The American Health Care Act (AHCA), passed by the U.S. House of Representatives on May 4, 2017, will profoundly change Kansas’ Medicaid program, KanCare. The bill is currently under fast track consideration in the U.S. Senate. For more than 50 years, Medicaid has been a health coverage safety net to the most vulnerable Americans – mostly low-income children, seniors, and individuals with disabilities. Costs are shared by the federal government and the state government and are based on the needs of patients. Three-quarters of KanCare enrollees are children and families and 70 percent of the program’s dollars are spent on care of seniors and Kansans with disabilities. The AHCA threatens to change that. It would impose caps on federal spending, shifting the risk for covering growing costs to the state. The federal contribution would increase less each year than the actual cost of care, squeezing the state budget more and more over time. The state will lose the ability to respond aggressively to health crises, cover new breakthrough drugs, and meet other needs that require flexibility and funding. Nationwide, the AHCA will reduce expected federal spending on Medicaid by $830 billion over the next decade. At least $1 billion of this cut – or about $100 million per year – will come from Kansas. The state will then face an inevitable choice – raise taxes or shift dollars from other programs to make up the difference. Or most likely, cut eligibility and benefits. That means fewer kids with health coverage. Pregnant women who can’t get prenatal care. Less funding for seniors in nursing homes. And cuts in services to Kansans with disabilities. Because Medicaid covers the most vulnerable Kansans with the greatest needs, they are the ones who will be hurt when the state is forced to make do with less. In turn, there will be increased pressure on local communities and health care providers to fill in the gaps. These Medicaid cuts won’t save much money. Instead, they’ll be used to deliver tax cuts to the wealthiest Americans. Tax cuts funded on the backs of low-income children and others who rely on Medicaid. The AHCA will harm KanCare and the Kansans who rely on it in other ways, as well. It will create bureaucratic barriers to enrollment and coverage. It will lock in the state’s relatively low program financing. And it specifically prohibits the state of Kansas from expanding KanCare, ensuring that Kansas taxpayers will continue to pay the tab for expansions in 31 other states without being able to bring our federal tax dollars back home. The AHCA is being rushed through the Senate with no plans to hold hearings or gather testimony and public input. Kansans and all Americans deserve better.