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How devastating would the Republican health care legislation be if enacted?

Leighton Ku, a leading health care expert and director of director of the Center for Health Policy Research at the Milken Institute School of Public Health at George Washington University, told NBC that, based on the Republican House bill, cuts in funding for Medicaid and health subsidies would trigger “sharp job losses and a broad disruption of state economies.”

“Within a decade, almost a million fewer people would have jobs,” he added. “The downturn would hit the states that expanded Medicaid the hardest.” That includes West Virginia, Ohio and Pennsylvania.

This job loss wouldn’t be offset by the effects of top-end tax cuts. If the wealthy do create any jobs — which is far from likely — they won’t be located in the states and communities ravaged by the cutbacks in hospitals, clinics and nursing homes.

Republicans hope to escape responsibility for this outrage by stealth and deception. The Senate bill was written in secret by a cabal of rich rulers — 13 white, male senators. They permitted no hearings; the experts and hospital and doctors’ associations that oppose it were not allowed to testify. Voters know little about it; most senators haven’t had time to read it, much less understand it.

The deception is that the gutting of Medicaid is phased in over time, even as the tax cuts for the rich are made retroactive to the beginning of the year. That allows Republicans to claim the bill is gentler than the harsh House bill when in fact it makes deeper cuts in Medicaid. It allows them to get past the next presidential election without people understanding what will hit them. This brazen trickery is particularly shocking in a bill designed to deprive millions of health care coverage.

The ugly tactics may be working. According to a recent Kaiser Foundation poll, barely more than one-third of Americans (36 percent) support rolling back Medicaid expansion or block granting Medicaid — which the Senate bill would do. Only 35 percent approve of the House GOP plan, and the Senate plan is worse. Yet only 38 percent of Americans know that the Republicans would make major cuts in Medicaid.

The Republican plan is indecent and immoral. It will cost lives and jobs. It was hatched in secrecy because it cannot survive the light of day. No senator can vote for this bill with a good conscience.

Will Senate Republicans vote to deprive tens of millions of Americans of health care coverage in order to cut taxes for the very wealthy? Senate Majority Leader Mitch McConnell wants a vote this Thursday on the Republican health care bill — which was only unveiled last Thursday. Push has come to shove.

The heart of the bill is a savage choice: to gut Medicaid — a program that covers one in five Americans — in order to lavish tax cuts on the rich — an average annual tax cut of $50,000 for millionaires.

This is a humanitarian catastrophe. Medicaid isn’t just about the poor. It covers 39 percent of all children, 49 percent of births and 64 percent of nursing home patients, not to mention extended care for millions of the disabled. Medicaid funding is vital for hospitals, particularly those in poor and rural areas.

When all the cuts kick in, literally tens of millions of the most vulnerable will be stripped of health care coverage. Premiums and co-pays will go up across the board, as subsidies decline. Workers over 50 will particularly be hit with soaring costs. Companies with more than 50 full-time employees will no longer be mandated to provide coverage, as they were under the Affordable Care Act.

This is a life and death decision. Bruce Siegel, president of America’s Essential Hospitals, a coalition of some 300 hospitals, told the Washington Post:

“Let’s not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services. . . . People will die.”

To add insult to this injury, the bill will also cost millions of jobs — particularly in rural areas and the Midwestern industrial states that gave Trump his electoral victory. In West Virginia, there are more people working in health care and social assistance than in the coal mines.

The Republican bill would savage those jobs and the families that depend on them to survive.

They say they want to make America great again, but this bill makes America suffer again. We’re going backward.