The once-fervent repeal contingent in Washington is shrinking. | REUTERS The repeal Obamacare chorus quiets

Washington’s repeal-Obamacare crowd is feeling a little lonely these days, abandoned by an increasing number of Republicans who have bowed to the political reality that the law isn’t going anywhere anytime soon.

First, the Supreme Court upheld the law last year. Then, voters returned President Barack Obama to office in the face of GOP vows to scrap his plan — and possibly replace it. Now, a growing number of Republican governors are embracing controversial components of the law, including its Medicaid expansion and its health care exchanges.


The latest Republican to buy in is New Jersey Gov. Chris Christie, who is in the top tier of 2016 Republican presidential candidates. In unveiling his state budget on Tuesday, Christie became the eighth Republican governor to say he wants to implement Obamacare’s Medicaid expansion and take the federal money that comes with it.

( PHOTOS: The eight GOP governors who said yes to Medicaid expansion)

“It’s not helpful. I’m disappointed that they’re doing it. I think that they’re obviously making the wrong decision.” Sen. Ron Johnson (R-Wis.) said of Republican governors who are signing up. “Let’s face it, our best shot was the Supreme Court, then the Nov. 6 election, and we are behind the 8-ball on this.”

But even many hard-and-fast repeal advocates on Capitol Hill have begun to acknowledge that the best they can hope for in the next four years is to make minor adjustments and wait for the chance to elect a Republican president whose purity on Obamacare hasn’t been compromised by participation in it at the state level.

The result is that a Republican Party once unified and energized by the prospect of overturning Obamacare is now arrayed across a spectrum of positions that range from pursuing full repeal of the law to signing up for parts of it.

“Republicans in many states are shifting their messaging from ‘How do we repeal this law?’ to ‘How do we implement this law in the least-damaging way?’” Kristen Soltis Anderson, a pollster and strategist with The Winston Group, said. “A lot of the friction you’re seeing within the Republican Party on this issue stems from that divide and the question of how best to push back against the law. Is it better to reject it as much as possible, or is it better to accept parts of the law and try to implement them as best you can in accordance with your principles?”

The once-fervent repeal contingent in Washington is shrinking. Reps. Michele Bachmann (R-Minn.) and Steve King (R-Iowa) have introduced bills to repeal the entire law. But the two bills together have only 37 co-sponsors — far fewer than the 182 who co-sponsored a repeal bill in 2011.

That’s a far cry from where Republicans were in the tea party summer of 2009 — when they pulled together to fight the law — and after they took control of the House in the ensuing 2010 election and numbered their repeal bill H.R. 2.

Some Republicans feel like they’ve been forsaken.

“You called Chris Christie a Republican governor. I’m not sure many would agree with that,” said Rep. Lee Terry (R-Neb.), a high-ranking member of the Energy and Commerce Committee, which oversees parts of the nation’s health care system.

While Terry isn’t happy with governors participating in Obamacare, he understands overturning the law isn’t in the cards right now.

“We all want to [repeal Obamacare]. We just know that with a now even-more strengthened opposition in the Senate and the White House maybe we can nibble at the edges and try and make some repairs where we can, but just a wholesale repeal is just impossible,” he said. “Yeah, reality is disappointing, but that’s the reality.”

Indeed, many Republicans are focusing on more targeted alterations, hoping to make improvements — and that some piece of the law catches enough negative attention to gather steam for a full repeal.

That push is now centered on the Independent Payment Advisory Board, a panel tasked with reducing Medicare cost growth, and a tax on medical devices — both of which have minimal Democratic support.

Rep. Leonard Lance (R-N.J.), whose governor signed on to a Medicaid expansion on Tuesday, acknowledged that full repeal is all but impossible in the next four years.

“At the very least I hope we can repeal the terrible medical-device tax and IPAB — both of which I think are extremely onerous provisions of the legislation,” he said. “And that’s not a comprehensive list of what I wish repealed.”

There’s still zeal for repeal in some corners, but conservatives who are committed to that effort say they have had to recalculate their strategy in the face of Obama wielding a veto pen for the next four years.

“The effort has become much more targeted — that’s just the realities of the political process,” said Grace-Marie Turner, founder of the Galen Institute and one of House Speaker John Boehner’s recent appointees to a long-term health care commission. “It’s the small battles that can win the war."

For example, Rep. Mac Thornberry (R-Texas) has introduced a bill that would delay the provisions of the law, including the Medicaid expansion and health exchanges, that go into effect in 2014.

The big signal amid the noise in the states is Florida Gov. Rick Scott, who reversed course last week after initially saying he would reject federal funds to bolster Medicaid rolls.

“With governors, it’s much less about the theory of policy and instead it’s much more about the bottom line pressure of managing the budget. … There’s no Republican or Democrat way to plow snow or pick up garbage,” said Kevin Madden, a veteran Republican strategist who advised 2012 GOP presidential nominee Mitt Romney.

Madden said Republicans have to make sure that they explain to voters how their policy approaches will help with quality of care for patients, and not as much on the abstraction of budget lines.

“What’s critical to Republican messaging on health care is that many families don’t sit together and get a diagnosis of a family member in a doctor’s office and turn to each other and say, ‘What does our political ideology tell us we should do?’” Madden said. “Instead, there are a whole range of considerations that come up: How are we going to pay for this? Or how is this going to affect the care that we’re going to get? It’s critical that we understand that those types of considerations are also given to health care policy as much as the dollars and cents” of a national or state policy.

Tevi Troy, a senior fellow at The Hudson Institute and a former health adviser to Mitt Romney’s presidential campaign, said the House won’t repeat the speed and frequency with which it brought repeal bills to the floor in the last Congress. At some point a repeal bill might make it to the floor, he said, but it won’t be a priority.

“From a larger perspective, don’t expect a lot of movement on repeal and ACA changes,” he said.

Still, the hard-core repeal advocates soldier on.

Several conservative groups are calling on Republican lawmakers to oppose a continuing resolution funding the government through the end of September unless it de-funds the health law.

A letter signed by conservative activists from Heritage Action, Club for Growth, the Tea Party Patriots and FreedomWorks argued that Congress must de-fund Obamacare “before it’s too late.”

It may already be.

This article first appeared on POLITICO Pro at 5:23 a.m. on February 27, 2013.