While members of the United States Senate enjoy the conclusion of their well-timed Independence Day recess, Americans remain in a state of concern about the future of their healthcare coverage and whether Senate Republicans will attempt to force through their unpopular healthcare bill or come up with a suitable alternative. This concern is felt no more than it is in West Virginia, which has more to lose should the current bill pass than most other states in the country.

Since the Affordable Care Act became law in 2010, West Virginia’s health insurance coverage has skyrocketed.  The West Virginia Center on Budget and Policy reported in 2015 that 91.4 percent of West Virginians now have health insurance as a result of the legislation and the number of uninsured individuals has dipped from 14 percent to 8.6 percent, the third largest percentage decrease in the nation.

This upshot in coverage has plenty to do with the state’s embrace of the Affordable Care Act’s Medicaid expansion. Today, over 564,000, or 29 percent of the state’s population, are covered by Medicaid, according to The Henry J. Kaiser Family Foundation, a non-partisan organization with a focus on health-related issues.

With these facts in mind, it’s not surprising the state’s reaction to a monumental loss in health care coverage and quality has been less than amicable. On June 26, six constituents were arrested after scheduling a sit-in at the Charleston office of Sen. Shelley Moore Capito, R. The next day, Capito pulled her vote from the Senate bill, citing insufficient Medicaid funding and the state’s escalating opioid addiction problem as her primary reasons.

“Throughout this debate, I have said that I will only support a bill that provides access to affordable health care coverage for West Virginians, including those on Medicaid and those struggling with drug addiction,” Capito said in a statement.

Senate Republicans have since offered Capito $45 million in funding to address opioid addiction, with similar tactics already being employed with the nine other Republicans eyeing a “no” vote on the bill. But the boost has yet to sway Capito, who maintains her position on the bill’s inadequacies. Still, West Virginians anxious Capito might fold under pressure have taken to demonstrations like Wednesday’s Tax March on the State Capitol grounds to urge the senator not to buckle.

As it stands, the Senate bill is at 12 percent support nationwide, according to a USA TODAY/Suffolk University poll. While some Republicans would like to push the current legislation through the gate, constituents be damned, others are more focused on repealing the Affordable Care Act now and coming up with a replacement later, despite the 2010 healthcare law’s record 55 percent support in an April Gallup poll. President Donald Trump himself advocated for this scenario in a June 30 Tweet.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump wrote.

Trump and some Republicans argue that the Affordable Care Act is in a “death spiral,” a clinical term characterized by premium increases that continually force the healthiest consumers out, further raising premiums until the market totally dissolves. Though it’s true the Affordable Care Act has its issues, the idea that it is in a “death spiral” has been deemed incorrect by Politifact, the man who coined the term and even the Congressional Budget Office, which determined the the Affordable Care Act to be “stable in most areas” in March. Simply put, the Affordable Care Act is not unsalvageable.

With this in mind, the repeal “solution” would be nothing short of a disaster and a potential death sentence for thousands of West Virginians, not to mention thousands more Americans. A repeal without a replacement would cost 184,000 West Virginians their health insurance and the state nearly $350 million in tax revenue over five years, according to the West Virginia Center on Budget and Policy. Overall, West Virginia would be the second most affected state in the country.

West Virginia is, in many ways, representative of some of America’s worst health problems; we have the country’s highest obesity rates, opioid death rates and rank 43rd in overall health. As one of the most vulnerable states, the effectiveness of the Republican’s healthcare plan, or lack thereof, will be determined by whether it helps West Virginians or turns our state into a death spiral — and not in the clinical sense.

Jared Casto can be contacted at [email protected].