The battle on the right over the GOP’s ObamaCare repeal-and-replace legislation pits President Trump against an old nemesis: the fiscally conservative Club for Growth.

The Club for Growth’s political arm spent millions of dollars trying to defeat Trump in the Republican presidential primaries. It battled him over Twitter, ran ads against him ahead of primaries in swing states and dug deep into Trump’s past positions on issues dear to conservatives to portray him as a big-spending liberal.

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All that ended up being no match for the populist wave Trump rode into the White House. But that same GOP wave also boosted many Club-backed candidates in Congress, including Rep. Rod Blum (R-Iowa) and Sen. Pat Toomey (R-Pa.), both of whom won competitive reelection races.

Now, the Club for Growth is opposing Trump again, spending big to pressure Congress to fight the American Health Care Act (AHCA) — Trump’s first major legislative initiative.

Trump and GOP leaders in Congress can afford only 22 defections in their effort to repeal and replace ObamaCare. According to The Hill’s Whip List, 25 House Republicans presently plan on voting no.

Many of the lawmakers who are opposed to the bill are Club-backed candidates, including vocal AHCA critic Rep. Justin Amash Justin AmashOn The Trail: How Nancy Pelosi could improbably become president History is on Edward Snowden's side: Now it's time to give him a full pardon Trump says he's considering Snowden pardon MORE (R-Mich.). Amash has received nearly $275,000 in contributions from the group since his election in 2010, according to OpenSecrets.

“Republicans promised a bill that would stop ObamaCare’s taxes and mandates, and replace them with free-market reforms that will increase health insurance competition and drive down costs,” Club for Growth President David McIntosh said in a statement. McIntosh, like other AHCA opponents, calls the bill “RyanCare,” after Speaker Paul Ryan Paul Davis RyanAt indoor rally, Pence says election runs through Wisconsin Juan Williams: Breaking down the debates Peterson faces fight of his career in deep-red Minnesota district MORE (R-Wis.).

“RyanCare fails on those counts, and that’s why the Club is letting millions of constituents know that their Representative should reject RyanCare.”

The Club for Growth has waged a war against the bill even as Trump pushes for its passage, spending $500,000 in an ad campaign that urges 10 Republican lawmakers to oppose the legislation during the House floor vote scheduled for Thursday.

Of the lawmakers targeted in the ad, five of them have said they won’t support the bill. Additionally, Rep. Pete King (R-N.Y.) said he is “slightly against it,” while Rep. Charlie Dent (R-Pa.) still has “serious reservations” about the plan.

Rep. Tom MacArthur (R-N.J.), who was targeted by the ad campaign, now supports the bill, and Rep. Darrell Issa (R-Calif.), who was previously on the fence, is now a likely yes after Trump’s Tuesday meeting with the House Republican Conference. Issa is a top Democratic target in the 2018 midterms.

In a last-ditch effort to whip support for the bill, Trump swung by Capitol Hill Tuesday morning to meet with the House Republican Conference. He telegraphed a strong warning to House Republicans: Vote in favor of the repeal bill or risk your reelection chances in 2018 — and possibly the GOP’s House majority.

McIntosh sent a fundraising email Wednesday morning urging supporters to donate and call members of the conservative House Freedom Caucus who have been under pressure to switch their votes and back the bill. Trump met with the Freedom Caucus on Wednesday, but a spokeswoman said 25 members still oppose the bill, which is enough to kill the legislation.

“Leadership allies are running ads against them in their district,” McIntosh wrote in the email.

“That is precisely why Club for Growth is on the air and saturating the internet with ads in key congressional districts to ensure RyanCare does not pass — so we can help Republicans deliver on their campaign promises of full repeal and replacement with free-market healthcare reforms.”

While most Club-backed members oppose the bill, there are some notable exceptions bucking the group and supporting the ObamaCare replacement.

After meeting with Trump, Rep. Steve King (R-Iowa) switched his vote to yes on Wednesday. The Club has donated more than $250,000 to him since 2012.

Rep. David Schweikert David SchweikertHouse Democratic campaign leader predicts bigger majority Democrat Hiral Tipirneni wins Ariz. primary to challenge Rep. David Schweikert Ethics watchdog finds 'substantial' evidence of improper spending by Rep. Sanford Bishop MORE (R-Ariz.), a Freedom Caucus member whose 2016 reelection bid received $2,000 from the Club, also said he’ll vote yes.

The president has also met with the conservative Republican Study Committee (RSC) and was able to sway a handful of them to back the bill. Freshman Rep. Jim Banks (R-Ind.) is a yes and took $118,000 from the Club in 2016.

Rep. Mark Walker (R-N.C.), chairman of the RSC, is bucking them as well. He received $5,400 in contributions from the Club for Growth in 2016.

The House GOP’s repeal-and-replace plan has drawn fire from other Republican groups as well. Club for Growth is joined by FreedomWorks and Heritage Foundation in pressuring members against voting for the GOP healthcare plan.

Conservatives — who have also called the bill “ObamaCare lite” — are framing the proposed tax credits, which replace ObamaCare’s subsidies to purchase health insurance, as a new entitlement. They also want to accelerate the rollback of state Medicaid expansions, currently pegged in the GOP leadership’s bill to begin at the end of 2019.

Instead of the current bill, many conservatives in both the House and Senate are seeking a clean repeal of ObamaCare along the lines of a repeal that passed both chambers in 2015.

The Club for Growth’s opposition to the bill has rekindled old tensions with Trump.

Its opposition to Trump in the GOP primaries was a change for the group, which is traditionally active only in House and Senate races.

It heavily targeted moderate Republicans during the 2010 Tea Party wave, propelling anti-government conservatives such as GOP Sens. Rand Paul Randal (Rand) Howard PaulSecond GOP senator to quarantine after exposure to coronavirus GOP senator to quarantine after coronavirus exposure The Hill's Morning Report - Sponsored by National Industries for the Blind - Trump seeks to flip 'Rage' narrative; Dems block COVID-19 bill MORE (Ky.) and Mike Lee Michael (Mike) Shumway LeeMcConnell shores up GOP support for coronavirus package McConnell tries to unify GOP Davis: The Hall of Shame for GOP senators who remain silent on Donald Trump MORE (Utah) into office.

The group has played in presidential politics before, however, going after Mike Huckabee in the 2008 GOP primaries. It attacked “Tax Hike Mike” for his record on taxes and spending while governor of Arkansas.

In 2016, the Club for Growth came out early against Trump, running $1 million in ads against him ahead of the Iowa caucuses. The ads called Trump “the worst kind of politician” and warned Republicans that he’s “playing us for chumps.” It then doubled its ad buy against Trump ahead of the Illinois primary.

At the time, McIntosh said Trump had the worst economic record of anyone running for president “with the possible exception of Bernie Sanders Bernie SandersMcConnell accuses Democrats of sowing division by 'downplaying progress' on election security The Hill's Campaign Report: Arizona shifts towards Biden | Biden prepares for drive-in town hall | New Biden ad targets Latino voters Why Democrats must confront extreme left wing incitement to violence MORE.”

The Club for Growth has attacked Trump for his pledge to hike taxes on hedge fund managers, his rhetoric on trade and support for cross-border tariffs that the group says will spark a trade war, as well as his past support for a single-payer healthcare system.

During the campaign, Trump fought back hard, describing the Club for Growth as a “mafia organization” and accusing it of “extortion.” Trump alleged that the group turned on him only after he declined its request for a $1 million donation.

The group’s GOP critics dismiss the $500,000 ad campaign opposing the health insurance bill, calling it a cynical ploy to get media attention that is unlikely to influence the final vote tally.

The Club for Growth’s spending has angered some Republicans, who note that it puts the fiscally conservative group on the same side as the Center for American Progress, a Washington-based liberal advocacy group that is also opposed to the GOP healthcare legislation — albeit for dramatically different reasons.

And they say that many Club-backed members opposing the bill, including Amash and Rep. Thomas Massie (R-Ky.), can rarely be counted on to play ball with mainstream Republicans.

“For years Republicans have promised the American people they would repeal and replace the disastrous ObamaCare law,” a White House spokesperson told The Hill. “It’s time for legislators to deliver on their promises and pass the American Health Care Act — the vehicle which will reform our broken healthcare system.”