From left, Sen. Bill Cassidy, R-La., Sen. Dean Heller, R-Nev., and Sen. Lindsey Graham, R-S.C., hold a news conference to discuss one of the GOP’s many previous attempts at rolling back the Affordable Care Act, September 13, 2017. (Photo: Bill Clark / CQ Roll Call)

On Friday, December 22, after receiving a “pay-go waiver,” which enabled the GOP to put off immediate cuts to Medicare and a bevy of other programs required to offset the debt increase, President Trump signed the GOP tax bill into law. The anger surrounding this legislation is well warranted. It’s another gift for the donor class. But this tax cut is far more than a bill designed to appease the 1 percent, it’s more than supply-side economics on steroids, it’s the first step in dismantling our current health care system.

The GOP tax bill repeals the Affordable Care Act’s (ACA) individual mandate, an unpopular, but necessary provision of our current health care system. The Congressional Budget Office estimates the elimination of the individual mandate will result in 4 million fewer people insured by 2019, and 13 million fewer by 2027, while raising premiums by an average of 10 percent. While no one can say for sure what the precise impact will be once the mandate penalty moves to $0 in 2019, there is no doubt that millions fewer Americans will have health insurance coverage, and an already unstable marketplace will grow even more turbulent. It’s also worth noting that repealing the individual mandate will result in fewer Americans signing up for Medicaid, which will save the government some money to help offset the enormous corporate and 1 percent-earner tax cuts that will soon be implemented.

The damage from the individual mandate repeal will be substantial, any way you spin it, but what is on the horizon may be even more catastrophic to overall coverage. The GOP has intentionally painted themselves into a corner. They are fine with this tax bill adding a trillion dollars to the national debt because they know just how they’ll address this issue: with cuts to so-called entitlement programs. It’s not like they’re hiding it. Paul Ryan said a major goal for 2018 will be cutting Medicare, Medicaid and welfare programs. As the Washington Post reported, Ryan said, “[I]t’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”

One of the primary achievements of the ACA was its expansion of Medicaid. Overall eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) was expanded dramatically under the ACA, even though 19 states refused to participate. Of the estimated 20 million more insured under the ACA, a large portion gained coverage under Medicaid and CHIP. As a report by the Kaiser Family Foundation shows, states that expanded Medicaid saw significant reductions in statewide-uninsured rates.

While this bill won’t immediately impact Medicare or Medicaid (CHIP, however, is a different story, as its long-term funding remains a question mark), the existence of these programs, as they are currently constituted, is in peril.

The GOP has a plan here: remove the individual mandate, which will serve to destabilize the market even further. Then they can blame the mess on the ACA itself, and work towards another full repeal effort. At this point, the situation may be dire, as our health care system will be a teetering, three-legged chair, so passage should be far easier than last time. Meanwhile, they can work to decrease the national debt — which they are about to add to significantly — by cutting Medicare, Medicaid, Welfare, Social Security, student loan programs and anything else they label an “entitlement program.”

The GOP is aggressively pushing health care in the wrong direction. According to recent data from the CDC, there are an estimated 28.1 million Americans currently without health insurance. Those 28.1 million could easily top 50 million in only a decade if these cuts are implemented. We should be working to ensure every American has insurance coverage. Instead, we’re leaving millions more in the dust each year.