Republicans are in a bit of pickle. Two years ago they popularized the phrase "repeal-and-replace" to intimate that they had some alternative approach to health care reform they wanted to put in place. And in 2009 they sort of did, tepid and unimpressive as it was. And back then they were more than happy to incorporate elements of the ACA that they (and the public) liked--e.g. eliminating annual and lifetime caps on insurance plans, or letting 26-year-olds stay on their parents' insurance--into their replacement suggestion. And why shouldn't they? The ACA seized the middle ground and moved on reforms that the right claimed had been its health priorities for years: it provided encouragement for high-deductible plans, put brakes on new state benefit mandates, created mechanisms for allowing insurers to bypass individual state certification processes and sell across state lines, facilitated small business pools, and offered the first federal attention to malpractice reform. But that was 2009-10 and this is 2012. The most vocal parts of the Republican party are the most radical and they're insistent that retaining or replicating any single piece of the ACA is unacceptable because that would in some way validate the ACA (and Obama--yuck!). And that's backing them into a bit of a corner. A Politico article yesterday--appropriately titled "Right infighting over health care"--captured some of this confusion: Tensions ran high on the ACA-destruction-dedicated Google email group the Republicans have dubbed The Repeal Coalition. Now that would be a listserv we can believe in. Boehner then rushed in front of a camera to pander to the hardliners: But by abandoning every single piece of the ACA the Republicans aren't just ditching the big-ticket items I mentioned above, they're also abandoning numerous provisions originally pitched in Republican health care bills over the last 3 years (indeed, the language from those Republican bills was explicitly copied and pasted into the ACA on some occasions), as well as pieces that were new in the ACA but already endorsed by the Republican party. Some examples: Popular pieces of the ACA that were retained in the original Republican repeal-and-replace legislation last session (legislation that never came back once the Republicans got a majority in the House): Extension of coverage for dependents through age 26 High-risk pools Elimination of annual or lifetime benefit caps Prohibiting rescissions Further administrative simplification of electronic health transactions The tort reform provisions of Mike Enzi's reform bill (later adapted by Paul Ryan in his bill) The state-based exchanges that set benefit standards and don't allow plans to turn away applicants due to pre-existing conditions that Paul Ryan, Tom Coburn, Richard Burr, and Devin Nunes were so proud of when they introduced them The "Health Plan and Provider Portal Web sites" created by states in the Republican Study Committee Bill to provide consumers with standardized information on certified health plans, as well as price and quality information on providers (in the ACA this website is the face of the state-based exchange) Use of various student loan programs to bolster the primary care workforce in particular, as in the Republican Study Committee bill Refundable tax credits to help low-income folks buy insurance (as in Enzi, the RSC bill, and Ryan et al's bill) Reducing premium subsidies for higher-income Medicare beneficiaries in Medicare Part B and Part D, as in Ryan and Coburn's bill Creation of Accountable Care Organizations in Medicare, as in Ryan and Coburn's bill Baby, bathwater, etc.