offices of North Carolina lawmakers with other activists from her state.
The displeasure is forcing an uncomfortable reckoning in the Republican Party much earlier and in a much more disruptive way than many think is constructive. And it has many conservatives asking why — now that they control both houses of Congress and the White House and have remained largely united so far — they are picking a fight with each other.
The criticism from the right has grown so harsh that President Trump asked leaders of several conservative groups in an Oval Office meeting on Wednesday to tone it down. He was especially troubled, one participant said, by the comparisons of the plan to “Obamacare lite,” which he said was inaccurate and harmful to their shared cause of gutting the current law.
One senior White House official described the meeting as “tough.” Referring to the president, the official said: “He listened. They vented.”
After the meeting, the White House appeared more confident about the prospects in the House for the health care overhaul. In a meeting with conservative leaders in the Oval Office on Wednesday, Mr. Trump said he anticipated the most trouble in the Senate, where Republican moderates and conservatives are opposing the plan for different reasons. He said he was prepared to pressure holdout senators by having the kind of stadium-style rallies he had during his presidential campaign.
Unified government was supposed to eliminate some of the infighting that plagued the Republicans during the Obama years, when the party’s right flank brought down a House speaker, defeated a House majority leader and blocked another majority leader’s ascent. Instead, it is underlining the difficulties of running Washington now that their party bears full responsibility.
“For a while, it did seem like Trump’s victory had transcended the old political battles,” said Matt Lewis, a conservative author, who added that the fighting was doubly odd because the repeal was not an issue central to Mr. Trump’s immigration- and jobs-themed campaign. “This is not why people elected Donald Trump. And yet here we are.”
As they find themselves sudden targets of a well-organized and well-financed opposition from within, some Republicans are beginning to question whether the squabbling is ultimately self-defeating. And their doubts raise a new question for this Republican faction that has been mocked as the “Party of No”: Can they ever get to yes?
“I fully respect people on the outside — who don’t have to take a vote or produce an outcome — who strive for perfect,” said Senator Thom Tillis of North Carolina, one of the Republicans who found activists in their offices this week. Perfect, he said, is never as attainable as people think. “But we’re going to get good here.”
Stopping government-mandated health care has been a cause unifying conservatives since Mr. Obama began talking about it as a presidential candidate nine years ago. Perhaps no other issue created as much energy among conservative voters, helping Republicans make historic gains in Congress as they railed against the law as an egregious government overreaching into a vast part of the economy.
But differences over how exactly to unravel the Affordable Care Act have long divided Republicans, even when the stakes were low and they knew that whatever they passed in Congress would be vetoed by Mr. Obama. In 2013, differences within the Republican Party over defunding it led to a 16-day government shutdown.
Back then, the fault lines in the debate were largely the same: hard-line conservatives butting up against the party leadership, which they accused of not acting aggressively enough.
But as much as the squabbling seems the same, there is one crucial difference: They are firing with real bullets now.
“We’re on the hook this time,” said Representative Dave Brat, Republican of Virginia, who is part of the group of conservatives pushing for an outright repeal. “This one counts.”
That they are firing some of those bullets at one another seems to be less of a concern the more conservative you are.
Representative Raul Labrador of Idaho, an opponent of the House bill who along with Mr. Brat is a member of the House Freedom Caucus, the driving force on Capitol Hill behind the resistance, said that any Republicans who will not vote to fully repeal the law will not be keeping a promise they made to voters. “And they can go back to their districts and explain to the American people why they lied,” he said.
Conservatives see many of the same problems in the Republican leadership plan today that bothered them about the Democrats’ 2010 health care bill: It extends a taxpayer-funded subsidy to help individuals buy insurance; though it revokes the Affordable Care Act’s mandate that nearly all Americans have insurance, it replaces the mandate with a new penalty if a consumer buys insurance after letting coverage lapse; it was negotiated largely without consulting the rank and file; and, they insist, its benefits could go toward people who should not receive them, like undocumented immigrants.
Matt Schlapp, the chairman of the American Conservative Union, echoed a concern that many conservative activists have voiced about not being briefed or consulted on the plan. “It goes a long way when you hear people out,” he said. “And there are a lot of natural allies that this caught by surprise as much as it did Democrats.”
The unhappiness on the right could be especially worrisome for Speaker Paul D. Ryan, whose status as a favorite target of the conservative base seemed to fade in the wake of Mr. Trump’s election.
Now, many conservatives appear willing to reopen the wounds of old leadership fights. Some of them have already taken to mocking the repeal plan with what they consider to be the most damning of pejoratives — not “Trumpcare,” as Democrats call it, but “Ryancare.”