Congressional Republicans girding for what looks to be a tough election year may view wading into another messy fight over health care to be like the film “Groundhog Day” — but restless conservative activists are urging them to do just that.

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A pair of letters by two different groups of conservative leaders urge President Donald Trump and congressional Republicans to make repealing Obamacare a top agenda item for 2018. The letters add intrigue to a meeting at Camp David this weekend between Trump and top lawmakers, who will plot strategy for the legislative agenda and the midterm elections.

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“Americans need relief, and we believe they will hold their representatives accountable at the polls this November,” says a letter to Trump, House Speaker Paul Ryan (R-Wis.), and Senate Majority Leader Mitch McConnell (R-Ky.).

Former Pennsylvania senator and GOP presidential candidate Rick Santorum and 11 others signed the letter.

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Meanwhile, a letter by the Conservative Action Project Steering Committee lists Obamacare repeal as the first of four legislative priorities for 2018. The letter, signed by 22 conservative activists, argues that repealing the individual insurance mandate as part of the tax cut law is insufficient.

“This must be the focus of the 2019 budget reconciliation instructions,” the letter states. “Under no circumstances should health insurance companies be given billion-dollar bailouts.”

Both letters come as Republican leaders prepare for meetings with Trump on Saturday at the Camp David presidential retreat in Maryland to discuss the 2018 congressional campaign.

Repealing the Affordable Care Act has been the Holy Grail of the GOP for nearly a decade, but the effort to do so has brought more frustration than satisfaction. Although the House of Representatives last year passed a bill to repeal and replace the law, Senate Republicans suffered several humiliating failures in trying to complete the job.

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McConnell has sent conflicting signals in recent weeks. He told National Public Radio before Christmas that the Senate would “probably move on to other issues.” Later, he told reporters at his end-of-the-year news conference that he would commit to a vote on a plan offered by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) if they can get enough support.

“I wish them well,” he said.

The letter headed by Santorum, who helped the senators develop their 11th-hour proposal, argues the Graham-Cassidy proposal should be the starting point for 2018 reform efforts. The legislation would reorganize federal health care spending under Obamacare into block grants for the states, which would have great flexibility to design their own programs.

Grace-Marie Turner, president of the Galen Institute think tank in Alexandria, Virginia, said she understands the reluctance to tackle the issue anew. But she predicted the continued deterioration of health insurance markets would force action.

“Even if the politicians want to move on, the people aren’t going to let them.”

“They don’t really have a choice, I think,” said Turner, who signed the letter along with Santorum and the others. “People are still suffering … They need relief.”

The letter cites a recent Associated Press poll indicating nearly half of Americans identify health care as their biggest concern this year.

“Even if the politicians want to move on, the people aren’t going to let them,” she told LifeZette.

The Graham-Cassidy proposal got a lukewarm reception last year from some grass-roots leaders. But some of them appear to be coming around in the absence of a politically viable alternative.

“The feeling back then, when Graham-Cassidy first started being bandied about … was [that] all manner of repeal options … were better than that one,” said one of those leaders, ForAmerica President David Bozell.

Bozell, who signed the Conservative Action Project letter, said the proposal is a “step in the right direction” as long as it does not include “bailouts” for insurance companies that already will benefit from tax reform.

As hard as pushing health care reform through a closely divided Senate was in 2017, it will be even harder this year. With the victory of Sen. Doug Jones (D-Ala.) in a special election last month, the Republican majority in the chamber dropped from 52-48 to 51-49.

“Republicans just can’t agree on what to replace Obamacare with,” Bozell said.

Turner acknowledged that repeal will be harder. But she added that Graham-Cassidy was rushed last year because the authors were trying to beat a deadline imposed by Senate budget rules after earlier proposals fell apart.

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“They didn’t have time to really refine this the way they need to,” she said.

The conservative Heritage Foundation think tank concluded last year that Graham-Cassidy would give the states the ability to beef up public health programs and shrink the private insurance market. A study by the think tank estimated that the expansion could lead to the transfer of up to 8 million people — about half the individual insurance market — to government-run programs with no consumer choice.

But Mike Needham, CEO of Heritage’s political advocacy arm, signed on to the Santorum letter.

Edmund Haislmaier, a health care expert at Heritage, deferred questions about the politics of the issue. Of the policy concerns, he said, “Since it didn’t get passed, there’s been some work to see if it can be improved.”

Marie Fishpaw, director of domestic policy studies at Heritage, said embracing the Graham-Cassidy approach is not just a case of accepting a flawed idea because other alternatives are not political feasible. She said the block-grant idea has real merit.

“We’ve been spending time making sure it meets our goals,” he said.

PoliZette senior writer Brendan Kirby can be reached at [email protected]. Follow him on Twitter.