A majority of the most conservative Democratic members of Congress in 2009 and 10 voted to do the literal opposite of what Republicans are doing in this bill. They expanded Medicaid and financed 100% of the expansion via Federal dollars through 2016, then via a 90% share through 2020. This was done specifically to incentivize states to enroll people–the most in need–in a publicly funded healthcare program.
Compare this to what Republicans are doing. The Senate bill not only cuts Medicaid, it creates a ratcheting effect that incentivizes additional cuts to the program via budget “offset” rules in Congress while slowly whittling away its purchasing power by tying its funding to the CPI. Republicans know states will trim benefits since FMPAs will ratchet down while future Congresses, especially under Republican control, will trim block grants to offset other budgetary priorities. This isn’t just mean, it’s reprehensible, designed specifically to incentivize states to disenroll people from the program.