To the parade of horribles likely to occur if the latest Republican plan to repeal Obamacare succeeds, add two more: health care jobs would dry up and recessions would likely end up worse.

S&P Global Ratings analyzed the Cassidy-Graham bill, which would repeal most of the major provisions of the Affordable Care Act, and found a sizable list of problems it would cause. Among other things, the bill would leave states and cities with a major funding shortfall. It would also cut employment by 580,000 jobs—mostly in the health care industry—since federal health care funding would plummet starting in 2027. This comes after other researchers have determined that the bill would bump millions of Americans off the insurance rolls and once again allow insurers to charge people with pre-existing conditions dramatically higher rates.

One problem S&P highlights would arise from changes in the way Washington administers Medicaid, which is currently an open-ended entitlement program available to all who qualify. Federal Medicaid payments to the states normally rise during a recession, since that’s when people lose jobs and more need public insurance. In that way, Medicaid is a “stabilizer” that provides more stimulus when the economy needs it most. But the Cassidy-Graham bill would change Medicaid to a block-grant system, with states getting a fixed amount each year and nothing extra during recessions. “The legislation would result in more acute fiscal pressure on the states in economic downturns,” S&P believes.

States would probably feel more pain well before a recession came along. The shift in Medicaid from federal to state control would require each state to set up new rules and agencies necessary to dole out the money and comply with federal regulations. The law is supposed to go into effect in 2020, but that wouldn’t allow nearly enough time for state legislatures—many of them part-time — to accomplish something so complicated. “The bill won’t work,” writes Timothy Jost, emeritus professor of law at Washington & Lee University. “The states cannot possibly design and implement new programs to replace the ACA marketplace subsidies and Medicaid expansions by 2020.”

Even if that were plausible, the sharp cutback in Medicaid funding overall would produce a variety of unhappy consequences. Some of the ramifications S&P predicts:

Rural areas would probably suffer more because they’ve gotten a larger share of funding under the ACA. So unwinding the ACA, by contrast, would concentrate cutbacks there.

Revenue would decline for some health care providers, simply because there would be fewer people with health insurance seeking care. Many for-profit providers would have the agility to deal with that, but intense pressure could hammer nonprofits. “We would expect … a sharp rise in charity care and bad debt,” S&P says.