The Congressional Budget Office published its latest estimate of the Republicans’ One Big Beautiful Bill Act on Wednesday. The results are gruesome. From this year through 2034, food stamps get gored by almost $300 billion, and Medicaid by well over $700 billion. Affordable Care Act subsidies come in for another $125 billion in cuts, in addition to Republicans’ separate refusal to extend Biden-era marketplace subsidies that expire at the end of the year. The CBO concludes this bill will directly kick 10.9 million people off their health insurance, and if you add another five million from the refusal to extend ACA subsidies, that’s a total of about 16 million losing coverage.

The suffering from these cuts will be concentrated among the poor and working class, including perhaps 51,000 preventable deaths per year, according to researchers from Yale and the University of Pennsylvania. That makes this bill considerably worse than Trump’s previous attempt to repeal the ACA during his first term, which would have caused “only” an estimated 24,000 to 46,000 deaths annually.

It’s worth pointing out that four Republican senators, namely, Josh Hawley and Eric Schmitt of Missouri, Lisa Murkowski of Alaska, and Susan Collins of Maine, have all promised not to cut Medicaid. And others, like West Virginia’s Shelley Moore Capito and Jim Justice, have expressed concern about the impact on rural hospitals, which operate on thin margins and would near collapse if many of their patients lost insurance coverage.

These cuts, immense as they are, do not come close to canceling out the effect of $3.7 trillion in tax cuts, so the net result is a $2.4 trillion increase in the national debt by 2034. On the benefits of these reduced taxes, per an analysis by the Institute on Taxation and Economic Policy, 68 percent will be collected by the top fifth of Americans, and the top one-hundredth will get 24 percent. The poorest fifth will get a measly 1 percent—and that small tax decrease will be canceled out many times over by the cuts to Medicaid and food stamps.