Republican lawmakers have wasted much of the year trying to repeal the Affordable Care Act, a move that would deprive millions of people of health insurance. They’re back at it. Like a bad sequel to a terrible movie, a proposal whose main architects are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would in many ways be worse than bills that came before. It would punish states like California and New York that have done the most to increase access to health care and set in motion cuts to Medicaid, the federal-state program that provides insurance to nearly 70 million people, many of whom are disabled and elderly.

This is not an idle threat. President Trump wants this bill passed by the end of next week, before the expiration of a budget rule that allows the chamber to pass a health care bill with only 50 votes (and a tiebreaker from the vice president). It’s unclear whether the votes are there, but the bill’s chances increased on Monday when Gov. Doug Ducey of Arizona said he supported it. His endorsement is important because it could convince Senator John McCain, who cast the decisive vote against repealing the A.C.A. in July, to vote for this version.

It is hard to overstate the cruelty of the Graham-Cassidy bill. It would eliminate the mandate that even healthy people buy health insurance, end the subsidies that help people purchase coverage and stop the expansion of Medicaid. It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, over all, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities.

Worse, the formula for determining state grants would penalize the 31 states that expanded Medicaid under the A.C.A. so as to provide more money to the 19 states that did not. This is a cynical attempt to win votes by taking money from generous states that are more likely to be governed by Democrats and giving some of it to representatives of stingier states that are more likely to elect Republicans. The block grants would disappear entirely in 2027, and it is by no means certain, given the pitched partisan battles over health care in recent years, that Congress would be inclined to reauthorize them.