As of June 28, the American public’s opinion of the GOP Senators’ health care plans is starkly negative. In three separate polls, only 12-17% approve of the plan and 53-58% disapprove or think the ACA should be left alone or tweaked.

With such a strong condemnation of the process and plan, you might think that Republican lawmakers will listen to the electorate and work on a health care plan that the voters want. There are a few Republican senators who are openly calling for the bipartisan approach, but they are very much in the minority.

So why are so many Republican senators ignoring the wishes of the voters and trying to push through a Republican-only health care plan which gives $700 billion in tax breaks primarily to the wealthy while kicking about 15 million people out of Medicaid? Oddly enough, they are listening to the voters – they’re listening to their primary voters and the big money on the far right.

Just ask Senator Dean Heller of Nevada. The day after the release of the Senate GOP bill, the Better Care Reconciliation Act or BCRA, he stated that he would not support the proposed legislation in its current form. Mr. Heller explained that the BCRA would not protect the most vulnerable in Nevada – the elderly, those with mental health and substance abuse issues, and people with disabilities. He noted that half of the Medicaid expansion money goes to pay for mental health and opioid addiction treatment.

The response from the right to Mr. Heller’s reasoned arguments was swift. The political action committee (PAC) America First Policies – which was founded and is run by top Trump campaign officials – launched a TV, radio and social media campaign attacking the Senator. The TV ads claimed that now that there is “a chance to repeal and replace Obamacare with patient-centered care that protects American families, Sen. Dean Heller is saying ‘No.’”

The radio and social media ads went further accusing Mr. Heller of saying  “‘No’ to tax cuts to help small business, ‘No’ to ending Obamacare penalties, and ‘No’ to families who can’t afford to see the doctor of their choice.” Per Political, “over the weekend, America First Policies launched an aggressive digital campaign deriding the senator as a liar, labeling his behavior ‘unacceptable,’ and even likening him to House Minority Leader Nancy Pelosi, a reviled figure in conservative circles.”

The reported $1.3 million campaign by the PAC against the senator was cut short by outrage and complaints from the vast majority of Republican senators. The program stopped after senators complained to White House officials over the weekend and to the president on Tuesday, but the message was clear to Sen. Heller. The attack reminded him of The Godfather movies, and in that spirit he reportedly told the Senate Majority Leader, “It’s going to be very difficult to get me to a yes …have to make us an offer we can’t refuse, me and the governor.”

So even though 3 to 5 times as many people disapprove of the Republican health care plans than approve, most GOP lawmakers are not worried. The threat from the right in a primary election is much more of a concern than a large disapproval rate in the general election. Due to gerrymandering, only a small percentage of districts in the House of Representatives are competitive. For more than 90% of the candidates in safe Republican districts, they will be re-elected as long as they survive the primary.

Senate elections are statewide, but most states are predictable in whether their senators are Republican or Democrat. For those in purple states – those who sometimes elect Republican senators and sometimes go for Democrats – the senators need to be more moderate. Nevada is one of those states and Mr. Heller must be more centrist to retain his seat in next year’s election. A far right candidate is less likely to win the primary election because that candidate would be less likely to win in the statewide general election. As a result, Sen. Heller can weather the attack from America First Priorities and make a Godfather reference about it.

The majority of Republican senators, however, fear a primary challenge from the right and will not concern themselves with that 56% disapproval rate with respect to the BCRA.

It’s politics, not doing the best for the American people.

It’s politics, not making sure there is enough money for nursing home care for the elderly.

It’s politics, not protecting rural hospitals from an onslaught of uninsured patients who have no other options than the emergency room.

It’s politics, not worsening the national debt by giving $700 billion in tax breaks – more than two-thirds to those making more than $220,000/year and nearly 45% to those making more than $500,000/year.

It’s just politics, and the risk of not keeping the campaign promise to repeal and replace Obamacare is a much more insidious threat to Republican lawmakers than having the majority of the nation disapprove of your actions. And that is why opinion polls don’t matter to our elected officials.

It seems like a good time to have a viable, centrist third party in the United States.