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WASHINGTON Republicans are in position to finally deliver on their long-standing campaign pledges to repeal the Affordable Care Act, but that effort could be derailed by conservatives who oppose the GOP health care bill introduced last week.

Sen. Chuck Grassley, R-Iowa, said the friendly fire from some on the right isnt helping Republicans take action on health care.

Weve been promising for six years we were going to do something about it, Grassley said. Forty Republicans in the House and three or four in the Senate might be putting the whole Republican campaign of the last six years in jeopardy.

The House GOP bill, called the American Health Care Act, enters a pivotal period this week. With a relatively small majority in Congress and little support likely from Democrats, Republican leaders cant afford too many defections from their ranks if they hope to pass the legislation.

While the bill won approval from two key House committees last week, nonpartisan bean counters are poised to release their analysis of just how much the proposal will cost and how many Americans could lose coverage.

At the same time, conservative groups and their allies in Congress have stepped up attacks on the proposal, which they deride as Obamacare 2.0 and Obamacare Lite.

The bill would roll back the Affordable Care Acts expansion of Medicaid, but not as quickly as some conservatives would like.

Critics on the right also want to strip out the bills refundable tax credits to help people buy health insurance, which are intended to take the place of the ACA subsidies.

Grassley rejected the notion that such tax credits are essentially the same as the subsidies in the current law, as conservative opponents contend. He said tax credits have long been a staple of GOP health policy proposals.

The Republican answer to that, all the time, has been tax credits that are refundable tax credits, said Grassley, a senior member of the Senate Finance Committee, which does much of the heavy lifting on health care policy.

That said, Grassley indicated that he may well push for his own changes to the bill if it gets to the Senate.

The conservative pushback threatens to blunt the bills momentum after it cleared two House committees following marathon sessions.

Rep. Adrian Smith, R-Neb., a member of the Ways and Means Committee, issued a statement hailing that panels approval shortly after 4 a.m. Thursday.

For years, Nebraskans have called on us to provide relief from Obamacares rising premiums and dwindling choices, Smith said. Too many Americans have been hurt by this failing law, and now we finally have the opportunity to reset our health care system.

Smith and Rep. Don Bacon, R-Neb., have expressed support for the proposal. But other House members from Nebraska and western Iowa have been withholding judgment as have those on the other side of the Capitol.

Sen. Ben Sasse, R-Neb., who made health care his signature issue in his 2014 Senate race, has said only that he remains committed to repeal but is still reviewing the House bill.

Sen. Deb Fischer, R-Neb., was asked about the bill during her weekly conference call with reporters and repeatedly said she first wants to see what the House approves. She then reiterated criticisms of the current law.

But is she confident that Republicans will be able to pass something?

I am, as I said, waiting to see what comes to us from the House, and Im going to look at it and assess what impact its going to have on the American people, Fischer responded.

Fischer did note with approval that the House bill preserves the current laws prohibition on denying coverage to those with pre-existing conditions, and it continues to allow young people to stay on their parents insurance.

Sen. Joni Ernst, R-Iowa, also lauded those provisions.

That should really please a lot of people, she said.

Ernst said shes still studying the bills impact on Iowa, particularly the thousands covered by the states expansion of Medicaid.

She said Democrats talk about the millions covered under current law is misleading, saying that many of those people have deductibles so high that they cant afford to actually access health care. That, she said, renders their insurance cards useless.

Ernst also pointed to counties where theres a dearth of participating insurers.

Thats no choice and thats no option for those who really need the care, she said.

Health care is an emotional issue for people, she said, noting those with children who have chronic conditions such as diabetes.

It is a complicated issue, she said, but we need to do something to make sure that our families are getting the proper care they need.

joe.morton@owh.com, twitter.com/MortonOWH

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Republicans, long united by Obamacare, now divided on its replacement - Omaha World-Herald