Many people will face a Hobson’s choice, said Craig Garthwaite, a health economist at Northwestern’s Kellogg School of Management. They will have to choose between a plan with a premium they cannot afford or a plan with a deductible they cannot afford.

A number of Republican senators have already come out against the bill, with the handful of dissenters divided between those who think the bill is still too generous, and those who think it’s not generous enough. The former camp are mostly staunch conservatives, like Senators Rand Paul and Ted Cruz, who say the government should do almost nothing to help make health care affordable except get out of the way and let market forces do their jobs. The more moderate group includes vulnerable Nevada Senator Dean Heller, who announced Friday that he “cannot support a piece of legislation that takes away insurance from tens of millions of Americans.”

At the center of the debate over the future of the $3 trillion U.S. health care system, which comprises approximately one-sixth of the economy, is a fundamental ideological divide that is finally facing public scrutiny. Democrats, the Times’ Neil Irwin notes, “are focused on trying to maximize the number of people who have decent health insurance, and are willing to accept whatever tax increases and arrangements with health insurers and other private interests are needed to make that happen. They seek the broadest possible availability of health care, whatever the cost and political trade-offs it takes to achieve it.”

Republicans, despite what they have told voters over the past seven years, “are focused on trying to minimize taxes, especially on investment income, and keeping federal subsidies for health care to a minimum. They are willing to accept the wrenching consequences that attaining those goals might have for Americans’ insurance coverage, betting that lower taxes and smaller government will fuel a more vibrant economy.”

Some Republicans are still obfuscating on this point. Trump’s chief dissembler, Kellyanne Conway, insisted Sunday on ABC’s This Week that the Senate bill’s $800 billion cuts to Medicaid “are not cuts to Medicaid.” She explained to host George Stephanopoulos that the administration doesn’t see the cuts as cuts because they are merely returning the health care system to the way it was a decade ago, as if Obamacare’s expansion of Medicaid had never happened. Plus, she added, “If they are able-bodied and they want to work, then they'll have employer-sponsored benefits like you and I do.”

But it is impossible, as a political or practical matter, to pretend that Obamacare never happened—that millions of new people weren’t able to secure health insurance coverage for the first time, or that it won’t be a human catastrophe to strip it away again. As former President Barack Obama noted Thursday in an emotional appeal on Facebook, “The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America.”

That has long been the underlying objective of the Party of Reagan, whose fundamental mantra has always been lower taxes and smaller government. It was only with the passage of the Affordable Care Act that Republicans launched a massive public relations campaign to win back Congress and the White House with promises of better, more affordable insurance coverage. That deception is now exposed, which is presumably why McConnell drafted the bill in secret and is pushing for a vote as early as next week, without any committee hearings. If the gambit is successful, the details of the Senate bill may ultimately see little public debate. But the human and electoral consequences of the bill, if passed, will be unavoidable.

This article has been updated.