With his shady business deals and checkered history as a fundraiser, I used to think Gov. Terry McAuliffe was the most venal politician among Virginia Democrats. But, I was wrong. That title goes to state Sen. Phillip Puckett, who resigned on Monday as part of a deal to give Republicans control of the state Senate, and thus a full veto on the Medicaid expansion.

You can get the full story from the Washington Post. The short version is this: For the last five months, Gov. McAuliffe and state Democrats have been fighting to expand Medicaid through the budget process. Despite its even split of 20 Democrats and 20 Republicans, the Senate made its move, passing a budget with the Medicaid expansion earlier this year. But, with its large Republican majority, the House of Delegates refused to budge, and has passed a budget without the expansion.

McAuliffe is willing to compromise—he’s offered a market-based solution for expanding Medicaid—but he won’t abandon expansion, which was a key promise during his campaign. Likewise, Republicans won’t do anything to implement Obamacare or further its goals, which has left Virginia with a stalemate that promises to become a government shutdown after the June 30 deadline for a budget.

Which brings us back to Puckett. By resigning, he gives control of the Senate to Republicans, who can then pass a budget without the Medicaid expansion. In turn, McAuliffe is left with a choice: He can sign the budget and break his campaign promise, or he can preside over the first shutdown in Virginia’s history. And what does Puckett get in return? A position on the state tobacco commission and a promise to confirm his daughter’s nomination to the state judiciary.

Because of outrage over the attempted bribe, Puckett won’t be taking the job. Even still, he’s leaving the Senate and giving Republicans the majority they need to block Obamacare in Virginia. (And it appears his daughter will get her judgeship.)

If this were just another round of routine political combat, it would be annoyingly venal—irksome but not consequential. L’affaire Puckett, however, is a big deal. Under the Medicaid expansion, an estimated 400,000 Virginians would get health insurance, as well as access to needed health services like check-ups, medicines, surgeries, and cancer treatments. It’s no exaggeration to say that there’s a health access crisis in Virginia, which Medicaid could ameliorate, if not solve altogether.

And Puckett isn’t some bystander to these problems. The former state senator represented the 38th District, which draws from 10 counties in southwestern Virginia: Tazewell, Pulaski, Russell, Buchanan, Dickenson, Wise, Radford, Bland, Smyth, and Norton. This is one of the poorest corners of the state. The poverty rate in Russell County, for instance, is 20.4 percent, compared to 11 percent for the state writ large.

Even worse is Buchanan County, where 25 percent of residents live below the poverty line. Not only is it one of the poorest counties in Virginia, it’s one of the most impoverished in the entire United States. And according to a recent analysis from the Commonwealth Institute, it contains a chunk of the estimated 20,170 uninsured adults in Puckett’s district who are eligible for coverage under the Medicaid expansion.

Puckett didn’t just sell out his Democratic colleagues, he sold out thousands of his constituents—indifferent to their health and well-being—for little more than some cheap nepotism. No, the Republicans he helped aren’t much better; they would rather wage an ideological crusade against Obama than aid the voters who support them. Still, say what you will about right-wing extremism, at least it’s an ethos. And given the choice, I would rather have an opponent with conviction than an ally who couldn’t be bothered to care.