Thousands of Alaska’s indigenous people would have been at risk of losing their health insurance if Senate Republicans had successfully executed their plans to repeal Obamacare this week.

But many of the Alaska Natives were optimistic that Sen. Lisa Murkowski (R-AK) — whose political career they helped save in 2010 — would not abandon them, even in the face of an all-out campaign against her from President Donald Trump.

“The Alaska Native communities once saved Lisa Murkowski’s political career,” said Lloyd Miller, a natives’ rights attorney in Anchorage, ahead of the final vote. “And now she’s doing her best to save their health care.”

In the end, she delivered: Sens. Murkowski, Susan Collins (R-ME), and John McCain (R-AZ) killed Senate Republicans’ “skinny repeal” bill late Thursday night with three “no” votes.

On Capitol Hill, Murkowski has emerged as a key obstacle in Senate Republicans’ months-long campaign to repeal and replace the Affordable Care Act. Despite furious vote whipping from Senate Republican leadership and even threats from the White House, Murkowski was one of just two Republicans to vote against the motion to proceed on the GOP health bill on Tuesday.

Collins, another vocal critic of the Obamacare repeal bill, made her opposition to the bill clear months ago. But Trump lost Collins’s state by 3 points; he won Murkowski’s by 15. On Wednesday morning, Trump exploded in an indignant rage against Murkowski on Twitter. Right-wing groups were apoplectic that a senator from such a red state would hold up their party’s No. 1 legislative priority.

Her opposition even reportedly garnered threats from the Trump administration. But one reason Murkowski may have taken her stance has to do with her reelection campaign in 2010, when thousands of Alaska Natives learned how to spell the name of the embattled Republican so they could support her unprecedented write-in campaign for Senate as an independent.

Conservatives saw Murkowski’s votes as betrayal. But they’re missing the unique coalition that saved her Senate seat in the first place — one that gave her the political freedom to buck the rest of her party.

Alaska is a place where the Murkowski name means a lot — and establishment Republicans once left her for dead

The daughter of former Alaska Gov. and Sen. Frank Murkowski, Lisa rose rapidly through the ranks of Alaska politics after graduating from Georgetown University. Murkowski, who kept her maiden name after she married Verne Martell, worked as an attorney in private practice in Anchorage before securing a seat in Alaska’s House of Representatives in 1998.

In December 2002, Frank Murkowski nominated his daughter to fill his Senate seat as he left for the governor’s mansion. Broadly popular and still in her mid-40s, Murkowski looked likely to hold on to a safe Republican Senate seat for decades.

But then the Tea Party wave hit — and Murkowski was almost swept under the current.

Joe Miller, a Tea Party darling and Fairbanks attorney, ran against Murkowski in the GOP primary and attacked her as a “Washington insider.” Sarah Palin, then the state’s most prominent politician, threw her endorsement to Miller. (Palin had defeated Frank Murkowski in a race for the Alaska governor’s race in 2006.) On Election Day, Miller shocked the political world and beat Murkowski in the Alaska GOP primary.

At that pivotal moment, Republicans in Washington could have come to Murkowski’s defense. They could have sent key surrogates to back her independent write-in bid, or helped funnel donors to her campaign.

Instead, they did the opposite — and the National Republican Senatorial Committee sent staffers and millions of dollars up north to elect Miller.

Murkowski would never forget the betrayal.

Murkowski’s unique political coalition of Alaska Natives, Democrats, and centrist Republicans

Left to fend for herself, Murkowski cobbled together the votes of Alaska Democrats, centrist Republicans, and Alaska Natives. The bid for her independent write-in campaign was kicked off with an announcement featured several Alaska Natives in its backdrop.

“The natives in the Bush had to learn how to spell M-u-r-k-o-w-s-k-i,” said Kokayi Nosakhere, 43, an Alaska Native who lives in Anchorage. “They had to do a whole lot of handwriting practice.”

Several indigenous-run corporations quickly formed a new Super PAC, Alaska Standing Together, which spent more than $600,000 on ads supporting Murkowski in the final month of the campaign — more than twice what she herself raised.

“She got much more support from the Alaska Native population than either the Republican candidate or, surprisingly, the Democratic candidate,” said Jerry McBeath, a political scientist at the University of Alaska who has analyzed the 2010 election’s results. “And she did particularly well with the Alaskan Bush People — which was remarkable given how many live off road and away from a polling station.”

McBeath noted that 18 percent of the state is Alaska Native (the largest percentage of American indigenous people of any state in the union), and that they traditionally vote for Democrats. But facing the prospect of Sen. Miller — who Nosakhere said ran as an opponent of indigenous rights — they strategically supported the less right-wing Republican.

“The 2010 election showed Murkowski how dependent her career could be on a broader selection of Alaskans than just a narrow Republican constituency,” McBeath said. “And she’s kept that in mind ever since.”

As late as 2016, Murkowski still reportedly wore a gold-plated wristband from her reelection campaign, emblazoned with her name and the words, “Fill it in. Write it in.”

Murkowski promised to repeal and replace Obamacare — and could pay the price

Since she was saved by the center in that 2010 election, Murkowski has responded in kind by voting more and more from the political center. She has advocated for raising taxes on the rich and is pro-choice; in ideology scores, she is now consistently ranked one of the most moderate Republicans. This February, she and Collins were the only GOP senators to vote against Betsy DeVos, Trump’s nominee for education secretary.

Part of her shift can be explained by the Republican Party’s increasing embrace of the right. But in interviews, Murkowski flaunted and took pride in her newfound independence.

“I am not here as my party’s nominee. I am unique among the 100 senators in that regard,” she told Politico in 2011. “And so, there is that distinction, and I think it’s a very clear distinction.”

But that independent streak can rankle the conservatives in her state, particularly when they think it flies against her promises to enact policies like repealing Obamacare.

"She really needs to consider that repealing Obamacare was a central promise of the Republican Party, and that she made it,” said Tuckerman Babcock, chair of the Alaska Republican Party.

In April 2016, Babcock and about 50 of Alaska’s most important Republican officials traveled to the Chamber of Commerce and Visitor Center in the city of Kenai (population 8,000) for a private fundraiser. During a presentation at the front of the room, Murkowski vowed to dismantle the Affordable Care Act, according to Babcock. She’d already voted twice to repeal the Affordable Care Act and denounced the legislation in multiple statements.

“I can remember her saying it: ‘We must repeal and replace Obamacare,’” Babcock said in an interview.

Babcock was watching Fox News when he learned that Murkowski had defied both Senate Republican leaders and President Trump by voting against starting debate on the health bill.

“We have an Alaska Republican Party Facebook page, and 95 percent of the people who weigh in are completely opposed to what she did,” Babcock said. “I have to delete or hide a lot of them because they’re so virulent and filled with too much swearing at her.”

The pressure from conservatives has been no less intense in Washington. Trump sat in the seat next to Murkowski at a White House meeting that was intended to get recalcitrant senators to a yes. His White House threatened retaliation against Alaska over her health care vote, perhaps by withholding resources from the state. McConnell even crafted a special “Kodiak Kickback” scheme to give Murkowski’s state alone billions of dollars for health care.

“I'm sure they’re getting it from all sides and that [White House chief of staff] Reince [Priebus] is having whatever donors he can think of call her or her people,” said Jane Calderwood, who served for two decades as the chief of staff to another female moderate Republican, Sen. Olympia Snowe (R-ME).

“We used to take to sneaking down the back staircases to avoid being lambasted by leadership. I’m sure they’re going through something similar right now.”

Opposition to the Republican health care bill is mobilized in Alaska

Over the course of the health care debate, sensing that Murkowski may be vulnerable, union advocates and activist groups have made Alaska’s airwaves a crucial battleground for the health care debate.

“I turned on the local news the other day and they repeated the same 30-second ad about six times in a half-hour,” said the University of Alaska’s James Muller, a political science professor who lives in Anchorage. "It's almost to the point where people here have stopped watching television because they're so sick of seeing the health ads."

It’s not merely that Alaska is a Medicaid expansion state under Obamacare. The ACA also provided millions in new funding to the federal Indian Health Service and health care facilities operated by the tribes. In an email to Vox, Alaska Federation of Natives president Julie Kitka thanked Murkowski “for continuing to defend Alaska and Alaska’s Native people during the health care debate.”

Murkowski apparently listened. "While I clearly have concerns about the expansion's long-term costs, it has strengthened our Native health system and reduced the number of uninsured that are coming into our emergency rooms,” she told the New York Times.

Health care activists in the state said they went into the vote trying not to feel too confident. “She’s doing what we’re asking her to do — right now, at least,” said Nosakhere, who says he’s been in contact with staffers in Murkowski’s office over the health bill. “But we have to maintain the pressure — or she might flip back to the dark side.”

Every year, the Alaska Natives hold a three-day festival of indigenous dance called the Quyana. Tribes members come wearing florid regalia, bird feathers, and tufts of caribou fur.

Murkowski dances in it every year.

“It’s almost a sign of her being one with the Alaska Native people,” said Lloyd, the indigenous rights attorney. “I’m sure she’ll be there next year again.”