Every healthcare association, provider group, and patient advocacy group in the country is on red alert over Trumpcare, Senate Majority Leader Mitch McConnell’s effort to end healthcare in the U.S. as we know it.

“There has never been a rollback of basic services to Americans like this ever in U.S. history,” said Bruce Siegel, president of America’s Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. “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.”

That National Association of Medicaid Directors—the people who administer the program in every state—agree, but in less blunt language:

Changes in the federal responsibility for financing the program must be accompanied by clearly articulated statutory changes to Medicaid to enable states to operate effectively under a cap. The Senate bill does not accomplish that. It would be a transfer of risk, responsibility, and cost to the states of historic proportions.While NAMD does not have consensus on the mandatory conversion of Medicaid financing to a per capita cap or block grant, the per capita cap growth rates for Medicaid in the Senate bill are insufficient and unworkable.

“Historic” cuts, “insufficient and unworkable” cuts—that’s a bureaucratic way of hitting the panic button. They have every reason to panic—they’re the ones who along with their states’ governors are going to have to make the decisions over who lives with Medicaid and who dies without it. All the while Republicans were screaming about death panels in Obamacare, they were actually plotting out the most cruel way to create them.