WASHINGTON — As Senate Republicans make a final stab this year at undoing former President Barack Obama’s health care law, health care advocates are urging their legislators to vote against the measure.

“We believe in protecting our neighbor,” said Perry Bryant, president of West Virginians for Affordable Health Care.

Alarmed by an independent estimate the bill would cost the state $1 billion in funding used to help hundreds of thousands afford medical coverage, Bryant urged Sen. Shelley Moore Capito “not to vote as a partisan politician in D.C.”

Republican leaders are hoping a different approach and the urgency of following through on campaign promises will this time muster enough votes to get rid of the controversial law.

However, they face some of the same obstacles as in July, when their effort fell a vote short.

GOP senators from states like West Virginia and Ohio — where Medicaid coverage was expanded to more people — face the prospect of supporting the loss of millions of dollars that help people afford medical coverage. Republican governors from those states, like Massachusetts’ Charlie Baker and Ohio’s John Kasich, are opposing the bill.

Health care advocacy groups representing doctors and hospitals, along with the AARP, say allowing states to undo the law’s regulations would again allow insurers to charge older people and those with medical conditions higher premiums.

With Republicans holding only a two-vote majority in the Senate, they can afford no more than two defections.

But conservative groups are divided over the proposal by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. Sen. Rand Paul, R-Ky., has said he would oppose it because it does not go far enough.

And one who’s leaning toward backing the proposal, Sen. Chuck Grassley, R-Iowa, has doubts it would pass. “I think we’re one or two votes short and I don’t see those other one or two votes coming,” he told reporters in a conference call Wednesday, but added, “I hope I’m wrong.”

More optimistic Republicans, though, point to differences this time around.

It’s their last shot to try to pass a repeal bill with a simple majority. A budget maneuver that only requires 51 votes for passages expires with the end of the fiscal year Sept. 30. Sixty votes, including support from Democrats, would be needed after that.

“I could maybe give you 10 reasons why this bill shouldn’t be considered,” Grassley said during a conference call with reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign.”

At a press conference on Tuesday, Graham argued his bill’s approach is a “uniquely Republican” one that senators from his party would find more difficult to oppose than July’s proposal.

The previous approach would have reduced funding to the 31 states and the District of Columbia that expanded Medicaid to 15 million people, who make too much to be covered by the program for very low-income people. It also would have reduced funding for subsidies that lower premiums for another 10 million people. Both programs would have continued to be run by the federal government.

The Graham-Cassidy proposal would eliminate the expansion and the premiums subsidies in 2020 and instead give states a smaller amount of money they can use for lowering premiums, or any health-related purpose they choose.

It should be an idea attractive to Republicans who believe in less federal power. “Under state control, people in charge will be accountable to you,” Graham said. “Unlike Obamacare, where the people in charge could give a damn what you think.”

Grassley said the bill would deregulate a “Washington-knows-all attitude.”

Bill supporter Sen. James Lankford, R-Okla., told an Oklahoma City radio station Wednesday the measure would hand funding to the states because “you are the closest to the people who are there. You are closest to the people. You are closest to the issues.”

The proposal also would eliminate a key provision of the Affordable Care Act that requires individuals to have insurance, and allow states to undo other Affordable Care Act regulations, like a prohibition on insurers from factoring in medical conditions in setting rates, and a requirement setting what plans have to cover.

The problem, critics say, is the block grants would provide far less funding than now projected. Cash-strapped states would not be able

to make up the difference, forcing them to reduce the number of people getting help or cutting back on their coverage.

Avalere, an independent health policy consulting firm, estimated the bill would lower federal health care spending by $215 billion through 2026.

The AARP estimated the proposal would increase premiums and out- of-pocket costs by as much as $16,174 a year for a 60-year-old earning $25,000 annually.