The prospects for the new legislation passing are murky. The proposal has generated a ton of conversation in political and health policy circles in just the past week, with multiple outlets reporting that leadership is now thinking about floor action before Sept. 30. That’s the magic date when, because of parliamentary rules, Republicans lose their ability to pass repeal with just 50 votes. But much of the chatter is hype from supporters and it’s hard to know just how difficult assembling a majority will be.

Still, even if the bill’s political fortunes are difficult to pin down, the impact it would have as a law is crystal clear. By dramatically scaling back what the federal government spends on health care and undermining rules designed to guarantee insurance for people with pre-existing conditions, this new proposal would leave millions of Americans struggling to pay their medical bills and to get coverage.