North Carolina Congressman Ted Budd cast an indefensible vote to repeal the Affordable Care Act and replace it with legislation that is so awful that Budd’s fellow Republicans were caught scheming to exempt themselves and their staffs from the measure’s draconian provisions.

But Budd got one thing right. “I’ll take around 2,000 votes this Congress. Most of them will be forgotten,” the Republican congressman said as the vote approached. “This is not one of those votes.”

Good. The vote by 217 House Republicans to gut the Affordable Care Act (while 20 of their colleagues and 193 Democrats opposed the move) must be remembered as the shameful abandonment of health and humanity that it is. This should become the permanent stain on every member of the House who supported it—the issue that does not to go away. House Speaker Paul Ryan and his caucus abandoned any pretense of deliberative or responsible legislating in order to deliver an empty “win” for the flailing administration of President Donald Trump.

To do this, Ryan’s Republicans voted for a devastating piece of legislation without knowing:

  • the cost of their plan
  • how many tens of millions of Americans will lose insurance
  • how their plan will be implemented at the federal or state level
  • what will remain of their plan after it is reviewed by the Senate

House Republicans simply did not care. The overwhelming majority of them cast their votes as Ryan said they should, and then they ran the gantlet—past crowds of citizens chanting “Shame! Shame! Shame!”—on their way to a White House Rose Garden “celebration” of their partisanship with Donald Trump.

Republicans claimed that they had addressed the fundamental flaws in a bill that had been widely decried for providing less health care to fewer people at greater cost. But that was a convenient lie, told for the sake of media outlets that could not keep up with the twisting and tinkering that was being done to win the votes of so-called “moderate” Republican holdouts. The truth came from the American Medical Association (AMA): “None of the legislative tweaks under consideration changes the serious harm to patients and the healthcare delivery system if AHCA passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill—that millions of Americans will lose their health insurance as a direct result of this proposal.”

That’s only part of the problem, explained the group that represents America’s physicians. “Not only would the AHCA eliminate health insurance coverage for millions of Americans,” the AMA added, “the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”

A Wall Street Journal review of assessments of the GOP measure from actual health-care providers was devastating: The American Academy of Family Physicians dismissed the “highly flawed” measure’s attempt to address the crisis it will create for people with pre-existing conditions as “inadequate” and “temporary.” The CEO of America’s Essential Hospitals decried an amendment on funding for high-risk pools as the equivalent of applying “a bandage to a mortally wounded patient.”

Sister Carol Keehan, DC, the president of the Catholic Health Association of the United States, was unequivocal in her opposition. “The recent amendments to the bill, intended to make it more palatable to those who did not support it initially, are even more disastrous for people who have just gotten health care,” explained Sister Carol. “Changing the current rules to undermine essential benefits requirements and protections for people with pre-existing conditions, as well as allowing insurers to set annual and life time caps on the care they cover, would seriously undermine health security and leave many individuals with substandard protection. Even the proposed state high-risk pools would be an inadequate and underfunded solution to a problem that need not exist in the first place.”

Sister Carol counseled that “It is critically important to look at this bill for what it is. It is not in any way a health care bill. Rather, it is legislation whose aim is to take significant funding allocated by Congress for health care for very low income people and use that money for tax cuts for some of our wealthiest citizens. This is contrary to the spirit of who we are as a nation, a giant step backward that should be resisted.”

That is precisely right. The health-care debate will go on. What House Republicans voted for on Thursday will not be the final word on this issue. But the votes those Republicans cast for this particular bill ought never be forgotten. House Minority Leader Nancy Pelosi warned Republican backers that “they have this vote tattooed on them. This is a scar that they will carry….” Her admonition should serve as a call to arms.

Republicans now must be identified for what they are: charlatans who would lie to Americans with cancer and heart conditions about the health care they cannot live without.

Representative Gwen Moore, Democrat of Wisconsin, got it right as she outlined her opposition to Ryan’s plan for the mangling of health care in America by tweeting photos of people who have battled leukemia and other diseases—constituents who had contacted her to express their fears about what the speaker of the House proposed to do to them. “They’re not numbers and statistics. They’re cancer survivors and people with disabilities. They’re sons and daughters,” explained Moore, who declared that she was voting “no” for them.

The politics of health care is personal. It’s about whether human beings can get the care they require, about whether they will live or die. The choice that House Republicans made Thursday was inhumane. It should be remembered as such—and it should be continually condemned as such.

Primary and general-election challengers to Paul Ryan and to every member of Congress who voted for Ryan’s “repeal and replace” scam—which Moore correctly described as “a massive tax giveaway masquerading as a health care bill”—should not be allowed to talk around what they have done. They should not be allowed to run in 2018 on whatever final reform eventually is agreed upon—if, indeed, an agreement can be reached.

They should be held to account for their willingness to tear apart a health-care system in order to reward campaign donors and political allies at the expense of ailing Americans. These wicked politicians will face opposition in 2018. Their opponents should pull no punches. What Ryan and his minions have voted for is not just wrong. It is immoral.

That is the message that must go forward from this awful day. No quarter should be given in delivering it.