The egg that is the president’s health care reform legislation is starting to crack.

A court has ruled the bill unconstitutional. The Senate has moved to repeal by a huge margin the onerous paperwork nightmare the bill imposes on small businesses. More significantly, a select group of Democrat senators are looking for ways to legislatively roll back the individual mandate provisions of the law -- undermining key partisan unity that is keeping the law in place.

Sens. Jon Tester (Mont.), Joe Manchin (W.V.), Claire McCaskill (Mo.) and Ben Nelson (Neb.) (aka the “vulnerable caucus”) -- all of whom are up for tough re-election battles in 2012 and who represent states Obama lost in 2008 -- are poised to give Republicans the votes necessary to decimate a major provision of the legislation.

Republicans are at a critical strategic juncture. Repeal of the individual mandate is like breaking a leg of a three-legged stool -- the chair will topple.

Facing the reality that outright repeal is not possible in the Senate this year, Republicans should begin breaking the bill up, forcing critical votes on its most unpopular provisions. The Senate vote on repealing the onerous 1099 provision on small businesses found 17 Democrats willing to defend the provision. Other provisions are harder to support.

It’s a strategy that has succeeded before. In 2000, Republicans tried to pass a major tax-cut bill to send to the president but had trouble getting it out of the House, due to unified Democrat opposition. Democrats railed against “tax cuts for the rich” and held together on the big package. Instead, the Republican leadership broke up the provisions of the bill and brought them to the floor individually.

Each provision passed with large number of Democrat votes -- the same provisions Democrats had voted against in the larger context. The time has come to do the same with health care.

Start with the individual mandate. Then move on to rationing.

The effort to “reduce the cost of health care” means that seniors and the sick will face rationing of key drugs and treatments. It’s already happening with a breast-cancer drug named Avastin -- and all because of cost. Thousands of women rely on Avastin, but if the FDA “de-labels” it, as it is proposing, insurance and Medicare will no longer cover it -- which means patients who take it will be denied treatment (unless they’re wealthy and can buy it themselves out of pocket). Congress should act quickly to ensure that breast-cancer patients don’t see this drug rationed.

Timothy Riley

Timothy Riley is a communications director specializing in health care issues in Washington, D.C.