Sen. Shelley Moore Capito (R-WV) released an extraordinary attack on her own party’s plan to repeal Obamacare on Tuesday, saying she rejected it because “I did not come to Washington to hurt people.”

My latest statement on the Senate health care bill & planned vote to repeal Obamacare: pic.twitter.com/yAVIxgptCu — Shelley Moore Capito (@SenCapito) July 18, 2017

After support for Republicans’ Better Care Reconciliation Act crumbled Monday night, Majority Leader Mitch McConnell proposed that Republicans simply repeal Obamacare altogether and come up with a replace bill at a later date.

That plan was in big trouble within hours. Sen. Susan Collins (R-ME) quickly came out against it, and with Sen. John McCain (R-AZ) still recovering from surgery in Arizona, Capito’s defection ensures that McConnell doesn’t have the 50 votes he needs to advance the bill — at least not until McCain returns.

But perhaps even more consequential than Capito coming out against “clean repeal” of Obamacare is her strident, moral condemnation of the bill’s impacts on her state’s Medicaid patients — and what that suggests about the bill’s possible path forward.

The Capito-Collins coverage caucus?

Late Monday night, Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) announced that they would not be supporting the latest version of McConnell’s health care bill.

Liberals were quick to celebrate: This was a bill they had been determined to strangle before it came to a vote. But the good news was tempered by the fact that the defections killing the bill came from the party’s right, rather than its moderate faction. As Vox’s Matt Yglesias pointed out, only Collins opposed the bill on the grounds that it didn’t cover enough people. That suggested it would grow more conservative — and cost more people their health insurance — to shore up its political support.

Capito’s salvo may change that calculus. In her statement, she suggests that a condition of her vote will be for Republicans to do more to temper the Medicaid cuts. One estimate by the Urban Institute found that West Virginia’s uninsured rate would rise by about 300 percent under the Republican bill, and the state is already battling one of the worst opioid crises in the country.

“I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis,” Capito writes. “All of the Senate health care discussion drafts have failed to address these concerns adequately.”