Dante Alighieri had a tough life. Exiled from Florence because of political machinations and with no timely news network to convey his fury, he decided to seek his revenge by penning what is arguably the greatest poem in world literature: The Divine Comedy. The poem provides a road map to heaven, purgatory and most importantly hell, where Dante, with suitable venom, positioned the political hacks of his day on various rings. Each ring was characterized by moral deficiencies in the human temperament. There was lust, greed, gluttony, pride, hypocrisy and so forth. Not unsurprisingly these faults are still with us today, and so are the politicians who — with great disregard for the quality of their souls, much less their constituency – still manage to provide food for the devil’s banquet.

Let’s begin with the low hanging fruit right here in Virginia, Senator Phillip Puckett, a nominal Democrat. A week or so ago he decided to resign his position as state senator for a number of reasons, none of which are especially edifying: to allow his daughter to be confirmed as a judge and to potentially receive a lucrative position as deputy director of the Virginia Tobacco Commission. Whether this is legal remains to be seen, the FBI is sniffing around, and Puckett appears to have turned down the deputy position out of concern for his ‘legacy’ and the negative publicity it has garnered, at least for the short-term.

But the problem isn’t so simple. Puckett might get away with a stint in purgatory for that bit of venality, but the context in which he resigned points to a much larger ethical failure. For the last five months, Governor McAuliffe and state Democrats have been fighting to expand Medicaid through the budget process. Despite its even split of 20 Democrats and 20 Republicans, the Senate made its move, passing a budget with the Medicaid expansion earlier this year. But, with its large Republican majority, the House of Delegates refused to budge, and has passed a budget without the expansion.

By resigning, Puckett gave control of the Senate to Republicans, who have now passed a budget without the Medicaid expansion. This in turn forces Governor McAuliffe’s hand. He can sign the budget and break his campaign promise, or he can preside over the first shutdown in Virginia’s history.

In either case, the prospect for Medicaid expansion has become incredibly dim. An estimated 400,000 Virginians will likely not get health insurance or access to needed health services like check-ups, medicines, surgeries, and cancer treatments. Worse than what Puckett has done to his party, is what he has done to his own constituency. He represented the 38th District, which draws from 10 counties in southwestern Virginia: Tazewell, Pulaski, Russell, Buchanan, Dickenson, Wise, Radford, Bland, Smyth, and Norton. According to Jamelle Bouie writing in Slate, “This is one of the poorest corners of the state. The poverty rate in Russell County, for instance, is 20.4 percent, compared to 11 percent for the state writ large. Even worse is Buchanan County, where 25 percent of residents live below the poverty line. Not only is it one of the poorest counties in Virginia, it’s one of the most impoverished in the entire United States. And according to a recent analysis from the Commonwealth Institute, it contains a chunk of the estimated 20,170 uninsured adults in Puckett’s district who are eligible for coverage under the Medicaid expansion.”

Puckett didn’t just sell out his Democratic colleagues, he sold out the lives and well-being of thousands of his constituents for what amounts to a bag full of silver and a nepotistic arrangement. Dante, who did not fool around, would probably not assign him to the fourth circle of hell, the ring reserved for those who hoard and squander wealth, so involved in their acquisitive cycles they lose their identities. No, Dante would assign him an honored position in the ninth circle of his inferno, the one reserved for those who betray a special relationship of some kind—like the relationship between a politician and those who vote for him, hoping he represents their interests. Dante used the word treachery to describe this particular circle of hell. The punishment that is meted is especially convincing. Traitors are immersed in ice up to their chin for eternity. In Dante’s ninth circle, it’s always a cold day in hell.

Puckett, of course, didn’t act alone. Working in concert with him are the state Republicans, pretty much en toto, although there are a few Republicans who manage to stand out even in this bleak landscape.

At the point when Medicaid expansion was still in play, three state Republican senators, Emmett Hanger, Walter Stosch and John Watkins, nominally supported Medicaid expansion. Up until the primary results were in for another Virginia Republican—majority whip Eric Cantor, in the US House of Representatives. As everyone knows by now, Cantor lost his primary bid to newcomer Libertarian and Tea Party acolyte, David Brat who won 56 percent of the vote, compared with 44 percent for Cantor. “Political earthquake” is the cliché making the rounds for Brat’s victory. As of last week, when Medicaid expansion received its death-blow, the conventional wisdom was Brat won because of an overwhelming tide of tea partiers coming to the polls and shoving through their agenda—an agenda that included a rabid denunciation of Obamacare, of course. That conventional wisdom likely shocked the three state Republican senators and turned tepid support for Medicaid expansion to outright denial.

Unfortunately, the ‘conventional’ wisdom may very well be wrong. Approximately 18,000 more votes were cast in Tuesday’s primary than in 2012, when Cantor easily defeated another Tea Party-backed challenger, Floyd Bayne. Some of those votes look to have come from precincts that were Democratic leaning. Why does that matter? Because not only were Republicans voting in the primary which defeated Cantor, so were Democrats. The open primary law allowed this, and Democratic operatives like Brian Umana had been working for years to put a coalition together to defeat Cantor: a coalition of Democratics and populist Tea Party Republicans disaffected with the Cantor brand.

Said Umana, “Anyone But Cantor” mentality was beginning to take hold in central Virginia and the Richmond suburbs. In this heavily Republican district, many Democrats and Republicans told me in conversations that they saw Cantor as a disingenuous political insider looking out for his own self-interest above the interests of his constituents. …. Put succinctly by one journalist on the scene, “Cantor lost because he was a ‘dick’.”

After the election results were in, the campaign strategist for Brat, Tammy Parada, emailed Umana, writing: “This was the direct result of active participants working together across party lines. An unpopular but honest truth in [the] VA7 victory: Mr. Umana and Mr. Stevens, even as their political ideology is far left of conservative, were important players, offering strong analytics behind ‘the numbers’ that eventually led to Cantor’s defeat.”

So it looks like the state Republican senators flipped their votes based on the fear of a Tea Party ‘tide’ that is more speculative than real. They were willing to prevent 400,000 Virginians from receiving decent healthcare rather than risk a few votes at the polls—votes that may never be cast in any case. According to Dante, such cowards dither at the gates of hell, neither aligned with the demons or the saints, their punishment is to eternally pursue a banner of self-interest while stung by wasps and hornets; the sting of conscience. One last, vivid note. To illustrate their stagnant moral state, maggots drink their blood and tears.

Of course we would never wish such a fate on anyone, and Dante’s writing was speculative in the extreme. But the fate of 400,000 Virginians without medical care is all too real.