Senate Majority Leader Mitch McConnell unveiled a revised GOP health-care proposal on July 13 — but two other Republican senators released a competing plan. Here's how it all breaks down. (Peter Stevenson/The Washington Post)

There are rare moments when the national spotlight falls upon a theretofore little-known member of Congress and everyone waits to see what that person’s decision will be on a critical issue. For instance, prior to now it would be shocking if more than 1 in 100 Americans outside Nevada had ever heard of Dean Heller, the most vulnerable Republican senator up for reelection in 2018.

But he is about to decide whether tens of millions of Americans lose their health coverage, millions more face skyrocketing costs and millions lose the security they’ve enjoyed for only a few short years.

Not just Heller, actually. There are a few other Republican senators whose votes on the gruesome Republican health-care plan are still up in the air. Two Republicans — Rand Paul of Kentucky and Susan Collins of Maine — have said emphatically that they won’t support this bill. Because the GOP has only a 52-48 advantage in the Senate, all that’s needed is one more to vote no and the bill is dead. According to The Post’s whip count, there are seven others who have indicated they have concerns about it: Shelley Moore Capito (W.Va.), Bill Cassidy (La.), Bob Corker (Tenn.), John McCain (Ariz.), Lisa Murkowski (Alaska), Rob Portman (Ohio) and Ben Sasse (Neb.).

Consider the nature of the choice they’re faced with. Let’s be clear that almost no one thinks this bill will actually be good for Americans. It will leave 20 million fewer Americans with health coverage, scale back the help that middle- and lower-income Americans now get to afford insurance, increase deductibles, lead to skyrocketing premiums for older people and gut protection for those with preexisting conditions, to name just a few of the things it does. Despite the removal of some of its biggest tax giveaways, it still contains many provisions that benefit the wealthy while waging an all-out assault on the poor. It is, in short, an abomination.

So perhaps it’s not surprising that when Republicans are asked about this bill, they can’t even bring themselves to make an affirmative case for it. They say one of two things, and often both: First, that Obamacare is terrible, so something has to be done, and second, that they promised for seven years that they’d repeal it and they have to keep that promise. Neither one of those is an argument in favor of this bill.

So as these senators weigh their options, on one side they have the somewhat abstract notion of keeping a promise to GOP primary voters, and on the other side they have the substantial and demonstrable harm the bill will do to their constituents. That this is a remotely difficult choice for them tells you a lot about who these people are.

Let’s take a look at just one piece of this puzzle, the effect of the bill’s evisceration of Medicaid. If this bill succeeds, not only will the ACA’s expansion of Medicaid be rolled back, but also the program will be slashed even further and converted to a block grant, which would give states the “flexibility” to kick enrollees off their insurance and scale back benefits. While we’re awaiting the Congressional Budget Office’s score of this latest version, the Medicaid provisions haven’t changed from the previous version the CBO scored, in which it said that 15 million people would lose Medicaid. The Center for American Progress took the CBO’s estimates and broke them out by state; here are the figures for what our wavering senators would do to the people they’re supposed to represent:

  • Nevada (Dean Heller): 87,300 people losing Medicaid
  • West Virginia (Shelley Moore Capito): 83,700 people losing Medicaid
  • Louisiana (Bill Cassidy): 188,800 people losing Medicaid
  • Tennessee (Bob Corker): 395,000 people losing Medicaid
  • Arizona (John McCain): 246,200 people losing Medicaid
  • Alaska (Lisa Murkowski): 17,200 people losing Medicaid
  • Ohio (Rob Portman): 396,300 people losing Medicaid
  • Nebraska (Ben Sasse): 81,200 people losing Medicaid

To clarify, these numbers don’t represent everyone who would lose coverage, only those who would lose Medicaid; the total numbers would be even higher. And there may well be other senators who could be persuaded to vote no. But each one of those senators has to understand the spectacular human suffering he or she might unleash. How do you say to a family who lost health coverage and is thrown into a pit of worry, despair, financial vulnerability and in many cases literally even death (yes, people die when they can’t get medical care), “Sorry about that, but primary voters would have been mad if I didn’t repeal Obamacare, so you’ll just have to suffer”? How do you say that to thousands and thousands of families?

And as for the politics, if they’re afraid of a backlash if their party fails to pass this bill, just wait until they see the backlash if they do pass it.

There is no perfect choice for these senators, no choice that will see them hailed from both sides of the aisle and guarantee their reelection. But there is a better choice, both substantively and politically. The only question is whether they have the compassion, and the courage, to choose it.