At the time the only insurance available to her was California's Major Risk Insurance Program (MRIP). This was a program designed at the state level to address the insurance needs of people like my wife who have pre-existing conditions (she happens to have a genetic mutation that can lead to colo-rectal cancer). MRIP was better than nothing, but it was paltry: it had an annual cap of $75,000 per year. That first year, we blew through this cap by February. Same thing the second and third years, 2009 and 2010. All the rest of our medical bills -- for multiple surgeries, hospital stays, chemotherapy, radiation, CT-scans, etc. -- we had to pay entirely out of pocket. In 2011, to our huge relief, the ACA came into effect. Amid all the pain and the heartache and soothing our children and long days and nights and fears for the future, we at least knew that we had help with the expenses. We felt our country had our backs.

For many families, if the GOP repeals the ACA it means that they will be thrown back on state programs like MRIP again, at best. Politicians will be able to say proudly that everyone with a pre-existing condition can still get insurance! But without the structure of the ACA and its mandate they will know full well that these insurance programs will severely limit what they cover. Private insurance plans would simply not have large enough pools to do better. State programs would lack funding. People like us would be left in the lurch once again.

This doesn't just mean that "millions will lose their health insurance."

it means someone's mother coughing blood. Or a father groaning in pain and yelling behind a closed door. It means parents or other family members arguing because after one of them missed a promotion at work -- because of all the time spent taking care of a loved one. It means slammed doors. It means missed dinners. Most of all, it means a child somewhere, in some inconsequential town, crying, heaving sobs into his pillow, because his parent is going to die. Another child sitting in stunned silence in class, not listening to a word the teacher says.

I want TPM's readers to visualize this as concretely as possible whenever they consider millions losing their health insurance. Of course I would like members of the GOP leadership and the Trump transition team to visualize this too. Repealing a health insurance program that has been working for millions of people is worse than proposing something ineffective. It demonstrates outright a willingness to be cruel. To hurt people unnecessarily. There is no other word for it. It is heartless.