House Republican lawmakers voted today to add more than 20 million Americans to the ranks of the uninsured. House Republican lawmakers voted today to add more than 20 million Americans to the ranks of the uninsured; require millions more people to pay thousands of dollars more each year for coverage and care — often for skimpier care; rip $800 billion out of Medicaid over the next decade by ending the Affordable Care Act’s Medicaid expansion that provides coverage to 11 million poor and near-poor people and by cutting federal support for state Medicaid programs and thereby forcing states to cut back health care for low-income people who are elderly, disabled, children, or parents; sharply weaken, and in many cases gut, protections for people with pre-existing conditions; eliminate the national requirement that health plans cover basic benefits like prescription drugs, mental health treatment, and maternity care; and let employers and insurers again impose lifetime limits on coverage for important health services for most people covered under employer-based health plans.

In all, the House bill takes roughly $1 trillion over ten years out of Medicaid and subsidies to help low- and middle-income people afford decent coverage and meet high deductibles and cost-sharing charges — and uses the bulk of this money to give lavish tax cuts to the nation’s richest people instead.

Indeed, the majority of the bill’s individual tax cuts would go to the fewer than 1 percent of Americans who make over $1 million a year. And the wealthiest 400 Americans — whose average incomes exceed $300 million a year — would get an average tax cut of $7 million a year each, even as millions of Americans could no longer afford needed health services.

I have been in Washington, D.C. for 45 years. But I have never seen members of Congress vote to so deeply hurt so many of their own constituents. If enacted, this bill will stand as the biggest assault on ordinary Americans — and the largest Robin-Hood-in-reverse transfer of income up the income scale, from low- and middle-income families to those at the top — in our country’s modern history.

Specifically, the bill’s Medicaid cuts would reach 24 percent by 2026, the Congressional Budget Office estimates, placing adequate coverage at risk for many of the tens of millions of Americans whom Medicaid serves. The bill also sharply cuts the premium subsidies that now help 10 million lower- and middle-income people afford health coverage — and the bill entirely eliminates all assistance to help such people meet their high deductibles and cost-sharing expenses.

Overall, the bill subjects millions of Americans to higher out-of-pocket health costs. Those costs would rise by an average of $3,600 in 2020 for people buying coverage through HealthCare.gov — and by even more for people with marketplace coverage who are older, have lower incomes, or live in rural areas or in states with high health insurance premiums.

Rubbing salt in the wounds, the bill takes the $1 trillion it extracts from low- and middle-income Americans and uses the bulk of it for tax cuts tilted to those at the pinnacle of the income scale.

House GOP leaders continue to deny these very real problems. They assert that the bill would protect people with pre-existing conditions, make health care more affordable, strengthen Medicaid, and the like. But their claims are strikingly inaccurate and do not fairly represent what their legislation actually does.

The most charitable interpretation of the many misleading or inaccurate statements from House leaders is that they, themselves, don’t understand many of the bill’s implications. That could very well be the case. After all, despite working for four months (almost entirely behind closed doors) on what is one of the most consequential pieces of domestic legislation in decades, House leaders refused to hold a single congressional hearing on it so that their members could learn what the bill actually does before having to vote on it.

Non-partisan organizations that do have deep expertise in this area and do understand what the legislation would do — like the American Cancer Society, the American Heart Association, the American Lung Association, the American Diabetes Association, the American Medical Association, the American Academy of Pediatrics, the American Hospital Association, the Catholic Hospital Association, the March of Dimes, AARP, and others — all oppose the bill.

It’s also striking that none of these groups was allowed to testify on the legislation since, as noted, the House held no hearings on it. Along with avoiding hearings on the bill, GOP leaders rushed it to a vote today — without bothering to wait for a Congressional Budget Office cost estimate and analysis of its impact.

So today is a sad day, not only for tens of millions of Americans who deserve better from their elected representatives, but also for basic democratic norms in developing highly consequential legislation in a representative democracy. Both the legislation, and the disturbing process that Republican leaders used to pass it without allowing an adequate understanding of its effects, should outrage anyone with a conscience.