ROBERT SIEGEL, HOST:
There seems to be a rift between Tea Party activists and other Republicans over health care. As Eric Whitney reports, some influential conservatives are now saying, like it or not, the health care law is here to stay.
ERIC WHITNEY, BYLINE: When the Affordable Care Act passed in 2010, the U.S. Chamber Of Commerce, an influential business lobbying group in Washington, immediately got behind the lawsuit to fight it at the U.S. Supreme Court. Here's Chamber President Tom Donahue speaking out against the law in January of 2011.
TOM DONAHUE: It's time in my opinion to go back to the drawing board. And thus, we support legislation in the House to repeal it.
WHITNEY: But this year, the Chamber's Donahue is no longer calling for Obamacare's repeal.
DONAHUE: We're not going to get rid of that bill, and so we're going to have to devise ways to make it work.
WHITNEY: Business news writers called that a striking about-face and a Nixon-goes-to-China moment." But Avik Roy, opinion editor at Forbes, says not so fast.
AVIK ROY: He didn't say that he opposes repeal. He just didn't think repeal was realistic in the next several years.
WHITNEY: Roy, a health policy advisor to Mitt Romney's 2012 campaign, says business groups, like the chamber, have to be pragmatic and deal with the world as it is, not as they'd like it to be. That's why, he says, the chamber is now focusing on changing specific parts of the health care law they don't like, rather than repealing it.
Roy thinks Republicans missed their chance to repeal the law in 2012. They won't get another chance until after the 2016 elections, he says. And by then, it will only be a small chance.
ROY: It's very difficult once a law that transformative has been in effect for seven years to repeal it. I think there are more attractive ways to achieve the goals of conservatives than repeal and replace.
WHITNEY: That doesn't sound attractive or pragmatic to conservative talk show host Erick Erickson, who runs the Red State blog. In a recent podcast of his show, he says it sounds more like capitulation.
ERICK ERICKSON: The lobbying groups who have open access to Republican leaders are abandoning repeal. The wonks the GOP leaders listen to are abandoning repeal. They're laying the groundwork to bail on fighting Obamacare.
WHITNEY: But the Chamber of Commerce and Roy say they remain committed to fighting Obamacare. The chamber wants specific items thrown out, like requiring businesses to provide health care. Roy says conservatives can accomplish more by using Obamacare to push for transformation of all government-funded health care.
ROY: The ACA is really an important, but smaller, portion of the overall reform picture. And I think what's happened with a lot of the more populist conservatives is that there's not necessarily that appreciation for how much the government is already involved in the health care system through programs like Medicare and Medicaid.
WHITNEY: Conservative activist Erickson says the traditional GOP doesn't like its populist wing and that it needs to be taught a lesson in the 2014 primary elections.
ERIK ERICKSON: The single, biggest thing you can do to get the Republicans back on the right and straight path is to support Matt Bevin against Mitch McConnell in Kentucky.
WHITNEY: Erickson also urges financial contributions to conservative primary challengers in Georgia, Mississippi, Nebraska, and other states. That means some Republican candidates will face heat for not doing more to repeal Obamacare. At the same time, they're fighting Democrats who say they aren't doing enough to help implement the health care law. For NPR News, I'm Eric Whitney.
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SIEGEL: Eric Whitney's story is part of a collaboration between NPR and Kaiser Health News.
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