Unlike the House Republican plan to end Medicare, which is fading fast, the GOP’s vision for Medicaid is worth worrying about — not because it’s worse, but because it has a better chance at passing.

The consequences for millions would be severe.

The House Republican budget would leave up to 44 million more low-income people uninsured as the federal government cuts states’ Medicaid funding by about one-third over the next 10 years, nonpartisan groups said in a report issued Tuesday.

The analysis by the Kaiser Family Foundation and the Urban Institute concluded that Medicaid’s role as the nation’s safety net health care program would be “significantly compromised … with no obvious alternative to take its place,” if the GOP budget is adopted.

This isn’t exactly a secret; proponents of the GOP agenda know this would happen. Indeed, for many, it’s a feature, not a bug — turn Medicaid over to states in the form of block grants; save a lot of federal funds; and let states start limiting access and /or rationing health care serves for beneficiaries.

For Republican leaders, it’s simply a question of priorities. These 44 million Americans, nearly all of whom are already struggling badly, need to “sacrifice.” GOP officials racked up some huge debts over the last decade and now they’ve decided to take the clean-up seriously — just so long as they get to pick who suffers and ensure its low-income families who aren’t likely to vote for them anyway.

So to review, leaving 44 million struggling Americans with no health care is on the table. Any tax increase on anyone at any time by any amount is “off the table.”

The Republican agenda isn’t just misguided; it’s genuinely and needlessly cruel.

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Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.