Last week, the U.S. House of Representatives passed legislation that takes a major step toward repealing and replacing the Affordable Care Act. The bill, known as the American Health Care Act (AHCA), damages many elements of the Affordable Care Act that have worked to lower rates of uninsured. In particular, the AHCA allows states to waive insurance market rules that protect people with pre-existing conditions. The plan would allow insurers to charge more to people who are sick, leading to premium increases upwards of tens of thousands of dollars for coverage that is unlikely to meet their health care needs. Pre-existing conditions are common; more than 41 percent of Kansas and Missouri residents have a pre-existing condition that could interfere with their ability to purchase affordable health insurance. In its current form, the legislation would allow states to get rid of the essential health benefits, leaving consumers without coverage for maternity care, substance use disorders or mental health services. Although much attention has rightly been focused on changes to access for those with pre-existing conditions, it is also concerning that the current version of the AHCA would impose per-capita caps on Medicaid and reduce Medicaid funding by more than $800 billion over 10 years. This would end the option for states like Kansas and Missouri to expand their Medicaid programs. It’s also important to note that this version of the bill has not been evaluated by the Congressional Budget Office (CBO). The previous version was projected to cause 24 million people to lose insurance coverage over the next 10 years and all parties concede that the current version will cause even further coverage losses. The U.S. Senate must pass this bill before it becomes law. It is our hope that the U.S. Senate will work to achieve a solution that will guarantee affordable care and coverage and ensure health security for the most vulnerable – the older, sicker and poorer patients. Our focus at Health Forward has always been on those at the highest risk of being left behind when it comes to health opportunities. The Affordable Care Act, while far from perfect, has resulted in substantial gains in health care access for our community’s poorest and sickest. Any changes to our health care system should balance the need to control ever-rising health care costs with the human costs of being uninsured. Those who are uninsured live sicker and die younger. We ask that those who represent us ensure continued coverage and access for the thousands of Kansans and Missourians who have benefited from the Affordable Care Act.