Rep. Renee Ellmers (R-N.C.). (Pool photo by Travis Long/News & Observer via AP)

HOLLY SPRINGS, N.C. — In six short years, Renee Ellmers has gone from tea party darling to enemy.

Elected in the 2010 conservative wave in which Republicans recaptured the House majority, the North Carolina congresswoman now finds herself in jeopardy from another GOP lawmaker — George Holding — who outside groups believe is the truer conservative. And their aggressive campaign to take down Ellmers, a former nurse who entered politics because of her anger at Obamacare, may just be successful.

If Ellmers loses Tuesday’s primary, it will be at least partially because of the very same forces that elevated her to office to begin with.

When she ran six years ago, Ellmers joined the bus tour hosted by the Koch-backed Americans for Prosperity that traveled the country railing against President Obama’s health care law. She later spoke at rallies hosted or co-sponsored by the group and promoted AFP events. In 2010, she even nabbed an endorsement from Sarah Palin.

Now, AFP is one of the main players in the costly crusade to oust Ellmers in the group’s premier foray to defeat an incumbent in a Republican raceOthers taking on the congresswoman include the Club for Growth and the antiabortion National Right to Life and Susan B. Anthony List.

The latter two organizations have previously endorsed Ellmers but are now backing Holding, angry at her efforts in 2015 to temporarily stall a bill that banned abortions after 20 weeks. It is the first time Susan B. Anthony List is backing a man over a woman in a Republican primary.

This constellation of conservative groups has a single message for voters: Their congresswoman, they say, has “gone Washington.” They take firm issue with Ellmers’s vote to renew the Export-Import Bank and her support for the 2016 budget and allege that she is too close to the House GOP leadership.

“Renee Ellmers, in 2009 and 2010, she came to AFP events and touted her conservative values,” said AFP president Tim Phillips. “And she hasn’t kept her word on that.”

Ellmers acknowledges she has “become this poster child” for conservative fury and argues that’s because she refuses to do the bidding of special interests in Washington.

“Apparently [it’s] because I’m not beholden to any of them. I’m not beholden to my House Republican leadership. I am not beholden to the special interest groups,” she said in an interview before a town hall here last week. “I absolutely refuse to feel the pressure they put on other members to vote the way they want them to vote. I don’t care about the scorecards that they keep. And because I have been so vocal about it, I believe this is the reason they’re coming at me. Because I have been pointing out what so many others are too afraid to say, which is that special interest groups want to control members of Congress.”

She avoids naming specific groups, but her remarks are an ostensible jab at AFP and Heritage Action for America, which scores lawmakers’ commitment to conservative policies. Ellmers has a 59 percent Heritage Action score; Holding has a 90 percent rating.

Ellmers’s erstwhile friends are sparing no effort to oust the Republican congresswoman. AFP and Club for Growth have bought hundreds of thousands of dollars of airtime to try to defeat Ellmers, and AFP has parachuted into the House district for a grass-roots get-out-the-vote effort.

The conservative advocacy group Americans for Prosperity released a video accusing Rep. Renee Ellmers (R-N.C.) of failing to follow through on promises to her constituents. (Americans for Prosperity)

The Susan B. Anthony List is spending “mid five figures” to send canvassers to knock on 10,000 doors in the 2nd district before Tuesday, and on a Facebook ad campaign urging North Carolinians to vote against Ellmers, the group’s spokeswoman said this week.

By some accounts, the campaign to unseat her seems to be working.

Ellmers may become the first Republican House member to lose this primary season (Philadelphia Democrat Chaka Fattah was defeated in his primary, but he’s facing federal corruption charges). Even if she does go down, however, the seat will likely still be held by a Republican after November because of its conservative nature.

[How Chaka Fattah became the first person booted from Congress in 2016]

“The congresswoman has a lot of forces working against her,” said Nathan Gonzales, editor of Rothenberg & Gonzales Political Report, which tracks U.S. House and Senate races (Stuart Rothenberg is a PowerPost contributor). “She not only has inspired enemies who believe she’s become too close to the establishment, she also had her congressional district pulled out from underneath her. And she’s not only facing a challenger who’s running to her right, she’s facing a fellow member of Congress.”

However, the North Carolina legislature nixed runoff elections for 2016, so the winner needs only a plurality, not a majority of the vote, to win the primary.

“That’s the reason why I pause in declaring her defeat,” Gonzales said.

Thanks to an unusual set of circumstances, odds were already stacked against Ellmers even before AFP got involved four weeks ago.

In February, a panel of three federal judges ruled that North Carolina’s 1st and 12th congressional districts had been drawn in a way that disproportionately disadvantaged black voters. In order to give the General Assembly time to redraw the districts, the March 15 date for House primaries was pushed back to June 7, even though the presidential and Senate primaries proceeded as planned on March 15.

As a result, Holding’s previous district, the 13th, got moved across the state, leaving him to compete in the 2nd district. The redistricting gave Holding, who does not live in the new 2nd district, an advantage: an estimated 60 percent of the newly redrawn 2nd used to be Holding’s previous district, while just 15 percent is Ellmers’s former district.

“To even call Renee Ellmers the incumbent is a stretch,” Gonzales said. “This is a new district. It doesn’t really have a lot of constituents she’s represented the last few years.”

Ellmers still identifies as a conservative Republican, and eschews the idea that she’s “gone Washington.” But in recent days, in an interview and in conversations with her constituents in the Raleigh area, she sounds more pragmatic than ideological, choosing words like “common sense” to describe her approach, and touting her ability to work with Democrats to get things done.

“I’m an effective member of Congress that uses common sense and cares about my constituents,” she said in response to charges that she is not conservative enough. “It’s not an issue of conservatism to me. I use my conservatism as a tool for good policy to fix problems in Washington.”

“To me it’s a matter of effectiveness and getting things done. The conservative question, I think, is created by the special interest groups in Washington so they can put their support behind the members that are beholden to them and are weak.”

At a town hall last week attended by about 30 voters here, Ellmers cited two healthcare measures that she worked on with Democratic National Committee Chair Debbie Wasserman Schultz (D-Fla.) to protect women’s access to preventive breast cancer screenings and train medical professionals to recognize signs of human trafficking and intervene on patients’ behalf.

“Many of our bills were bipartisan,” she replied to a constituent who asked Ellmers how she has bridged the partisan gap in Washington. “It’s the best way you can be effective in Washington. That’s what the Founding Fathers wanted. They wouldn’t want everyone to get everything they want all the time just because they’re in the majority.”

On top of that, voter turnout is expected to be unusually low because the House primary and a judicial election are the only items on the June 7 ballot. Fewer than 20,000 may show up to the polls, according to AFP’s best guess, compared to the roughly 36,000 who voted in the 2014 Republican primary. For AFP, that means fewer doors to knock on (the group aimed for 12,000 doors in suburban and rural Raleigh), and fewer mailers to distribute.

Holding also has a significant financial advantage. He raised nearly $295,000 in April and May, compared to Ellmers, who raised just $27,000 during the same period, according to FEC filings.

The American Foundations Committee, a super PAC, has spent $189,000 backing his campaign and $113,000 opposing Ellmers’, according to the Center For Responsive Politics. The group also backed Holding’s 2012 campaign, and a number of its donors are members of the Holding family, which has maintained a controlling stake in Raleigh-based First Citizens Bank for three generations.

Club for Growth’s super PAC has spent about $700,000 on television and digital ads to defeat Ellmers. They criticize Ellmers for being “too liberal for North Carolina” and says she’s “become part of the problem in Washington.”

“I’m glad to have the support,” Holding said.

Correction: An earlier version of this story said the congressional primary was the only item on the ballot on June 7. There is also a primary for a spot on the N.C. Supreme Court.