President Trump promised to replace the Affordable Care Act with something that is better, is cheaper and covers more people. Scratch that. Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people.

In a half-baked policy paper released on Thursday, the House speaker, Paul Ryan, trotted out washed-up ideas for “improving” the country’s health care system that would do anything but. For example, the paper calls for reducing spending on Medicaid, which now provides insurance to more than 74 million poor, disabled and older people. Many millions of them would be cast out of the program. The Republican plan would also force most people who don’t get their health insurance through an employer to pay more by slashing subsidies that the A.C.A., or Obamacare, now provides. The proposal would allow families to sock away more money in health savings accounts, which may sound good at first but would primarily benefit affluent people who can afford to save more.

The paper is Mr. Ryan’s blueprint for effectively repealing and replacing Obamacare. Unsurprisingly, he and his colleagues offered no estimates of how many people would lose coverage or how much premiums and deductibles would rise for middle-class and poor families. Yet those missing details did not stop the Trump administration’s top health official from embracing the proposal. Tom Price, the secretary of health and human services and a former Ryan lieutenant in the House, said the president “is all in on this.”

To understand how far out of the mainstream the House Republican plan is, consider its ideas for Medicaid. It would roll back the A.C.A. provisions that helped more than 11 million people gain Medicaid coverage. Republican governors like John Kasich of Ohio and Rick Snyder of Michigan have praised the expansion because it has helped reduce uncompensated care at hospitals and provided addiction treatment to people suffering from the opioid epidemic. “Thank God we expanded Medicaid, because that Medicaid money is helping to rehab people,” Mr. Kasich said last month.