RACHEL MARTIN, HOST:

This past week, the House of Representatives was set to vote on a bill modifying the president's health care law. It was a Republican bill supported by the leadership, but it ran into trouble, and it was pulled from the floor before the scheduled vote. It's an example of the kind of obstacles House speaker John Boehner faces in getting legislation passed. In a number of recent cases, his problem hasn't been the Democrats as much as members of his own party backed by proudly conservative outside groups.

NPR's Tamara Keith has more.

TAMARA KEITH, BYLINE: The bill was supposed to show the softer side of House Republicans, a measure that would have taken money from one part of Obamacare, and used it to boost coverage for people with pre-existing conditions. And, as an added bonus, House majority leader Eric Cantor said it would make Democrats look bad for voting against it.

REPRESENTATIVE ERIC CANTOR: You know, that's not something they can go home and be proud of. We're trying to find solutions here.

KEITH: But there was a problem. Conservatives hated the bill. Justin Amash from Michigan was elected in the Tea Party wave of 2010.

REPRESENTATIVE JUSTIN AMASH: We're shifting money from one part of Obamacare we don't support, to another part of Obamacare we don't support. That's a non-starter for me.

KEITH: He was speaking an event called Conversations with Conservatives.

And it wasn't just a few contrarian Republicans. The outside groups that helped many freshman and sophomores get elected said they'd be watching the vote. The Club For Growth issued a key vote alert urging a no-vote. And Heritage Action made it clear it thought the bill was both bad policy and bad politics. Leadership came up against a wall of conservatism and the wall won. A spokesman for Cantor says he hasn't given up.

But this is part of a pattern. On a number of bills in recent months, if these groups urge a no-vote the measure is either pulled from the agenda or it passes but only because of Democratic support.

DAN HOLLER: A lot of these seem to be self-inflicted wounds.

KEITH: Dan Holler is with Heritage Action, the activist offshoot of the Heritage Foundation.

HOLLER: There is this inherent tension between the Republican Party and the conservative principle base. And a lot of that time that tension plays out on the House floor in these sorts of bills.

KEITH: Often that means these conservative groups are working at cross purposes with House speaker John Boehner and others in leadership. Holler says it doesn't have to be that way. They could be allies if only the speaker would push conservative policy.

HOLLER: The proper way to look at that question is not necessarily what outside groups are doing that's counterproductive to the leadership agenda. It's why the leadership agenda is divorced from what their party wants.

KEITH: Traditionally, if leadership decides something is a priority and schedules it for a vote, it will get a vote and it will pass with a majority of the majority. But with a key vote alert calling for a no-vote from the Club for Growth or Heritage Action, leadership-backed bills are facing challenges. The speaker's office dismissed their influence, but the Club's Andy Roth says the House is now loaded with members who agree completely with the Club.

ANDY ROTH: You know, in previous years there were a lot of the moderate and even liberal Republicans in the House. But thankfully their numbers have dwindled and they've been replaced by so-called Tea Party conservatives, that conservativeness - if that's a word - of the Republican conference has gotten demonstrably higher.

KEITH: The Club for Growth would like to boost those numbers even more and has a project called Primary My Congressman, aimed at replacing moderates with more conservative members like Jeff Duncan of South Carolina.

REPRESENTATIVE JEFF DUNCAN: Philosophically, we're all - and that's why they endorse me. That's why they helped me get elected. But right down to the very heart of it, the very core, is that I'm conservative, they're a conservative group. We're probably going to land on the same page anyway.

KEITH: And sometimes, that's a very different page from the speaker of the House and his leadership team.

Tamara Keith, NPR News, the Capitol.

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