WASHINGTON — House Republican leaders say they’re optimistic about taking another shot at replacing the nation’s health care law when Congress returns from its Easter recess.

To support that confidence, they must placate both moderate and conservative GOP factions that blocked their first attempt two weeks ago to overhaul the Affordable Care Act, also known as Obamacare.

The conservative Freedom Caucus, formed two years ago by the hard-right to shrink federal influence and spending, and the moderate Tuesday Group, created in 1994 to thwart Newt Gingrich’s “Contract with America” movement, do not often see eye-to-eye.

They did, however, join in opposition to replacing Obamacare with legislation proposed by President Donald Trump and House Speaker Paul Ryan — but for very different reasons.

The Freedom Caucus said the Trump-Ryan plan did not go far enough in repealing federal subsidies and other features of Obamacare driving up health insurance rates. The Tuesday Group objected to the roll back of Medicaid assistance to millions of presently insured individuals.

Rather than risk a failed House vote, Ryan withdrew the legislation March 24, with the intention of bringing it back another day, with negotiated changes to ensure approval the second time around.

That day wasn’t expected until much later in the year. The timetable changed when the Trump administration began to crack resistance among some conservatives and moderates to a restructured bill, giving and taking from both factions.

“We are all going to work together and listen together until we get this right,” said Ryan.

Trump dispatched his chief political consultant, Steve Bannon, to try to convince conservatives it was in their best interest to support the renewed effort to get rid of Obamacare even if it didn’t satisfy their complete demands.

The Freedom Caucus and the Tuesday Group are informal caucuses with about 40 members apiece. They operate with some secrecy, meet privately and don’t disclose an official roster.

Neither group indicated if it had modified previous opposition to the unwanted provisions of the original Republican health care bill.

“They’re in fight for what it means to be a Republican,” said Andrew Clarke, a doctoral student at the University of Virginia who has researched the Freedom Caucus.

Clarke said conservative interests urging the Freedom Caucus to stick to its hard right position on health care and other budget issues insulate those who do from threats by the Republican leadership to pull their campaign funds.

Acrimony between loyalists of both sides can get bitter. Rep. Chris Collins, an upstate New York Republican who is a member of the Tuesday Group, said he’d hang up if the Freedom Caucus tried to call him.

“The Tuesday Group are Democrats with an R next to their names,” said Andy Roth, vice president of Club for Growth, a conservative group that has financially backed Freedom Caucus members.

Roth said conservatives are different than the majority of House Republicans, who he musingly referred to as “zombies, walking around collecting a paycheck.”

The Freedom Caucus and the Tuesday Group say they do not require members to vote strictly along ideological lines. But Freedom Caucus co-founder, Republican Rep. Jim Jordan of Ohio, said the conservative faction has “an understanding that we’re stronger when we work together.”

That became apparent in the debate over replacing Obamacare with the Trump-Ryan American Health Care Act. Republicans hold only a 237-193 majority edge over Democrats in the House, and with defections from GOP moderates and conservatives, the legislation collapsed.

Trump focused his frustration over the party factions on the Freedom Caucus, tweeting recently it “will hurt the entire Republican agenda if they don’t get on the team, & fast. We must fight them, & Dems, in 2018!”

Republican Rep. Mo Brooks of Alabama, Freedom Caucus member, is unmoved at the notion of going along to get along to pass GOP legislation. He said that attitude helped create the nation’s growing debt problem and risk of insolvency.

“The best way to get my vote is by proposing good legislation,” said Brooks in an interview. “Not by bullying and name calling.”

He dismissed charges the Freedom Caucus consists of obstructionists. Rather, he said, it has the “backbone to do what’s right for America, regardless of the seducing by special interest and other politically powerful insiders.”

The conservative wing of the Republican House can and has disrupted Washington with insistence on a smaller federal government and reduced spending. Three years ago, it forced a 16-day shutdown of the government by holding up a short-term appropriations bill in return for repeal of Obamacare. Neither goal was achieved.

That widely-criticized 2013 showdown triggered formation of the Freedom Caucus. Rep. Mark Meadows, R-N.C., called on hard-right advocates to step up their tough tactics as a group.

Meadows, at a Politico question and answer session Thursday, said the group’s mission is the same today as when formed at a hotel in Hershey, Pennsylvania – “give voice to the millions of Americans who’ve felt like Washington has forgotten them.”

One caucus member, Rep. Ted Poe, R-Texas, quit the group over their opposition to the Trump-Ryan health care bill.

“Saying ‘no’ is easy, leading is hard, but that is what we were elected to do,” he said.

Contact CNHI Washington reporter Kery Murakami at kmurakami@cnhi.com.

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