The worst thing that could happen in the health care debate is not failing to pass an Obamacare replacement, a conservative activist said Monday. The worst thing would be passing a bad replacement that Republicans would own.

Heritage Action for America CEO Michael Needham told reporters on a conference call that GOP lawmakers in Congress need to get it right or risk a complete takeover of health care by the federal government.

“The biggest fear I have and what keeps me up at night is that Republicans pass a health care bill that keeps the fundamental architecture of Obamacare in place … and the American people look at a health care system that’s collapsing and vote a Democrat in who says the only answer is single-payer health care.”

“The biggest fear I have and what keeps me up at night is that Republicans pass a health care bill that keeps the fundamental architecture of Obamacare in place, that the same death spirals that are already starting to happen under Obamacare happen under a Republican replacement plan,” he said. “And that in 2020 or 2024, the American people look at a health care system that’s collapsing and vote a Democrat in who says the only answer is single-payer health care.”

The American Health Care Act, developed by the House Republican leadership and endorsed by President Donald Trump, has faced increasing headwinds from conservatives in and out of Congress.

Speaker Paul Ryan (R-Wis.) has responded by arguing that the bill represents the only opportunity to repeal the Affordable Care Act. Needham blasted that approach.

“It’s kind of a backwards way of looking it,” he said. “We have one chance right now, on a 51-vote Republican threshold [in the Senate], and we can either use that to repeal the architecture of Obamacare or not.”

Needham, who met with the president last week, described him as “extremely open-minded” and “still in a listening mode and looking for good ideas.”

But White House press secretary Sean Spicer offered no indication Monday that the president is considering abandoning the bill.

“The president is fully committed to this plan,” he said during his daily press briefing. “I think you saw Secretary [of Health and Human Services Tom] Price and Director [of the Office of Management and Budget Mick] Mulvaney out discussing that this weekend.”

Spicer added that does not mean the White House will not accept improvements.

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“We’re not saying this is the only way forward,” he said. “As it works its way through the House and then ultimately the Senate, if there are ways that we can enhance the bill through the legislative process, we’re willing to do that.”

The American Health Care Act would eliminate the requirement that people buy insurance, force states to pay a greater share of the cost of covering higher-income Medicaid recipients, and replace income-based subsidies with refundable tax credits based on age. Critics contend that those tax credits are subsidies by another name.

Needham also criticizes the bill for imposing a 30-percent surcharge on customers who let their coverage lapse and then try to sign back up.

“Ryancare replaces that individual mandate with a mandate that’s on insurance companies that they charge a 30-percent tax to incentivize continuous care,” he said.

He called it the “same concept, a different tool.”

The last time congressional Republicans worked so hard to cow conservatives on health legislation was in 2003, when lawmakers passed an expansion of prescription drug benefits for Medicare recipients. To force the legislation through, then-House Majority Leader Tom DeLay (R-Texas) held open the vote for hours while leaders coerced rank-and-file members to change their votes.

Needham said Republican legislators who come under similar pressure this year have a model to follow from the 2003 debate — Vice President Mike Pence, who then was a representative from Indiana.

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“He took a stand there, and he took a courageous vote against the Medicare Part D bill,” Needham said. “And it’s a vote I think helped establish his bona fides as a strong conservative leader. And I don’t believe there has ever been a moment Mike Pence regretted his vote in 2003. And if you were going to write a book on how Mike Pence got to the vice presidency, there would be a chapter on that courageous stand that he took.”

Needham said his organization is activating 19,000 conservative leaders across the country to put pressure on Republican lawmakers.

“We’re making the case every way that we can, and we’re reminding people that sometimes doing the right thing takes courage,” he said.