It seems the key to all the Republican Cruellas is Cruelty. The Fuck You Care Plan was looking at crashing and burning, but the two prime Cruellas, Trump and Ryan, have found a way to pull in the reluctant rethugs, who felt the “replacement” was simply too kind.

In a sane world, the problem with the House’s Trumpcare bill would be that it kicks 14 million people off of their health insurance in year one and uses the savings to give rich people a big tax cut.

In our world, though, the problem for Speaker Paul Ryan (R-WI) was that scores of his own members didn’t think the bill was harsh enough. With only a couple dozen votes to spare in the House, and party leaders rushing toward a vote to minimize public scrutiny, the initial revolt was enough to force tweaks.

Those changes landed Monday night in the form of a “manager’s amendment” to the Trumpcare proposal. The amendment makes Medicaid cuts even deeper, frees up governors to raid the program to plug other budget holes, and ends Medicaid expansion under Obamacare much sooner than Ryan’s original bill.

This would be why there was the previous insistence of a vote first, without looking over the changes. No one is being allowed all that close of a look, however, so there are no estimates as to how many people this version will screw over. You can be certain it will be more.

The new version accelerates that process of shoving poor, disabled, and elderly people off a health care cliff. Medicaid expansion would freeze immediately rather than in two years. While the 11 million slightly-less-poor-than-the-poverty-line Americans who today receive health insurance thanks to Obamacare’s expansion of Medicaid would technically be grandfathered in, there’s a false bottom to their recently-gained financial and medical security.

Anyone whose coverage lapses, or who takes a seasonal job that bumps their income up too high to be covered, would not be able to re-enroll in Medicaid after that blip. At the same time, the topline reductions in federal Medicaid spending would create fiscal attrition, effectively forcing states to throw Medicaid expansion patients back into the uninsured gutter a bit more quickly than the first version of Trumpcare.

The amendment also adds a cash incentive for states to impose work requirements for non-pregnant, non-disabled, non-elderly Medicaid recipients. Work requirements in anti-poverty programs are a longstanding and bipartisan white whale, despite their failure to achieve anything other than higher poverty rates.

Medicaid will be no exception, Center on Budget and Policy Priorities health care policy expert Judy Solomon told ThinkProgress. “While most adults on Medicaid already do work, the work requirement would likely prevent other eligible people from enrolling, including, for example, a young adult attending college, a married mother taking care of an infant, or an adult caring for an aging parent,” Solomon said.

There really is no limit to just how much rethuglicans want to stomp all over poor people. I expect what they’d truly like to do is “cull the herd”, but as that might meet some hard edged resistance, this slow way of killing people will have to do.

A few key low-ranking Republicans have already hinted the changes will secure their votes. A dozen members of the hard-right Republican Study Committee summoned to the White House on Friday agreed to embrace Trumpcare if the deeper Medicaid cuts were added, Rep. Mark Walker (R-NC) told the Washington Post.

Is everyone feeling loved by their representatives?

The amendments to Trumpcare effectively trade American lives for Republican votes. Like its predecessor, the 2.0 version is a swindle masquerading as technical, wonky reform. It will take medical care away from low-income families, which will mean more people in those families die sooner than they would have if they could still afford insurance coverage.

The bodies will be piling up against The Great Gold Curtain.

Via Think Progress.

Oh yes, almost forgot – this is what the Tiny Tyrant is concerned about:

According to CNN, Trump began his meeting with Republicans by congratulating himself for the crowd size at a Monday night rally in Louisville, Kentucky. The president warned that the value of his earned media would be diminished if the health care bill fails.

“We won’t have these crowds if we don’t get this done,” he reportedly complained.