The structure of the House bill that passed in May would lead to an interesting whirlwind of economic effects, according to this report. The AHCA repeals most of the taxes that supported the Affordable Care Act just about immediately, which might even act as a short-term stimulus. Between 2018 and 2020, authors predict the economy would actually grow by over 800,000 jobs, which notably would buoy jobs reports for two straight elections. The health-care industry, however, would begin sloughing jobs immediately.

Things get dicier after 2020. Reductions in federal funding for coverage through massive cuts to Medicaid and reduction of private-insurance subsidies all but reverse those gains by 2021, and begin what the researchers call “a period of economic and medical hardship in the U.S.” after that. Federal Medicaid funds and under the ACA themselves currently act as a stimulus to state governments, and the AHCA would cut those funds even below pre-ACA levels, and cap them.

Since that stimulus has multiplicative effects on businesses and total output, the AHCA slashes state outputs by amounts far greater than the amount of federal funds divested. In New York alone, the Commonwealth Fund report indicates the state gross domestic product would decrease by $10.5 billion by 2026 over current projections, and total business output by $16 billion. And similar losses would come across every state in every sector.

Of course the most dramatic effects would be in the health-care industry. Per the Congressional Budget Office estimates, 23 million fewer people are expected to be insured under the House’s draft of the AHCA. The industry will simply have to contract in the face of such losses of eligible patients, and in the face of increases in uncompensated care. This report suggests a net loss of about 700,000 jobs in the health-care sector alone. And while the president and his allies have worked hard to ensure the job security of rather small numbers of factory and coal-mining jobs in the Midwest and Appalachia, losses in the health-care industry (which employs millions of blue-collar workers) would hit those areas hard too. Kentucky and West Virginia would lose 16,000 combined jobs in the health-care sector alone.

Through their amendments, House Republicans have pulled off a rare policy feat: Their version of the AHCA invests much more federal money than the pre-Obamacare government ever did to insure fewer people and cuts taxes for small business owners and the wealthy while also killing jobs and economic activity. Their program is neither entirely austere nor a big-government boondoggle, yet manages to incorporate the pitfalls of each approach. Those contradictions might not matter for the prospects of the law’s passage, though, since it is front-loaded with economic sweeteners that should benefit Republicans in the all-important next two elections.