President Barack Obama, Senate Majority Leader Mitch McConnell, and Speaker of the House Paul Ryan in the Oval Office of the White House.

Jacquelyn Martin | AP Photo

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Republican leaders in the House have squished out again.

They have passed a key Obama administration health care initiative titled the “21st Century Cures Act.” This betrayal by establishment Republicans is further proof that the voters can’t trust most Republican House members moving forward.

It is also a sign that the American people who voted to repeal Obamacare may not get what they wanted. The citizenry voted for repeal, yet establishment Republicans may give them a “repeal and replace” that will resemble Obamacare.

Here is how the Obama White House described the bill in a press release issued on November 30, 2016:

This critically important legislation will get states the resources they need to fight the heroin and prescription opioid epidemic. It invests the $1 billion the President has repeatedly said is necessary to help communities that have seen far too many overdoses. It also responds to the Vice President’s call for a Moonshot in cancer research by investing $1.8 billion in new resources to transform cancer research and accelerate discoveries. Plus, it invests nearly $3 billion to continue the President’s signature biomedical research initiatives, the BRAIN and Precision Medicine Initiatives, over the next decade to tackle diseases like Alzheimer’s and create new research models to find cures and better target treatments.

If this is such a great bill, why wouldn’t Republicans wait a month and let President Donald Trump help craft a conservative version of this bill, rather than build up the Obama legacy? Because many Republicans agree with liberal Democrats that we need billion-dollar a new spending bill on health care without even attempting to cut waste, fraud, and abuse elsewhere to pay for it all.

Common sense dictates that it is a noble goal to fight opioid abuse, cure cancer, and tackle Alzheimer’s. Then why would the leading conservatives in the House and Heritage Action for America oppose the bill? Because it sucks.

Congress has so many priorities and great-sounding programs that it wants to fund with your tax dollars, yet they flat out refuse to pay for this new funding by cutting other spending. The national debt is approaching a staggering $20 trillion, yet Republicans — supposedly the party of fiscal responsibility — is pushing a bill that will pile further mountains of debt on future generations.

According to Heritage Action for America, the original version of the bill considered earlier this year was a bad bill:

Conservatives are rightly concerned about the amount of the federal budget that is classified as “mandatory” (also known as “direct” or “autopilot” spending). Many budget reform ideas put forward by conservatives throughout the years have sought to incorporate more of the federal budget into the normal, annual, discretionary budget process, so that spending programs have to re-justify themselves every year and so Congress must re-prioritize spending as new information and priorities present themselves. H.R. 6 moves in the opposite direction.

When the bill was considered by the House this past week, Republican had loaded it up with additional Obama administration requested spending that hiked the cost of the bill to $6.3 billion. Heritage argued that “In Washington terms, backroom negotiators have turned the Cures bill into a Christmas Tree, loaded with handouts for special interests, all at the expense of the taxpayer.” Special interest spending is bad enough, yet the spending is not the most offensive aspect of the consideration of this legislation.

That dubious honor goes to what Congress erroneously calls “offsets” — i.e., spending cuts. But let’s be clear: This new spending is not offset with real cuts — the offsets are garbage.

Congress has so many priorities and great-sounding programs that it wants to fund with your tax dollars, yet they flat out refuse to pay for this new funding by cutting other spending.

Again, per Heritage Action:

The legislation assumes $3.5 billion in savings by rescinding funds the Prevention and Public Health Fund (PPHF), a slush fund created by the Affordable Care Act (ACA). However, just last year, the House and Senate voted to repeal the ACA and rescind ALL of the funds from the PPHF.

Another accounting gimmick made to look like a “savings” is a sale and drawdown of the Strategic Petroleum Reserve (SPR). This is a favorite cash cow because it based on fuzzy math and accounting trickery. Without getting into too much detail, the SPR is an excess of oil and gas that the U.S. government sets aside to be available in a time of need.

So a health care bill loaded with a special interest provision and zero spending offsets garner the support of the establishment Republican leadership and a bulk of the Republican caucus. This should make conservatives very afraid that the weak-kneed House and Senate Republicans don’t have the stomach for a flat out repeal of Obamacare — with no replace bill.

The final vote tally in the Cures Act was 392-26. Twenty of the “Nay” votes were Republicans, including the rock star libertarian and conservatives comprising the House Freedom Caucus: Reps. Justin Amash, R-Mich. (A, 96%), Jim Bridenstine, R-Okla. (A, 97%), Ken Buck, R-Colo. (A, 93%), Tim Huelskamp, R-Kan. (A, 92%), Jim Jordan, R-Ohio (A, 94%), Raul Labrador, R-Idaho (A, 93%), Thomas Massie, R-Ky. (A, 94%) and Mick Mulvaney, R-S.C. (A, 94%). Three cheers to all the members who voted no!

This bill should be an early warning sign that establishment Republicans may be too meek to repeal Obamacare without a squishy bill to replace Obamacare ready to pass. And the replacement will inevitably be loaded up with Obamacare-lite proposals that will retain some of the core elements of President Obama’s signature health care law.

Conservatives should be very afraid.

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Brian Darling is a former staffer for Sen. Rand Paul. Follow him on Twitter @BrianHDarling.