As the debate over proposed legislation on health care heats up, West Virginia has been a flashpoint of opposition to a Republican-lead plan — with protests, rallies and sit-ins. With a high population of low-income residents, the increased grip of the opioid crisis and the fate of 184,100 Medicaid enrollees who would lose coverage under the GOP health care bill in West Virginia, the state serves as a go-to example for explaining what the plan might mean for the rest of America.

According to the Congressional Budget Office (CBO) score released Monday, 15 million fewer Americans will be insured next year under the bill. That number is expected to reach 22 million by 2026 – about a million fewer than a similar plan proposed by the House of Representatives.

On a tour promoted as an attempt to stop Americans losing health care coverage, U.S. Senator Bernie Sanders was the featured speaker at a Sunday afternoon rally in Charleston, the state’s capitol. Members of 13 activist groups — including West Virginia Healthy Kids and Families Coalition, West Virginians for Affordable Health Care and Planned Parenthood South Atlantic — urged attendees to call their congressional representatives and tell them to vote against legislation that would overhaul the Affordable Care Act.

“If either version passes, the effects will have a crippling impact on communities all throughout our great state,” said Josh Sword of the West Virginia American Federation of Labor.

Sword was referring to versions of the health care overhaul that have recently been drafted by the House and Senate, respectively.

“Hospitals, drug treatment facilities and countless other specialized care providers will have to close their doors due to the loss of federal funding to the system,” Sword said.

Attendees at the Charleston rally directed chants at Republican U.S. Sen. Shelley Moore Capito of West Virginia, asking her to vote against the Senate bill. Capito has said that she has “concerns” with the way the legislation is written, but hasn’t yet said how she plans to vote. With four senators currently opposing the bill, Capito’s decision on the matter becomes increasingly pivotal. 

Speakers at the Sunday event covered aspects of health care that would be impacted by the proposed legislation such as Medicaid expansion, substance abuse treatment and the ability of insurance companies to deny coverage to those with preexisting conditions.

Sanders came on stage about an hour into the program to a wildly enthusiastic audience.

“The legislation that is coming before the Senate in a few days, the so-called health care bill, will be the most devastating attack on the working class of this country in the modern history of the United States of America,” Sanders said to rousing applause.

Sanders has been increasingly present in West Virginia, talking health care and other issues affecting working class rural citizens. With multiple visits since winning the state’s Democratic Primary in May 2016 — before losing out on the party’s nomination to Hillary Clinton — Sanders’ presence on Sunday served as a lead-up to even more health care-related news.

On Monday, six West Virginians were arrested after holding a sit-in at Capito’s Charleston office where they urged her to vote against the legislation.

“Senator Capito has refused to attend multiple town hall meetings around the state on healthcare, let alone any other issue. She will not meet publicly with her constituents whose lives will be directly affected – and made worse — by this bill. That’s why I am here today – to ask Senator Capito to hear our stories and to vote against this immoral legislation,” said Joe Solomon, who was among those arrested after spending nearly six hours in Capito’s office.

Monday’s arrests at the sit-in at Capito’s office came as the CBO’s evaluation of the Republican health care bill that originated in the Senate. As the analysis came in, many in Congress used the score to weigh in again on how they plan to vote.

“In early May, the House of Representatives passed a healthcare bill that President Trump said had no heart and now Senate Republicans have proposed a bill that has no soul. Republicans wrote this bill behind closed doors, without input from their constituents, Democrats and even from members of their own party,” U.S. Sen. Joe Manchin, D-W.Va., said in a news release issued Monday afternoon.

Manchin also criticized the Senate bill’s tax cuts for the wealthy and alluded to the CBO’s analysis that states “few low-income people would purchase any plan.”

“I have said from the beginning that I want to be a partner in making healthcare more affordable and accessible for our state. I stand ready to work with anyone to do that, but this bill makes things worse not better, and I cannot support it,” Manchin said.

The Senate could vote on the proposed legislation as early as this week, before the July 4th recess. Critics argue the timeline on such a vote is too hasty, while supporters hope to push the bill through.