All are politically popular, although rarely mentioned by Republican lawmakers who say the country clamors for a total repeal of the law.
Despite pledging in the 2010 campaign to "repeal and replace" the law known as Obamacare, Republicans have yet to offer a comprehensive alternative. Efforts to create one have been hampered by opposition from conservatives to some of the mandates they tacitly agreed last week to leave in effect.
Conceding as much, Rep. Trent Franks, R-Ariz., said that as a conservative, he had often found during Obama's presidency that his choice was "between something bad or (something) horrible."
Republican unity, so valuable in pushing to reduce spending in the past three years, shows signs of fraying.
Even before the shutdown began, some moderates said it was time to shift the fight against Obamacare to another arena and allow the government to remain open. A handful of conservatives, backed by outside groups, rebelled when GOP demands for changes in the law were scaled back.
"I feel like we're retreating," said Rep. Phil Gingrey, R-Ga., while the conservative group Heritage Action said it opposed the last in a series of GOP maneuvers because it fell short of "fully defunding the president's failed law."
In the Senate, Sen. Bob Corker, R-Tenn., says routinely, "We're in a box canyon."
Sen. Kelly Ayotte, R-N.H., said the current strategy was not a winning one. "Why? ... Because the government shut down yesterday and the Obamacare exchanges opened and continued anyway."
Ironically, Obama and Senate Democratic leaders have said repeatedly in recent days they are willing to negotiate changes in the health care law — on another day and another bill.
Even Democrats privately concede that a tax on medical devices isn't likely to survive long, given that 79 members of the Senate backed its repeal on a nonbinding test vote last spring.
What survives is the expansion of the health care law that was passed in 2010, the opportunity for uninsured Americans to obtain private insurance at a cost oftentimes subsidized by the government.
EDITOR'S NOTE — David Espo is chief congressional correspondent for The Associated Press.
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