Because the Senate is writing their health bill in secret, we don’t know a lot about what is in it. But there is a good chance the bill will look very similar to the one passed by the House of Representatives on May 4 – one Senator told the media the bill will be ‘about 80 percent’ the same. So we can anticipate that whatever the Senate comes out with, it will include most of the shocking cuts to Medicaid that were proposed by the House.

The House bill is widely understood as an ACA repeal bill, which it is. But it isn’t just an ACA repeal bill.  The members of the House who voted for the bill, and many of their colleagues in the Senate, are not just talking about undoing the progress made over the last seven years of the ACA. What they really want to do is go back to over 50 years ago, before we had a program that let poor people get medical care.

Currently, if you qualify for Medicaid, the program pays for the medical care you need. The Republican plan, to “put Medicaid on a budget” as they call it, is to cap the amount that gets spent on each person. So if you need treatment that costs more than what the federal government decided you deserve, your state has to figure out how to cover it. That’s the flexibility Republicans keep mentioning – states will not get enough money from the federal government to cover people’s real heath care needs, and they’ll be on their own to figure out how to manage. The Center for American Progress tried to envision what this would look like – the last time states experienced a budget crisis like the one this bill would create, they cut education, both higher education and K-12. States also raised taxes, with disproportionate impacts on lower- and middle-income people.

The other option states would have is to start refusing people medically necessary care in order to save money. Most of the people who would have their care rationed in this way are our most vulnerable. The majority of Medicaid funding is used to pay for things that elderly people or people with disabilities need. Most of the individuals who get covered by Medicaid are children, who typically have inexpensive health needs – but who do sometimes experience serious health issues. What would it really look like to put a seriously ill child or adult, or a person in a nursing home on a health care “budget”? It’s terrible to imagine, but that is what the Republican bill is forcing us to consider.