It's looking like House Republicans haven’t learned anything from their late-March failure to repeal Obamacare, which would have caused upwards of 24 million people to lose coverage over the next decade while cutting nearly a trillion in federal spending on health programs serving the poor and the most vulnerable seniors.

The Republican leadership, egged on by an impatient President Trump, said their latest Obamacare repeal may come to the House floor by Wednesday. However, by Monday evening it appeared House Speaker Paul Ryan was on the verge of failing to secure sufficient votes to pass it. The Republicans can only afford 22 defections—or "no" votes from their ranks—for it still to pass. The Hill.com counted 22 Republican "no" votes.

In the meantime, advocates representing 100 million patients with serious health issues—including tens of millions of voters in red states—were pressuring House Republicans to reject this latest attempt to slash social safety nets.

“As introduced, the bill would profoundly reduce coverage for millions of Americans—including many low-income and disabled individuals who rely on Medicaid—and increase out-of-pocket costs for the sickest and oldest among us,” said Monday’s statement issued by 10 patient care organizations. “We are alarmed by recent harmful changes to the AHCA [American Health Care Act], including provisions that will weaken key consumer protections. These changes include allowing states to waive the requirement for essential health benefits, which could deny patients the care and treatment they need to treat their conditions.”

The advocates include American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, Cystic Fibrosis Foundation, JDRF, March of Dimes, National Organization for Rare Disorders, National MS Society and the National Coalition for Women with Heart Disease.

Not a single patient care organization has endorsed the GOP bill, tweeted Andrew Slavitt, who ran federal Medicaid and Medicare programs for the Obama administration.

“There’s one sentence every American needs to know: Trumpcare eliminates pre-existing condition protections,” Slavitt tweeted Monday. When a pro-Trumpcare lobbyist tweeted back saying that individuals with serious issues would be put into high-risk insurance-buying pools, Slavitt replied, “A tortured argument. Allowing it to be underwritten at any cost means eliminating protections.” Trumpcare’s defender countered, “Allowing it to be underwritten allows prices to drop and more people to be covered.” Slavitt swiftly replied: “Blind, wild-eyed assertions not borne out by the history we all lived through.”

That terse exchange provides a crystal ball into the grandiose sales points that will be raised by the White House and House GOP in coming days. They will claim that deregulation will lower health insurance costs. That’s nominally true, if you are young and healthy and if nothing bad happens, because policies costing less will cover less. Under Trumpcare, it certainly will be possible for a Californian to buy a health plan from an insurer based in another state, economist Dean Baker told AlterNet—but that policy will likely not cover much.

If anything, the repeal legislation now being considered is potentially more damaging than what failed in March, when Democrats stood up in the House and told every GOP representative how many tens of thousands of voters in their districts would lose health coverage under the legislation they were supporting. That proposal would have taken coverage away from 24 million people, raised premiums and deductibles by thousands for millions more, slashed Medicaid by $800 billion and given millionaires an average annual tax cut of $50,000, the Congressional Budget Office’s analysis concluded.

The proposal now before the House is the same bill with amendments designed to win the support of extreme right-wingers who opposed the bill last time because Ryan’s legislation did not go far enough. These amendments would additionally gut protections for people with pre-existing conditions, end nationwide standards for what health plans must cover, and reinstate annual and lifetime coverage limits, according to the Washington-based Center on Budget and Policy Priorities (CBPP), a progressive think tank. (The Henry J. Kaiser Family Foundation, which specializes in health policy, has posted a section-by-section analysis.)

In a transparent effort to hide how bad its effects will likely be, Ryan is pushing the revised Obamacare repeal without an updated CBO analysis. The bill’s only winners appear to be the wealthiest Americans, whose current income tax surcharge supporting Obamacare subsidies would end, and the insurance industry, which after ignoring the likely public protests, would charge whatever it wants to ensure its profits.

The patient care organizations said deregulating coverage standards would lead to price gouging and the sickest people dropping coverage because they can't afford it.

“Weakening these rules would enable insurers to charge higher prices to people with pre-existing conditions, possibly making insurance unaffordable for those who need it most,” they said. “Offering these risk-sharing mechanisms as an alternative to affordable health insurance is not a viable option, particularly high-risk pools. Previous state high-risk pools resulted in higher premiums, long waiting lists and inadequate coverage.”

The advocates also said that the White House and House Republicans are operating in a fantasyland if they think putting sick people into pricey high-risk pools will work.

“The individuals and families we represent cannot go back to a time when people with pre-existing conditions could be denied coverage or forced to choose between purchasing basic necessities and affording their health care coverage,” the patient advocates said. “We challenge lawmakers to remember their commitment to their constituents.”

Meanwhile, media reports suggested the chaos Trump and House Republicans are sowing in insurance markets would harm Trump's base in the red states that elected him.

“Tennessee is a preview of what an Obamacare collapse could look [like] under President Trump, where the law technically remains standing but people don’t have access to the programs,” Sarah Kliff reported for Vox.com. “The areas most at risk for this type of collapse are those that voted for Trump: places that are lower-income and rural, which aren’t attractive markets to health insurance companies.”

Other analyses were clear that Ryan’s proposal would “shift costs onto the poor, old and sick,” as the Huffington Post’s Jonathan Cohn noted. “Specifically, the bill would shift financial assistance away from people with low incomes and high insurance costs, while giving insurers new freedom to vary prices by age, so that carriers could charge older customers more than five times what they charge younger customers. The bill would also allow insurers to offer skimpier coverage than the law permits today.”

While Trump has been defending the legislation since this weekend, what’s telling and more of a reality check is what growing numbers of House Republicans are doing as the possible vote approaches. They’re telling Ryan they are voting "no." As of Monday night, it will take only one more Republican defection to kill the bill.