There are almost no differences between the Congressional Budget Office score for this latest bill and the score for earlier iterations. It is beyond clear that repealing the Affordable Care Act (ACA) and capping Medicaid spending hurts Americans. Every idea based on the false premise that the ACA is failing and that Medicaid is a wasteful, unnecessary program leads to the same result: millions without health care.

Republicans are again planning to vote in billions of dollars in tax cuts to the wealthiest households in America. They are again proposing to pay for those cuts by drastically cutting the Medicaid program and rolling back the coverage gains achieved through the Affordable Care Act (ACA). This time the bill forces low-and-moderate income people to buy plans with $6,000 deductibles to qualify for assistance, plans that many will be unable to use and which are currently not legal because of their high cost-sharing. The tax credits offered by the Senate bill are inadequate and according to CBO, would leave most low-income people with no options, even with lower premiums. Eliminating the cost-sharing reductions also eliminates New York’s Essential Plan, which would leave over 700,000 people in the position CBO describes.

The changes Republicans want for Medicaid will fundamentally change the nature of the program in a way that forces states to ration the care provided to our most vulnerable people. Those changes are purposefully designed to hurt states like New York, which have elected to provide robust care to a broad population, by forcing us to match spending in states that provide weak coverage for very few people. CBO estimates that 15 million fewer people will get Medicaid coverage by 2026 under the Senate’s bill. Medicaid cuts in the bill total $772 billion over ten years.

Tweaks here and there cannot make this bill acceptable. There may be tweaks to the ACA that would really help people – maybe even tweaks to the Medicaid program so that more people could access it. But repealing the ACA and fundamentally altering Medicaid should be off the table by now.