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Are tea party groups more interested in purity or poking the bear?

Conservative groups have lined up behind Ben Sasse in the Nebraska GOP Senate primary, making Sasse the latest in a long line of underdogs to earn the backing of groups whose calling card is upending more establishment-friendly (and often more moderate) candidates.

And according to much of the coverage of their actions -- and the groups involved -- it's all about conservative purity.

But in some cases, including Sasse's, "purity" is elusive.

In backing Sasse, the Club for Growth noted he has worked intimately in the world of health care. That's true. Sasse worked for former Health and Human Services Secretary Mike Leavitt as an assistant secretary.

But Sasse has also taken a health-care-related position that flies in the face of the Club's mission: He has been a vocal proponent of Medicare Part D.

In a 2009 op-ed for U.S. News and World Report, Sasse urged the country to use Part D as a model for reforming the nation's health-care laws -- offering it as a substitute for Obamacare.

"Medicare Part D is (or should be) a policymaker's dream: a government program that efficiently delivers high-quality services, and does so under budget," Sasse wrote. "Unfortunately, throughout this year's healthcare reform debate, Part D's success has been at best ignored and at worst maligned."

That stands in stark contrast to the Club's take on Part D, which passed in 2003. The Club has called the law an "abomination" and said it should be repealed.

Asked about the apparent disagreement on a major policy issue, Club for Growth spokesman Barney Keller distanced the Club from the op-ed but not Sasse.

"We think Ben Sasse’s exemplary record on our issues and his commitment to pass pro-growth policy through Congress speaks for itself," Keller said. "We simply disagree with the content of this op-ed."

Asked whether the Club knew about the op-ed before endorsing Sasse, Keller re-sent the same statement.

Sasse, for what it's worth, has adjusted his tone on Part D. In an interview with Slate's Dave Weigel earlier this month, he said of Part D: "I was opposed to it then, and I’m opposed to it now."

Sasse's campaign manager, Tyler Grassmeyer, told The Fix that Sasse believes Part D was wrong because it was an unfunded entitlement. But he also defended the program itself. "Of all entitlement programs ... Part D has by far the best free market mechanisms," Grassmeyer said.

Sasse's opponents in the Nebraska Senate race will also likely note his work with Leavitt, whose Leavitt Partners firm has helped states implement health-care exchanges under Obamacare. Leavitt's work in this regard has earned the ire of some conservatives -- particularly when he was tapped to lead Mitt Romney's transition team during the 2012 election.

(Sasse was listed by Leavitt Partners in an April 2010 PowerPoint presentation as a "senior advisor" to the firm. Sasse's campaign disputes that he ever worked for the firm and emphasizes that its candidate wasn't involved in implementing the exchanges. "Ben Sasse has never worked for Leavitt Partners or received a dime from Leavitt Partners for any work, etc.," Grassmeyer e-mails The Fix. "We cannot control what some intern may have mistakenly put in a PowerPoint or on a tent card from three years ago.")

All of which is to say that Sasse isn't your stereotypical conservative insurgent candidate.

But he's also hardly the first candidate to win support from these groups despite some pretty significant blemishes on his record.

Sen. Marco Rubio (R-Fla.) earned the Club for Growth's backing when he challenged then-Gov. Charlie Crist (R) in a 2010 Senate primary, despite having been one of the biggest earmarkers in the Florida state House, where he served as speaker.

Similarly, the Senate Conservatives Fund endorsed Rep. Todd Akin (R-Mo.) in the 2012 Missouri Senate race despite having said earlier in the race that he was "too liberal on spending and earmarks." After Akin's "legitimate rape" comment led national Republicans to abandon him, SCF stepped forward. (SCF has also backed Sasse.)

The SCF last month opted to back Senate Minority Leader Mitch McConnell's (R-Ky.) primary challenger, businessman Matt Bevin, despite Bevin in 2012 having decried the "widening ideological divide" in politics -- not exactly a tea party position.

Similarly, the Club, SCF and numerous other conservative groups have backed state Sen. Chris McDaniel over longtime Sen. Thad Cochran (R-Miss.) in Mississippi's GOP Senate primary next year. It was reported this week, though, that McDaniel voted in the state's 2003 Democratic primary.

Asked about these apparent impurities, Keller pointed to another Club-backed candidate with a pretty big shortcoming on his record: Jim DeMint.

The former South Carolina senator got the backing of the Club in his 2004 race despite having been an earmarker. DeMint later launched the Senate Conservatives Fund and now leads the conservative Heritage Foundation.

"There’s a reason almost no one gets a 100 percent on the Club’s Congressional Scorecard -– nobody is perfect," Keller said. "We just think that Congress would be a lot better if there were more 95s serving and less 65s."

The question from there is why groups like the Club and SCF get involved in the races they do. In the cases of Rubio and Bevin, for example, it's pretty clear that it was all about who they were endorsing against -- Crist and McConnell.

In a lot of these cases, national Republicans suspect these groups are more interested in opposing the establishment and poking the bear than finding the most conservative candidates -- or at least as interested.

"They back candidates not based on ideology or party position, but to either be contrarian or cause trouble, because that puts money in the bank account," Billy Piper, McConnell's former chief of staff, told The Hill last month.

In an interview with The Fix this week, SCF head Matt Hoskins said conservatism is paramount, but he also suggested having candidates who are willing to "rock the boat" and not being beholden to the establishment is indeed desirable.

"The truth is the establishment generally likes incumbents and moderates better than their conservative challengers, because establishment candidates are less likely to rock the boat and disagree with the party’s leadership," Hoskins said.

Hoskins added: "We support the party but oppose many of its current leaders who have hijacked it and used it to support moderate candidates and liberal policies."

So when national Republicans say these groups are endorsing against the establishment for the sake of endorsing again the establishment, they're kind of right. But that's also a pretty significant part of the tea party's political identity and goals -- along with conservative purity, of course.

Updated at 2:01 p.m. with details of Sasse's work with Leavitt.

Update 2:40 p.m.: Grassmeyer passes this along, from Leavitt Partners President and CEO Rich McKeown: "Ben Sasse has never worked for Leavitt Partners as either a paid or unpaid consultant, advisor or as an employee and has, accordingly, never been paid for any services by Leavitt Partners."