In an effort to slow the pace if not fully stop the repeal of Obamacare, Democratic governors from across the country are making back-channel entreaties to Republican members of their state’s congressional delegations.

Their pitches have been simple and uniformly distressed: Uprooting the Affordable Care Act at this juncture, they warn, would cause a massive disruption in the health care markets and have costly impacts in members’ home districts.

Gov. Jerry Brown’s (D-Calif.) office confirmed that he had been in “close contact” with legislators in Washington, D.C., to discuss “potential challenges ahead” on health care. Gov. Tom Wolf (D-Penn), meanwhile, is drafting a letter to Majority Leader Kevin McCarthy (R-Calif.) and the entire Pennsylvania delegation, reminding them that some 63,000 people in the state depend on the law for drug and alcohol treatment ― at a time when they’re grappling with an opioid and heroin epidemic. And in Washington, Gov. Jay Inslee (D) made similar overtures to GOP leadership and fellow members, while noting that 51,000 health-related jobs have been added to the state’s economy since the ACA was passed.

“I’ve talked to some of our Republican delegates to Congress, just expressing the hope that that will turn out just to be a bumper sticker,” Inslee told The Huffington Post. “We want to make sure that this repeal and replace doesn’t just end up being a repeal. ... Whatever they do, we cannot allow it to be kicking people off their health care by the hundreds of thousands in my state.”

There is little indication to date that Republican leadership is heeding these warnings. Members have signaled that they plan on fully repealing Obamacare early in the new year, while establishing a window as long as four years to find a replacement. President-elect Donald Trump has given no indication of any hesitance about signing such a bill.

But the governors have a compelling case to make. The ramifications of appeal in certain districts could be massive. In California alone, 1.4 million people purchased plans through state exchanges, according to data from the Centers for Medicare & Medicaid Services, and the state’s Medicaid expansion gave 3.5 million new people coverage by the end of 2015, according to data compiled by the Kaiser Family Foundation. In Pennsylvania, those numbers are 412,000 and 600,000. And in Washington they’re 158,000 and 592,000.

County-level data shows that the law has affected areas that elect Republican lawmakers. In the two counties that make up McCarthy’s district ― Kern and Tulare ― roughly 28,000 people enrolled in plans through the state exchange, according to state data compiled in June 2016. This total doesn’t include the number who have enrolled in Medicaid because of the law. All told, 14 members of California’s delegation are Republican, including McCarthy; 13 members of Pennsylvania’s delegation are Republican; and four members of Washington’s delegation are Republican, including Cathy McMorris Rodgers, the third-ranking member in the House.

Yuri Gripas / Reuters Kevin McCarthy (right) has Speaker Paul Ryan's ear. He also has a number of constituents depended on Obamacare.

Depending on when the repeal legislation is considered, these governors will need to convince as many as 23 Republicans in the House, or three in the Senate, that it’s in their political self-interest to keep Obamacare intact ― as least until a replacement is passed.

It’s a tall task. But while they play an inside game ― working legislators through direct talks, political persuasion and thinly veiled threats (such as pledges to not help the GOP clean up the mess that a repeal will create) ― outside groups supportive of Obamacare are adopting a traditionally grassroots approach.

Almost immediately after the results of the election came into focus on Nov. 8, top advocacy and health policy officials began talks to reconstitute the same coalition that helped Obama pass the Affordable Care Act in 2010. Organizers met in subsequent days to discuss how to structure and staff the outfit, with leadership drafting up a state-based approach to localize pressure on lawmakers returning home for Thanksgiving and Christmas breaks.

“A lot of it is facing the new reality both in Congress and the administration. These people are institutionally engaged in these issues. It is wrenching for them,” said one organizer leading the efforts, who spoke on condition of anonymity to talk about specific plans. “They’ve spent their lives on this. It is not abstract. So, you suit up for this stuff because that’s what you do.”

To date, liberal groups have organized protests outside of GOP Senate office buildings and a “week of action” in various districts across the country. These same groups are gathering a database of individual stories from those whose lives and health are dependent on the law. They plan to make a patient-centric public relations push once Congress reconvenes in January, in addition to framing the repeal of Obamacare as the first step in a Republican-designed plan to downsize Medicare too.

“The biggest thing is making sure that people’s outrage about what the other side is doing is made visibly visible to decision-makers themselves and the press looking on,” said Ben Wikler, the Washington Director of liberal advocacy organization MoveOn.org.

To date, only a few GOP lawmakers have expressed reservations about their party’s strategy. That may suggest that GOP lawmakers are more emotionally committed to repealing Obamacare than they are open to arguments that it should stay in place. But it also reflects the broader political forces at play. While Democratic governors and outside groups are gearing up for a massive campaign to save the Affordable Care Act, the forces of opposition are organizing their own push too.

“We are willing to work with every other grassroots organization willing to work with us to make sure we repeal the law and making sure we [are] replacing it [with something] that doesn’t resemble Obamacare-light,” said Noah Wall, grassroots director for the conservative group FreedomWorks, which has led the effort to upend the law. “That’s key for us, and what we are going to need to do is going to require a tremendous amount of grassroots pressure. But our activists are so close to seeing the end of the tunnel that I think they will be super motivated on this.”

Amanda Terkel and Jeffrey Young contributed reporting.

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