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Donald Trump wants Republican Senators this week to make a cruel choice: Either vote for a version of medical insurance legislation that the Congressional Budget Office found would leave 22 million more uninsured Americans by 2026, or vote to take away health coverage from 32 million Americans.

Under the first choice, more than 900,000 health care workers, from physicians to home health aides, would lose their jobs, according to a Commonwealth Fund study. And a Harvard research team predicted that, by 2026, more than twenty thousand people a year would die before their time. In both cases, the toll of the second choice could even be higher.

The 22-million-uninsured option is what the Republicans call “repeal and replace,” although it would do neither to the Affordable Care Act (ACA). What this bill would primarily do is devastate Medicaid, the program that insures 60 percent of children with disabilities and nearly two-thirds of nursing home residents. For many middle-income families, this would lead to financial catastrophe. That’s because Medicaid often pays for the final years of the nursing home costs of their frail elders.

While proponents claim the bill would allocate funds for treatment for people misusing opioids, it would actually make things worse for them. Another Harvard-based research team found that the amount proposed would be significantly less than is needed for people addicted to opioids.

The 22-million-uninsured bill would leave in place the individual insurance market that’s the heart of the ACA. It would retain both the marketplaces through which insurers could sell medical coverage and the subsidies to help them sell it. But the bill would make it much easier for insurers to discriminate against older, sicker Americans.

The main reason Republicans want to devastate Medicaid and take these other steps is so they can give approximately $2.1 trillion over the next twenty years in tax breaks to the rich. Under this plan, while many middle-income people would be forced to deal with crushing health-care costs, billionaires like Trump would get richer.

The Senate’s other choice, the 32-million-uninsured option, is what the Republicans call “repeal” of the ACA, although it wouldn’t actually do that either. According to the Congressional Budget Office, this option would raise the number of Americans without insurance from 10 percent to more than 20 percent. This would be a consequence of doubling the average premiums for Americans buying their insurance individually by 2026, driving them out of the market.

The 32-million-uninsured choice would also eliminate funding for Planned Parenthood, a program that has provided health care to one in five women in the United States. Planned Parenthood’s main job is preventing unintended pregnancies, and they prevent more than a half million a year.

Moreover, the 32-million-uninsured choice also goes after home care for Americans who would otherwise have to go to nursing homes. It calls for eliminating program that now provides extra money to states so they can pay workers to help frail elders with tasks like dressing, eating, and toileting, allowing the elders to stay in their homes.

Additionally, the CBO found that, by 2026, three-quarters of Americans would live in areas where there were no marketplaces, mainly because the high premiums of this choice would make the number of buyers so low that the marketplaces wouldn’t attract any insurers.

The Senate leaders are pushing this choice without any committee hearings where the public could comment or where the consequences of these options could be publicly considered. They even want Senators to agree to make this choice without knowing what the consequences would be. The second-ranking Senate Republican, John Cornyn of Texas, has called knowing what the choices are a “luxury we don't have.”

The Senate needs to reject this barbarous choice.This must to done to so that tens of millions of people can remain insured, so hundreds of thousands of health care worker can keep their jobs; and so thousands of American can live out their full lives.