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The fratricidal Republican conflict du jour is whether Congress ought to shut down the government unless President Obama agrees to end Obamacare. Tea-party activists are confronting Republicans in town halls, and conservative organizations are mobilizing behind Marco Rubio, Ted Cruz, Mike Lee, and other shut-it-down conservatives. Establishment Republicans are flaying them as suicidal.

But the terms of this intramural debate are so extreme that the premises left intact are still highly crazy. The position of the Establishment Republicans — the non-suicidal ones who maintain at least some grasp of the practical limits of their power — is that a government shutdown may fail, but all other measures to attack Obamacare are fully justified. In particular, the party remains fully committed, without dissent, to a full-on boycott of any measures to help the law function in any way.

Sahil Kapur has an insightful report showing just how this plan of action is working in practice. One of the glitches to emerge in Obamacare is that it does not deem many church health-insurance plans to be fully qualified under the law. As written, it would make them disband their insurance plans and put their employees on to the exchanges. Churches are urging a reform to fix this flaw, and Senators Mark Pryor and Chris Coons are sponsoring a bill to do just that.

But they can’t get a Republican sponsor and have no realistic hope of attracting any Republican support in the near future. “We’re not expecting it to get a vote — at least not anytime soon,” Coons’s spokesman tells Kapur.

The reason is that Republicans are following a strategy of withholding support for any bipartisan fixes to the law. They will vote to repeal or undermine Obamacare, but they won’t support any changes intended to improve its functioning. It’s a pure Leninist strategy — heighten the contradictions to help hasten the collapse they are certain is inevitable.

The same strategy undergirds the Republican campaign to refuse Medicaid. This is a pure case of pain-infliction by Republican-controlled states. They are turning down the federal government’s offer to pay 90 percent of the costs of Medicaid expansion, and thus leaving their poorest residents uninsured, as a sadistic display of resistance to the dread Obamacare.

The infliction of harm upon poor people themselves will probably not rebound against these Republicans — poor people are disproportionately likely to not follow the details of policy debates and to not vote. Most of the uninsured aren’t even aware of Obamacare.

Where this policy is likely to hurt Republicans, though, is with organized interests. Uninsured people who could be getting federally financed health insurance will still be showing up in emergency rooms and getting access to care, which hospitals will be on the hook for. Now we can add churches, who will be seeing their health plans taken away. If they go to Republican elected officials seeking a solution, they’ll be told they won’t get any because Republicans are holding out to repeal Obamacare. There’s only one party that will be endorsing practical solutions. Republicans will be completely locked out by their insanely spiteful refusal to work within the contours of the new health-care law.

Over time, circumstances change, and more and more people and groups are going to need some kind of legislative adjustment in health-care law. That’s just how laws work. It’s how everything works — a company that creates a new product can’t keep the product exactly the same forever.

The Republicans’ Obamacare boycott will increasingly render the party useless for an expanding list of constituencies. Yet the Obamacare boycott remains a policy of universal agreement within the party. If conservatives are spilling blood on the floor over whether to shut down the government in a futile attempt to coerce Obama to repeal his own signature law, just imagine what’s going to happen when Republicans eventually abandon their boycott.