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WASHINGTON – While conservatives on Capitol Hill are waging a last-ditch battle to scuttle the Affordable Care Act, some powerful Washington groups that were among the legislation’s loudest critics are now trying to shape the law and how it’s carried out, an acknowledgment that they need to learn to live with the landmark initiative.

Other players who have been more supportive of the law are also engaged in a lobbying push, pressing Congress and federal agencies to refine provisions.

“Why shoot for the moon?” asked Randel Johnson, senior vice president of the U.S. Chamber of Commerce, a vocal critic of the law and Washington’s biggest spender on lobbying. “There may be five or six things we can get done – those are the ones we’re going to focus on.”

Several elements of the law that the Chamber still wants to change are significant, such as repealing the employer mandate and cutting new taxes it imposed. But the group’s current stance marks a break with the Chamber’s all-out opposition to the law when it was being debated in Congress and reviewed by the Supreme Court.

For the Chamber and other employer groups, a top priority is revising the law’s definition of full-time workers, from those who work 30 hours per week to 40 hours. Under the law, large employers are required to provide health insurance to full-time workers.

For hospitals, the focus is delaying cuts to payments they receive from the government for caring for low-income and uninsured patients, given that fewer of them may start getting insurance coverage as a result of the law than previously projected.

And an array of business interests wants to repeal the 2.3 percent excise tax on medical devices that was enacted to help pay for the health care initiative, arguing that the tax will cost jobs and stifle innovation. A House measure that would do that has 260 co-sponsors but has not yet been taken up by the Ways and Means Committee. A similar proposal has been backed by the Senate in a nonbinding resolution.

Big pieces of legislation typically require what one top lobbyist called “refinements or improvements or corrections,” and with the health care program, a main target of lobbying is the Centers for Medicare and Medicaid Services, which is still drafting regulations to carry out the law.

While few involved expect quick progress, they are all keenly aware of the approach of Oct. 1, when people are supposed to be able to start signing up for health plans through online marketplaces.

“Most of the health care industry is trying to figure out from a commercial standpoint how to work with the law, because they have to,” said Dan Mendelson, a former Clinton administration health official who is chief executive of Avalere Health, which advises companies on how they could be affected by proposed regulations.

Last week, as part of the International Franchise Association’s annual public affairs “fly-in,” about 325 members – including Dunkin’ Donuts, Lawn Doctor and Jiffy Lube owner-operators – met with members of Congress and their staffs to urge them to support legislation that would redefine full time as 40 hours per week.

The franchise group opposed the health care law, but a spokesman said it has changed its approach.

“We’re dealing in a political reality where the law is not going to be repealed until the political dynamic changes,” said Matthew Haller, a group spokesman.