The most vulnerable Republican in the Senate can’t stop caving on health care — and Nevada is fed up.

For the second time this year, Republican Sen. Dean Heller of Nevada has been faced with protecting the health care of his constituents or protecting his own senate seat from a Trump-fueled primary opponent. For the second time this year, Heller has chosen to protect himself and hang his constituents out to dry. And they’re ready to fight back.

Heller, who in June stood alongside his home state governor, Brian Sandoval, to tout Nevada’s commitment to Medicaid expansion and denounce the reconciliation process employed by Republicans to ram their Obamacare repeal through the Senate, is now a co-sponsor of the Graham-Cassidy bill that would gut Medicaid, lead to skyrocketing premiums, and risk coverage for people with preexisting conditions — things Heller denounced in June and yet ended up voting for.

This isn’t the first time Heller’s caved to Republican pressure on health care.

Shortly after his July rejection of the repeal, Donald Trump’s allies barraged him with attack ads and started talking up primary challengers for Heller’s 2018 re-election. Trump himself famously bullied Heller on television during a Senate luncheon at the White House, saying of Heller, “He wants to remain a senator, doesn’t he?”

Heller eventually flip-flopped and supported the failed repeal plot — and received a healthy campaign contribution for his vote. Since then, his approval rating back home plummeted to 22 percent, with 50 percent of Nevadans supporting a Democratic challenger in 2018.

On Monday, the health care advocacy group Save My Care announced a devastating ad blitz of its own against Heller, an effort out to hold him accountable for backing out of his promises to the people of Nevada — and remind his constituents that their senator is willing to risk their lives to win an election.

NARRATOR: If the Republican health care bill passes, coverage could be unaffordable for people with life-threatening diseases like cancer, even when they need it the most. Sen. Heller, keep your promise. Vote no on health care repeal.

Republicans have until Sept. 30 to pass this bill through the reconciliation process, which would only require 51 voters (or 50 votes with Vice President Mike Pence’s tie breaking vote). After that, any health care repeal efforts would require 60 votes from the Senate.

Despite plummeting poll numbers and strong Democratic challengers, Heller remains determined to run from a fight with Donald Trump and right-wing Republicans. But he can’t run from a fight next year.