With Republicans in control of both houses of Congress and the White House, repealing and replacing the Affordable Care Act should have been a slam dunk — and it would have been for a more united GOP. Instead, the ongoing debates over repeal and replace have been animated (and again stalled) by negotiations between the Republican Party’s moderate and conservative wings.

The House bill passed only after months of delays prompted by back-and-forth between the more moderate Republican Tuesday Group and the hard-right Freedom Caucus. The Senate, where Republicans hold a much thinner two-seat majority, has been gridlocked by a similar dynamic, as GOP leaders labored to find some compromise that could secure 50 votes.

The GOP’s struggles make for a sexy media narrative — the party’s top priority potentially doomed by internal ideological warfare. Yet this simplistic framing of moderates arrayed against conservatives obscures the reality of today’s Republican Party.

Journalists and pundits tend to label any Republican legislator who refuses to toe the party line on health care a moderate. But these disagreements are more accurately characterized as a struggle between conservative and very conservative Republicans. As the Republican Party, and American politics more generally, has migrated rightward over the past half- century, the space between the GOP’s opposing ideological poles has shrunk as moderates have withered away. Today’s bickering is a far cry from the much more fundamental disagreements within the GOP in the mid-to-late 1970s, when real moderates — some of whom even embraced the label “liberal” — waged (and lost) a final battle against conservatives aligned with Ronald Reagan.

Nowhere was moderates’ last stand more intensely fought than in New York in 1980. New York had long been the heart of moderate Republican rule. In the 1960s, moderate Republicans nationwide had been dubbed Rockefeller Republicans, after the state’s high-profile moderate governor, Nelson Rockefeller.

In New York, Rockefeller had ruled with a heavy hand, banning primary races, neutralizing county chairmen, hand-selecting candidates and using his personal fortune to otherwise bend the state party toward his will. Conservatives were marginalized and mostly confined to the sparsely populated upstate region.

Rockefeller’s retirement from politics in 1976 and death in 1979 finally made room for conservative Republican networks to flourish after decades of top-down moderate rule. Conservatives, working at the grass-roots level, began to organize in the populous suburbs of New York City, which could tip the balance of a statewide election.

These conditions encouraged Reagan to make a major bid for electorally rich New York in the 1980 — just four years after then-Vice President Rockefeller had all but shut him out of the state’s GOP primary. Reagan went on to twice win New York in the general election thanks to crucial suburban support.

The state’s shift to the right also set the stage for Al D’Amato, a little-known conservative from Long Island, to wage a primary challenge against Jacob Javits — a quintessential Rockefeller Republican and New York’s longest-serving U.S. senator.

Javits was not blind to the conservative insurgency raging around him, but he remained committed to moderate Republican policies — policies that opened a vast ideological chasm between him and D’Amato. Like other moderates, Javits offered full-throated support for modern feminist priorities such as legal abortion, which he linked to the GOP’s historical embrace of individual rights. D’Amato, by contrast, unequivocally opposed legal abortion in favor of what conservatives termed “family values” — policies and rhetoric that skewed toward the (white) heterosexual nuclear family and traditional gender roles.

The gap between Javits and D’Amato was equally pronounced on the economy. Like New Deal Democrats, moderate Republicans believed in having a more activist federal government boost the economy in ways that put money in people’s pockets — although they were less comfortable than Democrats with levying taxes, creating big federal programs or running deficits to do so. Conservatives, on the other hand, desired the smallest and most limited federal government possible, at least on domestic matters. Cut taxes and wealth supposedly would, as their common refrain promised, “trickle down” from there.

D’Amato’s conservative economic and cultural stances played well in the voter-rich bellwether suburbs of New York. He reminded voters that unlike Javits, who had an apartment in Manhattan, he felt the pinch of high property taxes on Long Island, coupled with increased state taxes to mitigate New York City’s near-bankruptcy in 1975.

These suburbs also served as the base for the mostly Catholic homemakers mobilizing against feminist changes — women who historically had been Democrats but now gravitated toward conservative Republicans over shared priorities, such as ending legalized abortion.

Javits lost the primary, and his breed of moderate Republicans became virtually extinct in New York and nationally. Some moderates suffered defeat; others became Democrats, especially as centrists wrested control of that party from liberals during the Reagan years; and still others exited politics, exhausted by having to fend off opponents left and right.

The formula that enabled the largely unknown D’Amato to unseat a party titan such as Javits has been replicated by successive generations of conservative Republicans. Newcomers look to unseat the old guard by lurching rightward to expand the GOP’s base, connecting social and economic issues in ways that appeal to white voters in major suburban and exurban population centers. As politics has become more polarized in the process, candidates use antipathy toward Washington and their own outsider status to justify even more domestic cuts to government.

Each new Republican cohort becomes more conservative than the last. Someone such as Sen. Marco Rubio (Fla.) ends up being labeled a moderate for departing from orthodoxy on an individual issue (in Rubio’s case, immigration), when in the not-so-distant past of 2010, he was a darling among tea party conservatives, beloved by the GOP’s right-most flank.

In reality, nearly all of today’s elected Republicans proceed from the same premises that guided D’Amato, even if some are further to the right on the same conservative ideological plane.

The health-care debate only underscores that today’s internecine Republican scuffles are between conservatives and ultra- conservatives. No Senate Republican is arguing, for example, that the federal government should augment its role in health-care oversight or increase — or even maintain — current funding levels; instead they bicker about how quickly and in which manner they should reduce both. With a few notable exceptions, the health-care debates also have illustrated broad Republican consensus for cutting off federal funds to Planned Parenthood — now a proxy war for abortion, even though federally funding abortion services has been illegal since 1976.

For all of the focus on Sen. Susan Collins of Maine — perhaps the last Republican senator in Rockefeller’s mold today — the other three dissenters in the Senate this week walked away because a very conservative bill did not go far enough.

The Senate health-care effort has ground to a halt because most Republicans are ideologically unified enough to overreach and attempt to take benefits away from millions of Americans. This gambit produced a very unpopular bill, and just enough Republicans were unwilling to take the political risk entailed by voting for it to create a deadlock.

In the earlier era, when GOP moderates numbered more than one in the Senate, Republicans would have crafted a bill capable of drawing wider public support, and the effort would not be flailing as it is today.