Most of the stories about the impact of the Republican budget passed by the General Assembly this summer have focused on education and the ongoing layoffs, from teacher assistants at public schools to faculty and staff at campuses of the university system.

UNC-Greensboro officials announced last week the budget cuts were forcing them to fire 90 people, abolish 235 jobs and cancel 975 course sections, making it difficult for many students to graduate on time.

There have also been reports about the elimination of the acclaimed N.C. Teaching Fellows program, the end of funding for the nationally recognized drug treatment courts and the struggles posed by the deep cuts to early childhood programs.

Those stories and dozens more have explained the damage to people and communities right now from the budget, the jobs lost, the opportunities denied for at-risk kids, and the additional burdens placed on thousands of families already barely able to make ends meet.

Last week brought a preview of the damage that is still come because of the cuts made by the General Assembly, reductions that are likely to hurt the most vulnerable people in the state.

Lawmakers slashed $356 million from the Medicaid budget in the current fiscal year, and another 407 million next year. State Medicaid dollars are matched two to one by the federal government so the cuts take a total of more than $2 billion dollars out of the program.

That funding not only supports tens of thousands of jobs in the health care industry, it pays for services to children, seniors, pregnant women, people with a disability, people living with HIV/AIDS, and other vulnerable populations.

Republicans didn’t slash many specific Medicaid programs and services. They were too politically smart to do that. Instead they ordered the Department of Health and Human Services to come up with the savings—even if that means slashing vital services.

Medicaid officials held the first of a series of public hearings about the cuts last Friday and the numbers and the timetables are grim. Even if the projected savings were possible, there is no way they can be realized this year given the federal requirements for making changes.

That means more cuts to services to make up the difference. Virtually no one believes the savings in the budget are realistic, but the funding will be less so Medicaid recipients will suffer.

State officials say almost everything is on the table, like no longer providing prosthetics to people who lose an arm or leg, ending dental services for seniors, even stopping prescription drug coverage.

The more you hear, the worse it sounds. Doctors could only prescribe life-saving medication for people living with HIV/AIDS after prior authorization, a ludicrous delay since the patient literally needs the drugs to survive.

As the North Carolina AIDS Action Network points out, a recent multinational study led by researchers at UNC found that early drug treatment for HIV/AIDS patients reduces transmission rates as much as 96 percent.

Nobody should need some additional authorization to prevent more people from being infected with HIV or to help people stay alive who are living with the disease.

And state officials shouldn’t have to make it harder for people with Multiple Sclerosis to see a doctor or even remotely consider denying an artificial limb to a woman who loses an arm or leg.

They shouldn’t have to, but they do because of the draconian and heartless budget the Republicans approved.

They ought to be ashamed.