The cuts to Medicaid in the Senate Republican health care bill would almost overnight cut off access to life-saving treatment for diabetics, sending them to the emergency room where they would incur enormous financial costs.

Donald Trump’s budget director said months ago that he did not believe diabetics deserve health insurance. Now, in their recently revealed health care bill, Senate Republicans are working to enshrine this callous mindset into the law.

Senate Republicans have finally released the text of their health care bill, devised and negotiated in private by 13 men, handed off to insurance lobbyists while the public was shut out of the process.

What came out of that sealed-off process is legislation targeting Medicaid, the government system designed to provide access to health care for the most vulnerable and at-risk Americans. The Republican bill, dubbed the Better Care Reconciliation Act of 2017, does this while fulfilling the ongoing Republican initiative to cut taxes for the extremely wealthy.

Obamacare expanded Medicaid, increasing the likelihood that diabetics would be diagnosed early, and providing coverage so that expensive medication like insulin can be paid for.

In a video released by Indivisible, a young woman visited Republican Sen. Susan Collins’s office to highlight the thousands of dollars in medication treating her diabetes requires. Before Obamacare, Indivisible noted that “Phoebe’s mother had to skip mortgage payments to pay for Phoebe’s supplies.” With the Medicaid expansion, those costs are now taken care of.

The Republican proposal ends that. The bill not only undoes the Medicaid expansion, but it also builds on the destructive cuts passed in the House by Republicans on a party-line vote. It would change the process by which states receive federal money for Medicaid recipients, cutting the amount of aid those patients receive and impacting the type and quality of care millions of Americans would have to deal with.

When those funds are cut off, diabetics can no longer afford their medication, and often will end up in the emergency room in a life-threatening situation and with massive hospital bills to contend with if they survive the stay.

A coalition of 120 patient organizations – including AARP, the American Diabetes Association, and the American Heart Association – have called on the Senate to defend Medicaid, pointing out it is a “as a critical lifeline for patients and consumers with ongoing health care needs.” They point out that the plan to turn Medicaid payments into block grants, instead of funding the program based on need, will cut off patient access to breakthrough treatments and reduce the ability to respond to emerging health threats. Similarly they pan the proposed repeal of Medicaid expansion, as the program is a “critical source of coverage for people with chronic diseases.”

Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services, said the bill represents “the destruction of Medicaid” and is “far, far worse than even the House bill.”

The bill would penalize states for spending more than the average Medicaid recipient, not allowing any leeway for the nuances of individual situations depending on differences in the economic conditions between the states. This would incentivize states to do the least possible for their Medicaid patients.

Diabetics are just one group of people who will suffer if the Republican legislation passes.

The budgetary games in the bill translate into an effect on lives from the first moments of existence. Nearly half — 48 percent — of births in America are covered by Medicaid, which means that the proposed Republican cuts would reduce the money needed to take care of those children. They would be left behind.

Medicaid also covers 69 percent of nursing home residents, 40 percent of poor adults, 60 percent of children with disabilities, and 76 percent of poor children.

Attacking the way Medicaid is funded, as the Republican bill does, limits the money available to help those vulnerable populations, reducing their quality of life as Americans.

Donald Trump said he would not cut Medicaid when he was campaigning for president, but he backs both the Senate and House bills, which have Medicaid squarely in their targets.

In fact, many of the areas of strongest support for Trump are also some of the regions that rely the most on Medicaid, including rural hospitals for which the program is a critical lifeline. As Trump and his fellow Republicans have so often done, they are sacrificing their voters for the benefit of well-heeled patrons.