The mounting criticism from governors, including sharp denunciations from within President Trump’s party, helped stymie Republican efforts to marshal support in the Senate and may have led, in a roundabout way, to the stalling of the measure this week. More than half a dozen Republican governors, including several from states with Republican senators, expressed grave reservations or outright opposition to the bill, while Democrats have been unanimous in their disapproval.
Gov. Brian Sandoval of Nevada rejected the proposal so forcefully that he helped sway Senator Dean Heller, Republican of Nevada, to oppose it. Mr. Heller’s unrestrained attack on the bill on Friday helped set off a chain of events that forced Republicans to delay a vote in the Senate.
On Monday, a second bipartisan team of governors, Terry McAuliffe of Virginia, a Democrat, and Charlie Baker of Massachusetts, a Republican, issued a joint letter asking the Senate to halt its dash toward a vote.
In an indication of the stakes involved for the states, Mr. McAuliffe and Mr. Baker wrote explicitly in their capacity as chairman and vice chairman of the National Governors Association — a striking gesture given the nonpartisan organization’s reputation for caution in politically sensitive matters. “On behalf of the National Governors Association, we urge you to give states sufficient time to review the legislation before proceeding, so that the full impact of the legislation may be understood and explained to the American people,” they wrote.
The doggedness of the governor-led effort reflects the expansive implications of a federal health care overhaul for state governments. In states that accepted expanded Medicaid funding under the Affordable Care Act, including Ohio and Nevada, the sharp restrictions on the program imposed under the Senate bill would batter state budgets and threaten the health coverage of millions.
The current Senate bill would wind down support for expanded Medicaid coverage and recalculate federal funding for longstanding Medicaid programs on a more restrictive basis. The Congressional Budget Office projected on Monday that the Senate bill would lead to 15 million fewer people receiving Medicaid coverage, over a period of 10 years.
There has been no visible effort among governors to lobby in support of the legislation, and most Republican governors have either remained silent or given equivocal statements on the bill. Several advisers to Republican governors, who spoke on the condition of anonymity, said they were wary of engaging in a fight with the White House and the Republican-led Congress over a bill that appeared headed for collapse anyway.
But if the legislation does unravel further, governors will have played a hand in that: Mr. Hickenlooper said in an interview that he and Mr. Kasich had agreed to team up after a February meeting of the governors’ association in Washington, where state leaders heard an alarming presentation about the potential consequences of a federal pullback in health care.
Within weeks, Mr. Hickenlooper said, both Mr. Kasich and Mr. Sandoval had called him personally to seek his help in taking on their own party. Mr. Kasich, he recalled, expressed confidence he could find other Republicans who would “take a pretty strong stand that coverage shouldn’t be rolled back.”
From those conversations emerged a tentative game plan: They would seek to assemble a nimble, informal group of governors, from the right and left of center, who would publicly express concern about health care legislation drafted in the House and Senate. They would press for a slower, less disruptive and more public legislative process, and insist on protections for states that had greatly expanded Medicaid rolls.
Joining Mr. Kasich and Mr. Sandoval, on the Republican side, was Mr. Baker of Massachusetts. On the Democratic side, Mr. Hickenlooper recruited Steve Bullock of Montana, John Bel Edwards of Louisiana and Tom Wolf of Pennsylvania, Mr. Kasich’s neighbor to the east. Other governors on the Republican side have drifted in and out of the conversations, including Rick Snyder of Michigan and Asa Hutchinson of Arkansas.
The core group of seven has consistently spoken out against a precipitous repeal of the Affordable Care Act, publicly urging caution, lobbying members of Congress and issuing dire assessments of how their states could suffer. They have also gently reached out to colleagues who might be wary of signing a joint letter criticizing Republican legislation, but who would be willing separately to express their own reservations about a rollback of existing health care law.
John Weaver, Mr. Kasich’s chief political adviser, said Mr. Kasich had spoken recently with other Republican governors, including Mr. Snyder, Doug Ducey of Arizona and Larry Hogan of Maryland, who have publicly criticized the Senate proposal. “He has worked it on the phone,” Mr. Weaver said of Mr. Kasich. “There are a number of Republican governors who he spoke to and didn’t want to sign the letter, but came out on our position.”
Mr. Weaver said that the group hoped its appeals would both put political pressure on the Senate and serve as a model of bipartisan action that Congress could copy in a more protracted health care negotiation.
“There’s all this talk in Washington that neither side can work with the other,” he said. “That doesn’t need to be the case.”
In addition to the disruptive impact the health bill would have on states, there are clear political implications for governors if the legislation passes, an increasingly tenuous possibility. Democratic strategists have signaled they intend to make the bill’s state-level effects a major issue in the 2018 elections.
The Democratic Governors Association is to begin running digital advertising and automated phone calls on Wednesday in several states, attacking Republican state leaders on the issue of health care, said a spokesman for the group, Jared Leopold.
Democrats have demanded that Republican governors and candidates for governor take clear stances on the bill, including its rollback of Medicaid, and have pressed Republican candidates for governor to say if they would seek federal waivers that could loosen popular health care regulations at the state level.
To the extent that governors openly opposed the bill, it helped create an untenable situation for undecided senators, and critics of the legislation embraced Mr. Sandoval’s role in wooing Mr. Heller as a template to follow. Mr. Heller offered his denunciation of the Republican proposal at a joint news conference with Mr. Sandoval on Friday.
Mr. Sandoval told other governors, at a conference in Montana over the weekend, that he had urged Mr. Heller to ignore potential backlash from the right and come out against the bill because “the people of Nevada will respect you and you will rise above that commotion,” according to Mr. Hickenlooper, who said he had drinks with Mr. Sandoval on Sunday night.
Mr. Kasich and Mr. Hickenlooper indicated on Tuesday that they were hopeful but far from certain that Republican senators from their states would help defeat the legislation. It is unclear when the chamber will ultimately vote on the measure.
Besides Mr. Heller, there are a number of Republican senators from states whose governors have been critical of the legislation, who have yet to take sides on the bill themselves, including Senator Rob Portman of Ohio and Senators John McCain and Jeff Flake of Arizona.
Mr. Kasich said that he had spoken with Mr. Portman and was unsure how he would vote, but that he “knows exactly what my concerns are.” He said that Democratic senators should volunteer to cooperate on a negotiated solution, and that Republicans who campaigned on root-and-branch repeal of the Affordable Care Act should be “big enough” to say they changed their minds.
Mr. Hickenlooper said he was seeking a meeting with Senator Cory Gardner of Colorado, a first-term Republican who is the chairman of his party’s campaign committee in the Senate.
“By hook or by crook, I will get ahold of him before there’s any vote,” Mr. Hickenlooper said. “I will go camp out on his doorstep if I have to.”
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