Virginia gubernatorial candidate Ed Gillespie (R) answers questions on federal health-care bills posed by Alexandria, Va., resident Mary Lagnaoui on Tuesday at Pork Barrel BBQ in Alexandria. (Fenit Nirappil/The Washington Ppst)

In Virginia, Republican gubernatorial nominee Ed Gillespie is getting peppered with questions on the campaign trail about President Trump’s efforts on health care, and he has declined to take a clear position.

In Maryland, Gov. Larry Hogan (R), who is up for reelection next year, says health-care plans being advanced by the Republican Congress “do not work” for his state, but he is still getting badgered by Democrats to speak out more forcefully against Trump.

And in Illinois, Gov. Bruce Rauner (R) is taking flak for saying he still needs time to study the GOP bills. A mailer sent this week by one Democrat hoping to challenge him in 2018 showed a pair of boxing gloves and called Rauner and Trump “a one-two punch that could knock out your health care.”

As Congress continues to debate unpopular Trump-backed legislation projected to drive up the number of uninsured, some Republican gubernatorial candidates are growing queasy as they are asked to defend it — and Democrats are eager to pounce.

Thirty-eight states are holding gubernatorial contests this year and in 2018. The challenge for Republicans is particularly pronounced in swing states and in those that have expanded Medicaid coverage under former president Barack Obama’s signature health-care law, the Affordable Care Act. Both the House and Senate health-care bills would phase out federal funding for those efforts, leaving the 31 states that took advantage of the provision to pick up the tab if they want to continue it.

Maryland Gov. Larry Hogan (R) is among the GOP governors being targeted by Democrats on health care. Hogan says he opposes proposed legislation backed by President Trump to roll back the Affordable Care Act. (Linda Davidson/The Washington Post)

That is one of several ways in which implementation of the GOP health-care legislation would fall to the states, raising the stakes for gubernatorial candidates to lay out their positions.

“Governors are the ones who’d be left holding the bag,” said Jared Leopold, communications director for the Democratic Governors Association, which on Wednesday unveiled digital ads targeting GOP candidates in six states whom the DGA accuses of staying silent on Trump’s health-care efforts.

The spots target Gillespie, who is on the ballot this year in Virginia, and candidates seeking the GOP nomination next year in Michigan, Ohio, Nevada, Florida and Rhode Island.

Jon Thompson, a spokesman for the Republican Governors Association, said the ads are a sign of Democratic weakness, citing in particular the decision to air them in Rhode Island, a state that Democratic nominee Hillary Clinton carried easily last year.

“I read polls every day, and there’s no evidence yet that President Trump or any of his policies are going to be a drag on any of our candidates,” Thompson said.

Only 17 percent of adults nationwide approve of the Senate health-care bill, while 55 percent disapprove, according to an NPR/PBS NewsHour/Marist poll released on Wednesday.

Even among Republicans, support is tepid, with 35 percent voicing approval and 21 percent saying they disapprove.

Ohio Gov. John Kasich (R), right, joined by Colorado Gov. John Hickenlooper (D), speaks at a news conference on Tuesday at the National Press Club in Washington. (Carolyn Kaster/AP)

John Weaver, a veteran Republican strategist, said federal action on health care will probably factor in significantly in gubernatorial races this year and next regardless of what actually happens in Washington.

If Congress does nothing and the health-care exchanges established under the ACA continue to have problems, that will be an issue, he said. And if a bill similar to what was unveiled last week by Senate Majority Leader Mitch McConnell (R-Ky.) becomes law, there will be plenty of talk about its impact on states.

The nonpartisan Congressional Budget Office has projected that the Senate bill could lead to 22 million fewer people with insurance by 2026.

“It won’t be forgotten by any means, clearly,” said Weaver, who worked on the presidential campaign of Ohio Gov. John Kasich (R).

Kasich is among a handful of sitting Republican governors who have spoken out against the GOP bills in Congress. Hours before Senate Republicans delayed a vote this week, Kasich said their bill was “unacceptable” because it would victimize the poor and mentally ill and redirect tax money “to people who are already very wealthy.”

Nevada Gov. Brian Sandoval (R) has also spoken out against the GOP legislation, citing the impact of phasing out federal funding for Medicaid expansion in his state.

Massachusetts Gov. Charlie Baker (R), who presides over a Democratic-leaning state, has been critical as well. On Monday, he joined Virginia Gov. Terry McAuliffe (D) in writing a letter to McConnell asking on behalf of the bipartisan National Governors Association that the Senate slow down its march toward a vote.

Thompson, the RGA spokesman, said such dissent was a byproduct of holding 33 governorships, compared with 16 for Democrats. “What works for some states might not work for another state,” he said.

For Gillespie, a former chairman of the Republican National Committee, the GOP health-care efforts are an ongoing headache as he campaigns in the only Southern state that Clinton won last year.

Gillespie has been trying to stay laser-focused on jobs and the economy. But he could not escape health-care questions during a routine campaign stop Tuesday at Pork Barrel BBQ in Alexandria, Va.

“So what do you think about the Senate health-care bill?” asked one woman who introduced herself as Gail and said that she had never met Gillespie.

Without skipping a beat, Gillespie repeated his common refrain. “Well, I’ll take a look at it, and I got concerns on both sides,” he said. “I don’t think the Affordable Care Act has been good for us in Virginia. Our premiums and out-of-pocket expenses have skyrocketed.”

“So, will you support a public option?” the woman interjected, referring to an idea embraced by liberals to include a government-backed coverage option on insurance exchanges.

“I don’t know that I’d support a public option,” Gillespie responded. “That makes me nervous.”

Mary Lagnaoui, an Alexandria resident, said she realized Gillespie was at Pork Barrel after spotting protesters with signs outside. She has been so consumed by health-care-related news that she felt compelled to go inside and get his thoughts, she said.

“Do you have a stand on Obamacare?” she asked Gillespie.

“Well, we were just talking about it,” he said. “I believe that the Affordable Care Act, Obamacare, has not been good for us here in Virginia.”

As their conversation continued, Gillespie said he hopes that Congress does not treat Virginia punitively for not having taken part in Medicaid expansion under the ACA.

“I’m hoping they get that right in Washington, D.C., but I’m focused on what we can do here in Virginia,” Gillespie said, before excusing himself to take a photo with restaurant employees and leave the building.

A recent Quinnipiac University poll pegged the president’s approval rating in Virginia at 40 percent and found that nearly 6 in 10 Virginians disapproved of the House Republicans’ health-care bill.

Gillespie’s detractors, including the Democratic nominee, Lt. Gov. Ralph Northam, have pilloried him for not taking a firm stance on the legislation, which Northam has characterized as “immoral and unacceptable.”

“At some point, Gillespie will have to say what he thinks is good for Virginia,” said Bob Holsworth, a longtime political analyst. “This issue is likely to come more to the forefront if something actually passes.”

Jennifer Duffy, an analyst who tracks gubernatorial contests for the nonpartisan Cook Political Report, agreed that Gillespie “is going to have a hard time fudging this issue and not taking a position.”

But she said it might not be as pressing for other GOP candidates around the country.

“He is too close to the Beltway,” she said. “People expect him to have a position, and Democrats are clearly not going to let this go.”

The Republican nominee in New Jersey, the only other gubernatorial contest this November, has voiced concerns about the ACA and the loss of Medicaid funding that would result from the Republican legislation.

Lt. Gov. Kim Guadagno (R) “is waiting to see a final bill, but believes Washington should pass a replacement plan that covers preexisting conditions and allows people to keep their health insurance at an affordable cost,” said spokesman Ricky Diaz.

In Maryland, Democratic Party chair Kathleen Matthews knocked Hogan on Wednesday for what she described as a “lack of leadership” in preventing Republicans in Congress from scaling back the ACA and called his position “wishy-washy.”

Hogan is “acting more like a politician than a true governor who cares about the health care of hundreds of thousands of constituents,” Matthews said on a conference call with reporters.

Hogan has criticized Congress’s latest plan for replacing the ACA, with a spokeswoman for his office saying last week that “Congress should go back to the drawing board in an open, transparent and bipartisan fashion to craft a bill that works for all Americans.”

The Maryland governor has also said he wants Congress to find a middle path between Democrats who want to preserve the ACA and Republicans who would like to drastically overhaul it.

Josh Hicks contributed to this report.