The Republican health care bill was already unimaginably cruel, cutting billions of dollars from Medicaid. But it gets even worse than that.

The Republican health care repeal bill would be a disaster for Medicaid patients, cutting funding by at least $770 billion from Medicaid. But that’s not all the harm it would do.

The proposed legislation would also allow states to squeeze people out of the system, cutting off thousands of people from services they often desperately need to take care of their health. Already, these techniques have been used to cut children out of the health care system, and the legislation backed by Donald Trump, Paul Ryan, and Mitch McConnell would boost this behavior into overdrive.

ProPublica reports on provisions in the bill passed by the House and under consideration by the Senate that would push states to repeatedly engage in assessments of Medicaid recipients to determine if they are eligible for the program.

The goal of this repeated scrutiny is to do as much as possible to exclude people from Medicaid. And it is part of an engineered assault in which Republican governors have worked to make the process of applying and reapplying so onerous that many people — particularly the ones who need it the most — just give up.

When Texas implemented such a policy, data showed that the number of children experiencing temporary gaps in their Medicaid coverage increased. Children, the most vulnerable demographic, slipped through the coverage cracks, all thanks to conservative policy.

When children lack coverage, health issues are allowed to flourish, and illnesses are missed and ignored until they reach a crisis point requiring an emergency room visit. But emergency rooms are not a substitute for regular health care.

The legislation, in concert with the Trump administration’s hostile approach to health services, would also create an atmosphere in which various right-wing proposals to cut off Medicaid recipients would receive a green light. Unlike under the Obama administration, these destructive policies would move forward easily, because the current White House is uninterested in the human cost of pursuing conservative aims.

These include ideas like those proposed in Indiana and Maine — led by Republican governors Eric Holcomb and Paul LePage, respectively — to implement work requirements for Medicaid recipients categorized as “able-bodied.”

This is a continuation of the Republican distortion that able-bodied people on Medicaid aren’t working already. In fact, they are working, and in most cases they are doing so at low-paying jobs that don’t offer health insurance. Medicaid is all they have, but conservatives continue to mock and demonize these people as government mooches.

Wisconsin, led by conservative Republican governor Scott Walker, is pushing for a drug-testing requirement for Medicaid patients, echoing Republican demagoguery of welfare recipients. In the past, those programs were a proven waste, only working to shame people seeking assistance without uncovering the fraud and abuse Republicans insisted were in practice.

Arizona wants to put a cap on the time non-disabled adults can stay on Medicaid, while Utah is pushing for limits to the number of adults without dependent children that can be on the program.

These proposals echo a lot of the same approaches of welfare reform that passed in the ’90s, which all operated under the assumption that there was massive abuse of the system underway. The effect was to make life difficult for the most vulnerable, assuming that everyone is a cheat and spreading that psychological assumption to the vulnerable, disabled, and children.

The proposed bill is already a giant wrecking ball against health care in America. In addition to destroying the Medicaid expansion put in place under Obamacare and cutting overall Medicaid funding, it converts the program into block grants which would force states to spend even less per patient.

In concert with Trump’s inclination to weigh in on the side of insurance companies and not patients, along with the bill’s bias in favor of giving conservative state efforts to trim Medicaid rolls, it adds up to a massive disaster in the making for millions of people.