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WASHINGTON (AP) — Little more than a month after they backed sweeping changes to Medicare, Republicans are on the political defensive, losing a House seat long in their possession and exhibiting significant internal strains for the first time since last fall’s election gains.

“We’ve got to get beyond this,” Rep. Paul Ryan, R-Wis., said recently after several days of back and forth over the proposal he authored and included in the budget that cleared on a party line vote. “And we’ve got to get onto a serious conversation about what it takes to fix the fiscal problems in this country.”

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