Dean Heller has a terrible choice ahead of him. Photo: Tom Williams/CQ-Roll Call,Inc.

Nevada senator Dean Heller is having a pretty miserable day. First Heller’s amendment expressing symbolic support for maintaining Medicaid funding failed by a vote of 10-90. Then on Wednesday night, this happened:

Group of 10 bipartisan governors urges the Senate to the "skinny repeal" bill. pic.twitter.com/0U2sfZDR3g — Kyle Griffin (@kylegriffin1) July 27, 2017

Obviously this does not bode well for the GOP’s effort to pass “skinny repeal,” which would eliminate Obamacare’s individual and employer mandates, as well as the medical-device tax. But it could be fatal to the GOP repeal push due to one name on the list: Republican Nevada governor Brian Sandoval.

Earlier in the day, Heller indicated he would support “skinny repeal” as long as it doesn’t include cuts to Medicaid (though, he’s rightly worried that House Republicans would just attack Medicaid once it’s in a conference committee). “We’ll see at the end of the day what’s in it, but overall I think I’d support it,” Heller said.

Governors and senators disagree all the time, but the split between Heller and Sandoval could be hugely significant. When Heller announced his opposition to a previous GOP bill to repeal and replace Obamacare, he repeatedly cited Sandoval’s disapproval.

“If you want my support (on repealing Obamacare) … you better make sure that the Republican governors that have expanded Medicaid sign off on it,” Heller said at the press conference. “I’ve been saying that for months […] Where is Governor Sandoval? What does he think?”

Back in June, Jon Ralston, the influential editor of the Nevada Independent, told Slate he wasn’t surprised that Heller — the most vulnerable Republican senator up for reelection in 2018 — sided with his state’s popular governor over his Senate colleagues:

He tethered himself to the most popular elected official in Nevada, who was the first Republican governor to expand Medicaid, and has hyped that ever since as putting hundreds of thousands of Nevadans on the rolls who otherwise would not be. Heller, not surprisingly, kept saying in the run-up to that news conference that he wanted to consult with the governor and see what the governor thinks. Heller is so vulnerable — he is the only Republican incumbent running in a state won by Hillary Clinton — and his numbers are terrible, and the health care bill’s numbers are terrible. I think the political calculus was pretty obvious.

But then, according to the New York Times, President Trump had his two pals Sheldon Adelson and Steve Wynn — the billionaire casino moguls and major GOP benefactors — call Heller to register their displeasure.

Whatever bill materializes in the next few days, Republicans can only afford two defections. Senators Susan Collins and Lisa Murkowski voted against even starting debate on the health bill, so there’s a good chance they’ll oppose “skinny repeal,” too. It may all come down to whether Heller decides to stand by Nevada’s popular Republican governor or its wealthiest donors.