It’s official: The Senate replacement bill for the Affordable Care Act (ACA) is dead, as is the attempt to pass a bill to repeal ACA without a replacement. Republicans right now are scrambling to find something to take away from the next few days of voting on healthcare amendments, and although Obamacare’s framework is safe, one last threat still exists.

This has been termed a “skinny repeal”. Republicans will attempt to pitch amendments to a patchwork, ephemeral bill that will take its final form on Friday, whereupon the Senate will vote on it.

A skinny repeal does not, as the name might suggest, repeal Obamacare – those efforts are dead. Nevertheless, it still threatens to take healthcare away from up to 15 million Americans by 2026.

The primary targets here are the individual mandate, which requires individuals and large employers to get health coverage or get fined, and Medicaid, the social program that gives low-income people healthcare, including treatments for opioid addiction, sexual and mental health issues.

Medicaid expansion was authorized under the ACA, which generally means that more disadvantaged people are getting access to healthcare. Plenty of Republicans want to add amendments to the final Senate bill that would stop this expansion or even roll it back, which would leave many of the poorest Americans without access to the healthcare system.

As The Upshot succinctly put it, “the individual mandate is unloved because no one likes being told what to do.” It’s true, this is broadly unpopular – but without it, studies have shown that the cost of healthcare for millions of Americans would go up, which means less would be able to afford it.

All in all, a skinny repeal would rob a significant number of Americans of their healthcare.

Both the House and Senate version of the bills would have taken coverage away from 22 million people, while at the same time rolling back the expansion of Medicaid. Repealing the ACA without a replacement would have left 32 million people without healthcare, and Medicaid would have been left at the mercy of individual states and federal government chaos.

The skinny repeal option, which would require a simple majority of 51 to pass, is the most appealing option for moderate Republicans at this point and for conservatives who have given up on repealing Obamacare completely. That makes its passage through the Senate a bit of a coin toss at this point, but if the Yes vote wins, it would still be a catastrophe.

Anything that takes healthcare away from literally millions of people cannot be right. America is currently the best place in the world to do biomedical research, but what’s the point if its own citizens don’t have access to these cutting-edge, life-saving treatments?