The Republican party’s upcoming budget reconciliation bill—a.k.a. President Donald Trump’s “One Big Beautiful Bill”—will come with a deadly cost. A study out today finds that the Medicaid cuts proposed in the bill could set off a powder keg of healthcare disruptions, potentially causing thousands of additional preventable deaths each year.

Researchers at Harvard and elsewhere conducted the study, analyzing the health impacts of six GOP-proposed Medicaid cuts, some of which are in the current bill. They estimated that the bill as a whole will cause millions to lose their primary care doctor, while also killing over 16,000 more Americans annually. Far from ensuring the prosperity of all Americans, the bill’s provisions will further enrich the wealthy at the expense of the poor and vulnerable, the researchers warn.

The One Big Beautiful Bill Act is intended to extend the 2017 tax cuts passed during Trump’s first term as well as to enact many of the administration’s other priorities (the nickname came from Trump wanting to accomplish all this in a single piece of legislation, rather than several bills as the GOP originally planned). To offset the continued loss of tax revenue and cover new expenditures created by the bill (including more defense spending), Republicans have promised cuts to several government-funded programs, particularly Medicaid.

The researchers looked at the six biggest Medicaid cuts proposed by the U.S. House of Representatives’ Budget Committee earlier this year, led by the GOP, each estimated to trim at least $100 billion in Medicaid spending over a ten year span. They also analyzed the version of the bill advanced by the House Budget committee in May, which included three proposals: work requirements for nondisabled adults, the delay of Biden-era regulations that would make Medicaid eligibility easier to achieve and maintain, and the freezing of Medicaid provider taxes (used by states to fund Medicaid). They analyzed smaller cuts proposed in the current bill as well, such as raising the cost-sharing for some enrollees.

The Congressional Budget Office has previously estimated that the bill will kick roughly 10 million Americans off Medicaid by 2034 and result in 7.6 million having no insurance at all. Based on past research showing how the loss of insurance coverage can affect healthcare outcomes, the researchers then estimated the toll of the bill’s Medicaid cuts on Americans’ health.

In the most likely scenario, they calculated that 1.9 million Americans would lose their primary care doctor; 1.3 million people would avoid taking needed medications; 1.2 million would go into medical debt; and nearly 400,000 women would skip their mammograms. Annually, these cuts would also likely contribute to 16,642 preventable deaths, they found (the estimates ranged from at least 8,241 deaths to as many as 24,604 a year).

“The Medicaid cuts now under consideration in Congress would take healthcare from millions of Americans and cause thousands of medically-preventable deaths, all to cover the cost of tax cuts that mostly benefit the well-to-do,” lead author Adam Gaffney, a critical care physician, public health researcher, and assistant professor at Harvard Medical School, told Gizmodo.

The team’s findings were published Monday in the Annals of Internal Medicine.

The researchers note that even these numbers might be under-selling the harm of the Big Beautiful Bill. They didn’t analyze other less direct consequences of the Medicaid cuts, for instance, such as states taking money away from other programs to cover the funding shortfalls caused by the bill. A separate estimate released earlier this month by Yale and University of Pennsylvania researchers found that the bill could actually lead to over 50,000 deaths annually. It’s also possible that the bill may still undergo revisions before it reaches Trump’s desk to be signed.

But either way, it’s clear that the Trump administration’s current plan to strip away healthcare from millions of people will spill plenty of blood. That these deaths will come in the service of transferring more wealth to the richest Americans while still raising the federal debt is just further insult to grievous injury.

“If Congress passes this law, it is saying quite clearly that the health and the lives of the poor matter less than the bank balances of the wealthy,” Gaffney said.