The Graham-Cassidy bill is atrocious. “Shifting of responsibility” for health care to states simply means fewer federal dollars for most states—but that's not unexpected. Many Republicans have made it clear that their main focus is to get rid of President Obama's Affordable Care Act by any means necessary. Unfortunately, this particular proposal doesn't just repeal the ACA (and with it, its marketplace subsidies and many protections for those with pre-existing conditions), it also includes massive cuts to Medicaid. For the thousands of people that gained health-care coverage through the Medicaid expansion, it's going to hurt.

And it's going to particularly hurt people in Senator Bill Cassidy's home state of Louisiana.

The poverty in Louisiana, as it is across the South, is devastating—and Louisiana consistently ranks at the bottom in just about every measure related to economic hardship and its effects—it has the second highest poverty rate, second highest income inequality, third highest infant mortality rate, and the fourth lowest median household income. The rates are even starker for African Americans and other people of color. (The expression “Thank God for Mississippi,” is mean-spirited, but it does speak to a sad reality: If it weren’t for Mississippi, Louisiana and some other southern states would often be dead last in such rankings.)

When Louisiana voters elected Democrat John Bel Edwards as governor last year, the first thing he did was to expand Medicaid to thousands of Louisianans. Not only does Graham-Cassidy end the Medicaid expansion by 2020, but it also caps and cuts Medicaid funding for vulnerable populations like families with children, the elderly, and people with disabilities.

The proposed block grants are structured so that states that expanded Medicaid are effectively punished. Louisiana stands to lose $7.2 billion in federal funding by 2027—when the block grants dry up completely.

But Medicaid expansion was a lifeline to many in Louisiana. By June 2017, one year after coverage began for the expansion population, more than 433,000 Louisianans gained health insurance. The uninsured population, which was a staggering 21.7 percent in 2013, dropped to 12.1 percent. Thousands were able to access preventative care and screenings.

Senator Cassidy, a physician who treated poor people in the state's charity hospital system, will not only vote to ruin the health and well-being of Louisiana residents—he helped write the prescription.

Rebekah Gee, Louisiana's health secretary, sent a letter to Cassidy (which she shared on Twitter) decrying the proposed bill, noting that it “gravely threatens health care access and coverage for our state and its people.” She said that ending Medicaid expansion is “a detrimental step backwards for Louisiana.” The New Orleans Times-Picayune editorial board also criticized the bill, noting that a doctor like Cassidy shouldn’t be party to such “a dramatic erosion of coverage.”

In 1935, Huey Long, the legendary Louisiana governor and U.S. senator, told his critics, “All I care is what the boys at the forks of the creek think of me.” Today it seems that Senator Cassidy just wants to send his constituents down that creek without a paddle.