If the Senate passes Cassidy-Graham, its latest attempt to repeal Obamacare, the legislation will then go to the House for a vote. If that happens, Speaker Paul D. Ryan (R-Wis.) has vowed to engineer its quick passage in the lower chamber, too, and President Trump will of course sign anything that allows him to boast that he obliterated President Barack Obama’s biggest accomplishment.

But we now have a new study from Avalere Health that shows that certain states are going to be hit with major losses if this bill becomes law. And it turns out that those states that would lose out happen to be heavy with incumbent House Republicans whose seats are vulnerable in 2018.

Will those vulnerable House Republicans vote for a bill that drains their states of huge sums of money that could have been used to cover their own constituents?

As we noted earlier, a number of states stand to lose very large chunks of federal spending on health care under the repeal bill — championed by Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.) — that may be voted on next week in the Senate. It ends the Medicaid expansion and the subsidies starting in 2020 and replaces them with block grants. This chart shows how large these losses stand to be in those states over the period of 2020-2026 (after which the block grants end).

Below, we’ve listed the states that stand to lose the most in federal funding, and the vulnerable House Republicans that come from those states. We started with the Republican incumbents who are in districts that the Cook Political Report has designated as “toss-up” or “lean Republican.” These are seats that Democrats have a real chance of flipping.

The Democratic Congressional Campaign Committee is targeting all of those seats, but it is also targeting a bunch more that it sees as gettable but are not rated in those categories by Cook. We’ve added those in, too. Here’s the result:

  • California (which faces a $78 billion cut under Cassidy-Graham from 2020 to 2026):

COOK: Toss-ups: Steve Knight and Darrell Issa. Lean Republican: Jeff Denham, Edward R. Royce, Mimi Walters and Dana Rohrabacher.

Additional DCCC targets: David Valadao, Devin Nunes and Duncan D. Hunter.

  • New York (which faces a $45 billion cut):

COOK: Toss-up: John Faso. Lean Republican: Claudia Tenney.

Additional DCCC targets: Lee Zeldin, Daniel Donovan, Elise Stefanik, Tom Reed, John Katko and Chris Collins.

  • Arizona (which faces an $11 billion cut):

COOK: Lean Republican: Martha McSally.

Additional DCCC targets: David Schweikert.

  • New Jersey (which faces a $10 billion cut):

COOK: Lean Republican: Leonard Lance and Rodney Frelinghuysen.

Additional DCCC targets: Frank A. LoBiondo and Tom MacArthur.

  • Washington state (which faces a $10 billion cut):

COOK: Toss-up: open seat owing to retirement of Dave Reichert.

Additional DCCC target:  Jaime Herrera Beutler.

  • Illinois (which faces an $8 billion cut):

COOK: Lean Republican: Peter J. Roskam and Mike Bost.

Additional DCCC targets: Randy Hultgren and Rodney Davis.

  • Minnesota (which faces an $8 billion cut):

COOK: Toss-up: Jason Lewis. Lean Republican: Erik Paulsen.

Additional DCCC targets: None.

  • Colorado (which faces a $6 billion cut):

COOK: Toss-up: Mike Coffman.

Additional DCCC targets: Scott R. Tipton.

  • Pennsylvania (which faces a $6 billion cut):

COOK: Lean Republican: Ryan Costello and Brian Fitzpatrick, and an open seat owing to Charlie Dent’s retirement.

Additional DCCC targets: Patrick Meehan and Lloyd Smucker.

  • Florida (which faces a $4 billion cut):

COOK: Lean Republican: Carlos Curbelo.

Additional DCCC targets: Ron DeSantis, Vern Buchanan, Brian Mast and Mario Diaz-Balart, and an open seat owing to Ileana Ros-Lehtinen’s retirement.

  • Maine (which faces a $1 billion cut):

COOK: Lean Republican: Bruce Poliquin.

That’s a total of 22 GOP-held seats currently rated as vulnerable by Cook Political Report that are in states that would lose billions in federal funding under Graham-Cassidy. Adding in the seats that the DCCC is targeting beyond those, and you get a total of 45 targets in these 11 states.

When the Republicans’ previous Obamacare repeal passed the House in May, 20 Republicans voted no, as the measure passed by just a four-vote margin, 217-213. Thus, if all those Republicans vote no on Cassidy-Graham, it would take only a shift of a handful of Republican yes votes to halt Cassidy-Graham, should it reach the House floor.

Of the incumbents in seats ranked toss-up or lean Republican, the following voted yes on the last House bill, the American Health Care Act, or AHCA:

  • Knight (Calif.)
  • Issa (Calif.)
  • Denham (Calif.)
  • Royce (Calif.)
  • Walters (Calif.)
  • Rohrabacher (Calif.)
  • Faso (N.Y.)
  • Tenney (N.Y.)
  • McSally (Ariz.)
  • Frelinghuysen (N.J.)
  • Roskam (Ill.)
  • Bost (Ill.)
  • Lewis (Minn.)
  • Paulsen (Minn.)
  • Curbelo (Fla.)
  • Poliquin (Maine)

The following voted no:

  • Lance (N.J.)
  • Coffman (Colo.)
  • Costello (Pa.)
  • Fitzpatrick (Pa.)

That makes 16 vulnerable Republicans who voted in May for the AHCA, whose states could lose billions in federal funding if they now vote yes on Cassidy-Graham.

There are signs that some House Republicans recognize this is a problem for them. GOP Reps. Peter T. King and Tom Reed, both of New York (which stands to lose big), have already said they may not support Cassidy-Graham. Will others from these states do the same?

We’ll see. But the DCCC, which has vowed to use the vote for the AHCA against those Republicans who supported it, is now planning to go after those who vote yes on Cassidy-Graham.

“The latest version of this bill would be uniquely damaging to states which did expand Medicaid and provide affordable health care,” Meredith Kelly, the DCCC’s communications director, tells us, adding that “those states happen to have a great deal of overlap” with districts the DCCC has targeted in 2018.

“We will hold them accountable,” Kelly said. “If they vote for this repeal, we will let voters know that Republicans are trying to rip away their health care.”

To be sure, if Cassidy-Graham does pass the Senate, it very well may pass the House. The pressure on Republicans — including the most vulnerable ones — to make sure it does pass will be extremely intense. But at the same time, voting for it could make them even more vulnerable in their reelection campaigns next year. All this underscores the dilemma they may face if it does get through the Senate. Many of them would likely prefer not to have to make this choice.