Share of uninsured nonelderly adults, by 2022 Wash. 10% 34 22 28 30 Me. Mont. N.D. Vt. Minn. Ore. N.H. Idaho N.Y. Mass. Wis. S.D. Mich. R.I. Wyo. Conn. Pa. Iowa Neb. N.J. Ohio Nev. Md. Ind. Ill. Del. Utah W.Va. Colo. Va. Calif. Kan. Mo. Ky. N.C. Tenn. Okla. Ariz. S.C. N.M. Ark. Ga. Ala. Miss. La. Tex. Alaska Fla. Hawaii Share of uninsured nonelderly adults, by 2022 10% 22 28 30 34 Wash. Me. Mont. N.D. Vt. Minn. Ore. N.H. Mass. Idaho N.Y. Wis. S.D. Mich. Wyo. R.I. Pa. Conn. Iowa Neb. N.J. Ohio Nev. Md. Ill. Ind. Utah Del. W.Va. Colo. Va. Calif. Kan. Mo. Ky. N.C. Tenn. Okla. Ariz. S.C. N.M. Ark. Ga. Ala. Miss. La. Tex. Fla. Hawaii Alaska Share of uninsured nonelderly adults, by 2022 10% 22 28 30 34

The latest Republican plan to overhaul the health care system would eliminate insurance coverage for millions of their own constituents, which should greatly concern senators who support the bill.

An analysis by the Urban Institute shows how states will be affected by the Better Care Reconciliation Act, the Senate proposal that is still in negotiation after the majority leader, Mitch McConnell, canceled a vote in late June. While all Democratic senators oppose the bill, only 14 Republican senators have raised doubts about the plan. The rest appear to support the bill.

States With Expanded Medicaid Are Hit Hardest

The plan will be particularly devastating for the 31 states that expanded Medicaid under the Affordable Care Act. More than 14 million people gained health insurance under the expansion. The legislation would phase out the expansion. In addition, it would cap federal spending on Medicaid and allow it to grow by the general inflation rate, which tends to increase much more slowly than the cost of medical care.

Change in the number of uninsured, compared with the Affordable Care Act, by 2022 States that expanded Medicaid +133% Did not expand +37% Source: Urban Institute Change in the number of uninsured, compared with the Affordable Care Act, by 2022 States that expanded Medicaid +133% Did not expand +37% Source: Urban Institute

The expansion states include Arkansas, Kentucky, Ohio and West Virginia, which have at least one Republican senator each. Under the Senate bill, nearly 2.3 million people in just those four states would lose access to Medicaid by 2022, according to the Urban Institute. While a small fraction of these people could possibly gain access to coverage through employers or the private market, experts say most of them would become uninsured.

People Who Use Exchanges Could Lose Insurance

Wash. Me. Vt. Mont. N.D. Minn. Ore. N.H. N.Y. Idaho Wis. S.D. Mass. Wyo. Mich. Pa. Conn. Iowa Neb. N.J. Nev. Md. Ohio Del. Ill. Ind. Utah W.Va. Colo. Va. Calif. Kan. Mo. Ky. N.C. Tenn. Okla. Ariz. N.M. Ark. S.C. Ala. Ga. Miss. La. Tex. Alaska Fla. Hawaii Increase in number of people uninsured, compared with the A.C.A., by 2022 +40% +60% +160% +220% +260% Increase in number of people uninsured, compared with the A.C.A., by 2022 +40% +60% +160% +220% +260%

In Republican-run states like Florida, Georgia and Texas that have not expanded Medicaid, the Senate bill would most hurt people who buy insurance on the health care exchanges created by the A.C.A. Nearly 2.3 million people in those three states would likely lose their private insurance policies by 2022, according to the Urban Institute.

The Senate bill hurts those people by greatly reducing the subsidies the A.C.A. provides families who buy their own insurance. These cuts will most hurt lower-income and middle-class families. The legislation would also let insurance companies charge older Americans much more for coverage. And the Republican bill would let insurers sell policies with higher deductibles.

Change to health insurance premiums A.C.A. premium Senate bill Age 21 Age 40 Age 64 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 Note: For a single individual with an annual income of $26,500 using a “silver” plan. Source: The Congressional Budget Office Change to health insurance premiums A.C.A. premium Senate bill Age 21 Age 40 Age 64 $6,000 $0 $2,000 $4,000 Note: For a single individual with an annual income of $26,500 using a “silver” plan. Source: The Congressional Budget Office

For example, a 40-year-old earning $26,500 can now buy a policy with relatively modest deductibles for $1,700 a year, according to the Congressional Budget Office. But under the Senate bill that person would pay $3,000 for a policy with higher deductibles. And a 64-year-old with the same income would see premiums jump from $1,700 to $6,500 under the Senate bill.

The Cost in Republican States

While most Senators have made up their minds on the bill — with Democrats universally opposed — a handful of Republican senators are undecided, and hundreds of thousands of their constituents are wondering whether they’ll lose coverage. Below, the number of additional people by people without insurance under the new plan, compared with the A.C.A. — and the Republican senator who is putting them at risk.

Republican Senators Undecided on the Bill

Lisa Murkowski Alaska 67,000 more people wouldn't be covered vs. the A.C.A. Cory Gardner Colorado 575,000 more people wouldn't be covered vs. the A.C.A. Jerry Moran Kansas 120,000 more people wouldn't be covered vs. the A.C.A. Rand Paul Kentucky 541,000 more people wouldn't be covered vs. the A.C.A. Bill Cassidy Louisiana 410,000 more people wouldn't be covered vs. the A.C.A. Susan Collins Maine 60,000 more people wouldn't be covered vs. the A.C.A. Dean Heller Nevada 328,000 more people wouldn't be covered vs. the A.C.A. John Hoeven North Dakota 70,000 more people wouldn't be covered vs. the A.C.A. Rob Portman Ohio 1,122,000 more people wouldn't be covered vs. the A.C.A. James Lankford Oklahoma 157,000 more people wouldn't be covered vs. the A.C.A. Ted Cruz Texas 1,123,000 more people wouldn't be covered vs. the A.C.A. Mike Lee Utah 245,000 more people wouldn't be covered vs. the A.C.A. Shelley Moore Capito West Virginia 218,000 more people wouldn't be covered vs. the A.C.A. Ron Johnson Wisconsin 286,000 more people wouldn't be covered vs. the A.C.A.

Republican Senators Who Support the Bill, or Their Stance Is Unclear