On Thursday, in what are only the most recent steps in a dogged years-long effort by the GOP to deny health care to millions of Americans, President Donald J. Trump announced an immediate end to the $7 billion in cost-sharing payments that, over the past several years, have helped 7 million low-income people afford health insurance. He also signed an executive order gutting standards under which insurance companies provide health insurance packages meant to cover essential benefits and potentially leading to weakened government protections.

The newest attacks came just after the administration, among many other things, stopped supporting open enrollment events for the Affordable Care Act (ACA); shut down the ACA website for 12 hours every Sunday during open enrollment (Sunday, of course, being a day that many people have free time to sift through health insurance plans); dramatically reduced spending on advertising for open enrollment dates and cut funding to groups that help people enroll; used government funds to spread misinformation about the ACA; weakened the mandate requiring people to buy health insurance and thereby supporting the market by spreading risk; and proposed dramatically weakening the ACA’s birth control benefit.

The strategy to purposefully create havoc in ACA enrollment and markets is meant to give credence to Republican claims that “Obamacare is failing,” and came after persistent attempts by the GOP-led majority in the U.S. House and Senate throughout the spring and summer to gut Medicaid and to deny anywhere from 22 million to nearly 30 million people access to health insurance via so-called repeal and replace bills. In turn, legislation aimed at denying people access to care itself came after years of both misinformation and sabotage of the ACA by Republican governors and members of Congress.

Now, thanks to Trump’s actions, millions of people will immediately feel the effects of higher or completely unaffordable health insurance premiums and no longer be able to access health care. People will suffer and they will die.

Welcome to Trumpcare. Or, more accurately, “No Care At All.”