As a Senate vote looms this week on a Republican health care bill that could hurt Illinois, we need a governor who is vociferously defending the state.

Where is Gov. Bruce Rauner?

Republican governors Charlie Baker of Massachusetts, John Kasich of Ohio and Brian Sandoval of Nevada last month sent a letter to Senate Majority Leader Mitch McConnell, R-Ky., saying the plan would hurt their states. Arizona’s Republican Gov. Doug Ducey said last week the bill “needs a lot of work.”

EDITORIAL

At the nation’s meeting of governors this month in Providence, Rhode Island, Democratic governors spoke out as well. Rhode Island Gov. Gina Raimondo said the bill would almost certainly cause job losses at her state’s hospitals and other health care facilities.

In March, Rauner said he was worried Illinois won’t do very well under a health care plan that later passed the U.S. House. But Rauner is far from the front lines in this battle, which has huge implications for our state.

Like other states that expanded Medicaid under the Affordable Care Act, Illinois would lose federal dollars that provide health care for many of its residents. The damage also would be felt in Cook County, whose Health and Hospitals System has been on much firmer financial group since the ACA went into effect because many more patients have health insurance.

Illinois could lose $4 billion a year in Medicaid funding, which could lead to 650,000 of the state’s residents losing their health care. That number doesn’t include people who buy health insurance through the ACA but who will be forced out by soaring premiums. We’ll have a clearer picture of how many people will lose their health insurance when the Congressional Budget Office score is reported in the coming week. Under the Senate’s first version, that number would have been 22 million people.

We need to hear Rauner’s voice among those of governors who are passionately and publicly trying to protect their states.

This week’s procedural vote on the Senate bill could be close. Senate Majority Leader Mitch McConnell, R-Ky., can afford only two defections, and two Republican senators have said they plan to vote no. What governors say could make a difference.

Instead, Rauner has been preoccupied by shaking up his staff after Illinois finally secured a fiscal year budget after going two years without one. His new hires represent a hard shift to the right, including naming Kristina Rasmussen, former president and chief operating officer of the Illinois Policy Institute, as chief of staff.

The staff shakeup suggests the governor will be pushing the state in a new direction on health care and other issues. Rauner owes Illinois a thorough explanation of his intentions.