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For decades, the Republican Party has stood for small government and pledged if given the opportunity it would safeguard the countrys financial future by cutting trillions of dollars from federal entitlement programs.

Thatchance finally came this week. The party balked.

At the heart of the failed Senate effort to repeal parts of the Affordable Care Act were irreconcilable differences over the proper role of entitlements and how far the party should go to pursue its small government mantra. Both wings of the GOP revolted senators who rejected steep cuts to Medicaid, a health program for low-income Americans, and others who felt the cuts were not deep enough.

Now, with the split unresolved, the party is struggling to find a way to govern despite controlling the White House and Congress. And that may leave it at risk of failing to pass any landmark legislation.

The division is expected to spill over Wednesday when Republicans in the House Budget Committee are scheduled to vote on a long-term spending plan that projects cuts to Medicaid and changes to Medicare, a health care program for older Americans that President Trump has vowed to protect.

It really boils down to the key question of Whats the role of government? said Mike Leavitt, the former Utah governor who served as Secretary of Health and Human Services during the Bush Administration. And this is a surrogate for that larger question that we often debate.

The splintering GOP philosophy is likely to define numerous other intraparty debates in the coming months.

Do they vote to raise the debt ceiling?

How much should they cut taxes?

Do they vote to cut food stamps? Housing assistance? Health care benefits for low-income children?

The current schism is a sharp break from the unity Republicans demonstrated during President Obamas tenure, when they repeatedly voted to repeal the Affordable Care Act. But lawmakers made those votes knowing the proposals would be blocked by Obamas veto. Now the votes have real power to reshape programs that have been in place since the 1960s, such as Medicaid and Medicare.

Were seeing the challenges of moving from political points to governing, said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, a group that has pushed for deficit reduction. And where that is really most challenging is finding spending cuts that back up the notion of small government.

The federal government is projected to spend close to $4 trillion in 2018, and almost half of that will go to Medicare, Medicaid and Social Security retirement benefits. Trump has promised to protect the Medicare and Social Security money from any cuts, and Republicans have now faltered in their efforts to cut Medicaid.

Reducing the budget deficit without cutting any of these programs or raising taxes is very difficult.

Those programs also provide benefits to between 15 percent and 20 percent of all Americans, almost all of them poor or older than 65. And its the concern about the impact of the cuts on low-income Americans that gave at least four Republican senators second thoughts about backing the Senate GOP health care bill.

Complicating matters for Republicans, the popularity of the Affordable Care Act has reached record levels in recent months as the GOP works to change the law. A Washington Post poll Monday found 50 percent of respondents preferred the current law, while only 24 percent backed the GOP plan. In April, Gallup found that 55 percent of Americans generally approved of the law, up from 42 percent in a survey taken just after the November election.

And the health law, particularly the expanded access to Medicaid, has won over numerous GOP governors who have vocally opposed the congressional GOP effort to cut the program back. Republican lawmakers have also faced furious opposition to their plan during town hall events in their home states.

Thats part of what led centrist Republican Senators from Nevada, Maine, Alaska, Ohio and West Virginia to revolt this week against years of their partys promises to cut spending on Medicaid. But by moving to protect parts of Medicaid, the members have scrambled the partys blueprint for governing.

The basic problem was Republicans got into promising something that could not be delivered, said Robert Reischauer, a Democrat and former director of the Congressional Budget Office. Talking is cheap. Action is politically very expensive.

Key Republicans were frozen by the Congressional Budget Offices forecast that the Senate GOP bill would lead more than 20 million people to no longer have health care coverage in the coming years. Sen. Shelley Moore Capito (R-W.V.), who has voted to repeal the Affordable Care Act in the past, said Tuesday that I did not come to Washington to hurt people.

She said she wanted to see a well-detailed plan to replace the Affordable Care Act before she could vote for anything to cull back its expanded Medicaid coverage.

But there were numerous signs that this stand by a number of Republicans had sparked fury among their colleagues.

Most of those people in our caucus - just about everybody - either voted at one time to repeal or promised to do it, said Sen. Richard Shelby (R-Ala.). They ought to keep their word.

With the Republican Party divided, these fights are expected to continue, and potentially intensify. Trump has shown a ideological openness to support most any GOP bill that has a chance of passage, hoping to notch a legislative victory after experiencing numerous defeats.

The dynamic is expected to accelerate during the budget debate, where White House officials have little experience but need a compromise in order to pave the way for an overhaul of the tax code, another top Trump priority that has languished behind the faltering repeal effort.

But the House budget resolution is already headed for a showdown among GOP members. House conservatives insisted that it contain promises to cut at least $203 billion in spending on programs such as Medicaid over 10 years in order for any tax cuts to win passage, and some are pressing for even deeper cuts. House GOP centrists have complained that this could poison the process and scuttle the budget resolution.

This is a version of the same fight that felled the health bill in the Senate. It ensures that the GOPs governing agenda, which has now become Trumps legacy, will remain in the center of this intraparty tug-of-war in the months ahead.

Now, the votes are not easy, said Ron Haskins, who was a GOP congressional aide who played a central role in the welfare overhaul during the Clinton administration. They are very difficult. These impacts are real.

Mike DeBonis and Kelsey Snell contributed to this report.

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Republicans' health-care split goes all the way to the party's soul - Washington Post