Sen. Rob Portman was right to reject a Republican health-care bill that would have slashed the Medicaid spending upon which millions of Ohioans depend for basic health care. As the GOP effort to replace the Affordable Care Act grinds on, Portman finds himself in a position of great influence to stand up for an approach that balances fiscal pragmatism with compassion and decency.

He already has shown a willingness to put Ohioan’s interests over party politics. He was among the handful of moderate Republicans whose opposition behind the scenes scuttled a July vote on the ill-thought, secretly crafted Senate replacement, the Better Care Reconciliation Act.

Party leaders most surely will need Portman to pass a health-care bill. The latest effort, unveiled Thursday, already has gotten off to a rocky start. It would eliminate a pair of tax cuts for high earners, easing one source of prior opposition, but it would would retain cuts to Medicaid spending that were opposed by moderate holdouts. Otherwise, it keeps most other major features of the earlier Senate bill.

All Democratic senators are opposed. If only one other of the Senate’s 52 Republican opposes the bill, it fails. Two Republicans already have gone on record to say they won’t vote to allow debate; among them is Sen. Susan Collins, R-Maine, who is calling for drafting a new bill the old-fashioned way: with Democrats, through committees. Fancy that! Bipartisan cooperation.

Conservative Sen. Rand Paul, R-Ky., also has announced his opposition, but for different reasons, denouncing insurance-premium subsidies as “crony capitalism” benefiting insurance companies.

Portman surely grasps Ohioans’ divergent viewpoints on federal health-care policy. Citizens are intensely lobbying key Senate moderates like Portman in an effort to block or include various provisions in the new Senate bill. Protesters have become a regular sight at his Washington and Columbus offices. And online news sites are populated with ads urging Portman to reject Medicaid cuts or caps. On Wednesday, the lobbying effort included a 6-year-old Dublin boy with a genetic disorder whose parents fear changes to health-care law could leave them unable to afford his care.

At the same time, Portman is under pressure from the Republican leadership to support the party-line efforts.

This tension is healthy; it’s how democracy ought to work — along with compromise.

Ohio’s other Senator, Democrat Sherrod Brown, has publicly offered to work with Republicans to craft a replacement. This could produce a historic accomplishment, but it would require true statesmanship on the part of a GOP leadership that has shut out Democrats — even as they’ve offered help.

Though Portman and Brown differ philosophically, both have demonstrated the integrity to put aside politics for the good of public policy. And Brown is a realist. He has made no bones about what has become painfully obvious: The Affordable Care Act requires improvements. We take his offer to participate as genuine.

A health-care bill that could pass with votes from Republicans and Democrats would be far stronger — and enjoy broader acceptance from the nation — than the current Democrat-crafted Affordable Care Act or a Republican-only version. And the GOP should be mindful of the gift-shop adage: “If you break it, you own it.” Involving both parties in a solution would protect Republicans from future finger pointing.

No one could better to lead the way than Ohio’s Democratic and a Republican senators.