This week, the Health Policy Consensus Group—a consortium of think tanks and former and current lawmakers—put forward a new plan to repeal the Affordable Care Act (ACA) that would end Medicaid expansion and eliminate the ACA’s robust consumer protections for individuals with preexisting conditions, adults over 50, and women. If this sounds familiar, it should. Last year saw several plans to end the ACA’s Medicaid funding and consumer protections, often couched in language promising states more “flexibility.” These proposals would have caused millions of Americans to lose access to critical services, pay more for care, or even lose health coverage entirely.

The ACA repeal bill led by Senators Bill Cassidy (R-LA) and Lindsay Graham (R-SC), generally referred to as “Graham-Cassidy,” bears the most resemblance to this latest proposal. The Graham-Cassidy bill would have caused most states to lose significant funding for both their Medicaid programs and individual Marketplace coverage. The bill would have eliminated guaranteed protections for millions of Americans with pre-existing conditions and steeply increased costs for adults ages 50-64.

The Brookings Institution, a nonpartisan policy think tank, estimated that Graham-Cassidy, if passed in 2017, would have resulted in about 15 million people losing coverage in 2018 and 2019, with an additional 17 million losing coverage within 10 years. In addition, the Graham-Cassidy plan was expected to increase individual market premiums by 20%, putting people who rely on Marketplace coverage—including many older adults who are not yet eligible for Medicare—at risk of not being able to afford care.

While the new Health Policy Consensus Group framework is not fully developed and most experts think it is unlikely to pass, its broad strokes are very similar to Graham-Cassidy, and it would likely lead to similar outcomes if it were able to gain traction. In addition to the inherent risks of the plan, it comes in a new environment. Congress has eliminated the penalty for violating the “individual mandate”—the requirement that people maintain health insurance—, which has already led to coverage losses and rising premiums. This could mean that any new proposal would cause even higher coverage losses than were estimated under Graham-Cassidy. The final result could be much more extreme.

This new framework has also come as the administration is expanding the availability of non ACA compliant health plans as well as joining a lawsuit aimed at undercutting the ACA’s consumer protections. Taken together, these efforts create a huge threat to health care for tens of millions of people of all ages. In addition, they are already driving up costs for the Medicare program.

Medicare Rights will continue to monitor these threats, especially as they put coverage for people approaching Medicare eligibility and the Medicare program itself at risk.

Read the new ACA repeal framework.

Read more about Graham-Cassidy