Congressional Republicans are having a tough enough time getting their own members to agree on repealing Obamacare.
Now they have a bunch of governors to deal with.
State executives are descending on Washington this weekend for the annual National Governors Association meeting and the Affordable Care Act is at the top of the discussion list. Governors will debate repealing and replacing the health reform law on Saturday, and then they will meet with President Trump and Congressional lawmakers to talk health care on Monday.
It's becoming ever clearer that what happens to Obamacare will not be decided solely in Washington D.C. Thousands of people are attending lawmakers' town halls around the country to defend the Affordable Care Act, while others are demanding their representatives give them a voice in the discussion.
Mayors are also jumping into the fray. A bipartisan group of more than 100 mayors sent a letter to Congress this week with their wish list, which includes continuing protection for those with pre-existing conditions and maintaining free preventative care. They also oppose turning Medicaid into a block grant program, a big part of the GOP's plan that would send a fixed amount of funding to the states to cover their low-income residents.
Governors have a vested interest in Obamacare, particularly in Medicaid expansion, which has extended coverage to 11 million low-income adults in the 31 states that have accepted it. Some 16 of those states are headed by Republicans.
All told, states get hundreds of billions of federal dollars each year in Medicaid funding to cover a total of more than 70 million people, mainly low-income children, parents, senior citizens and those with disabilities.
Congressional Republicans are privately turning to four GOP governors -- two from states that expanded and two from states that didn't -- in the hope that they can hammer out a deal that can win approval from their peers and from lawmakers.
Getting there will be a two-part task. First, governors need to decide how to handle Medicaid expansion, which funneled an extra $99 billion to the states between January 2014 and September 2015, according to the Kaiser Family Foundation.
Some governors have been very vocal about keeping Medicaid expansion. Ohio Governor John Kasich says he won't "sit silent" and watch the program get "ripped out."
"That is a very, very bad idea, because we cannot turn our back on the most vulnerable," said Kasich, noting the program's importance in treating those with drug addiction and mental health issues.
And though he still supports repealing Obamacare, New Jersey Governor Chris Christie told CNN's Jake Tapper that he doesn't want those who've gained coverage under Medicaid expansion to be left uninsured.
Second, state executives have to debate the larger question of what to do with the entire Medicaid program. Republican lawmakers are itching for the opportunity to completely overhaul it and shift more responsibility, control and risk to the states. While governors would like more power over the program, many aren't as keen to receive only a fixed amount of funding from Washington D.C.
Some Republican governors agree with their Democratic peers that block grants could reduce the effectiveness and reach of the safety net. And leaders of non-expansion states are concerned that funding might be frozen at current levels, which would leave them at a disadvantage since they did not broaden their programs.
Still, a few governors were supportive of block grants, saying the flexibility that comes with this funding can make it easier to transition able-bodied recipients to more independent living. Many Republican governors would like to be able to charge premiums or institute work requirements for the low-income adults in the program.
Governors also have to contend with their residents' support of Medicaid.
A Kaiser Family Foundation survey found that some 84%of those polled say it is either "very" or "somewhat" important for any replacement plan to ensure that states that received federal funds to expand Medicaid continue to receive those funds. This includes majorities of Democrats (95%), independents (84%) and Republicans (69%).
Two-thirds of respondents say they don't support turning Medicaid into a grant program. They prefer the status quo, they said.
--CNN's Manu Raju contributed to this story.