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Health Law's Downfall Could Put GOP In Odd Spot

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The Supreme Court will rule in the coming weeks on the constitutionality of the Affordable Care Act — the health care law that has been a flashpoint of partisan acrimony and debate since its beginning.

Much of that debate has been philosophical. But now that the law is under review by the country's highest court, politicians have to plan for the real implications of the court's decision. That's proving particularly difficult for congressional Republicans.

They've rallied for repeal of the plan since the day it passed in 2010. And they won a majority in the House later that fall.

But now the GOP has a problem. In the two years since the law passed, several of its parts have become very popular with voters — among them, parents' ability to keep kids on their health plans until age 26 and a ban on denying insurance because of pre-existing conditions.

So it wasn't surprising when news leaked to Politico last week that Republicans were making plans to try to preserve those popular parts of the act if the Supreme Court strikes the law down.

But the political blowback for the GOP was immediate and harsh. Staffers described dozens of calls from angry conservatives. Right-wing think tanks blasted the endorsement of what they called "government meddling in business." And just a few short hours after the news was leaked, House Speaker John Boehner, R-Ohio, sent an email blast to the media, saying, "Our plan remains to repeal the law in its entirety. Anything short of that is unacceptable."

This isn't the first time GOP leaders have hinted at their support for those provisions. Right after Republicans first won the majority, House Majority Leader Eric Cantor, R-Va., spoke at a forum at American University in Washington.

Student Alyssa Franke, who has a chronic medical condition, asked Cantor the question that still stands today: "Will you try to preserve these two provisions as they stand or continue to push for a full repeal of the health care bill?"

At the time, Cantor said: "We too don't want to accept any insurance company's denial of someone because he or she may have a pre-existing condition. And likewise, we want to make sure that someone of your age has the ability to access affordable care, whether it's under your parents' plan or elsewhere."

That was more than a year and a half ago, long before last week's firestorm over the same Republican sentiment.

What changed? Well, reality. Back in 2010, the concept of repealing the Affordable Care Act was a long shot. The idea of keeping the popular provisions and dumping the rest was mostly theoretical.

Now, there's a real chance the Supreme Court could strike the whole thing down. And the law is designed so that the ban on pre-existing conditions and the parents' insurance provision are paid for by the thing Republicans hate — the mandate that all Americans buy insurance.

House Democratic Leader Nancy Pelosi of California put the Republicans' quandary this way: "It's all about the guys who brung 'em to the dance. It's about the health insurance industry, and that's the agenda that they will roll out."

Insurance companies, many of which are big Washington political donors, are prepared to fight tooth and claw against any new insurance mandate that doesn't also generate new profits for them.

So Republicans may have to choose who they're going to listen to — the voters or the donors.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

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