In my 25 years of nursing, I have cared for thousands of patients, many of whom relied on Medicaid. As a public health nurse, I know firsthand that seniors, children, veterans, and individuals with disabilities could not gain a foothold on a healthy life without it. And it matters to me that more Americans have greater health-care security.

So it’s frightening to hear rumblings that Republican leaders in Congress will likely vote to repeal the Affordable Care Act (ACA) as soon as this month. It’s not yet clear how Republicans plan to deal with the Medicaid expansions that took place under the ACA, though President Trump has signaled support for block-granting funding, which could vastly reduce the amount of money available for Medicaid coverage. What is clear is that Republican leaders in Congress and Rep. Tom Price (R-Ga.), the nominee for secretary of health and human services, could make significant changes to Medicaid that would have harsh repercussions, leaving millions of patients in medical jeopardy across America.

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I know the health-care law is not perfect — there are ways it should be improved for sure — but expanding Medicaid guidelines has enabled 31 states and the District of Columbia to extend health care to 11 million working adults, children and veterans who would otherwise be left behind. Where Medicaid has been expanded, states have seen vast improvements in the lives of their residents. Medicaid expansions have made people more financially stable, have allowed them to visit the doctor when they’re sick, and have made people happier with their own health. The expansions have reduced income and race-based coverage gaps, and have helped people get back to work. Today, low-to-moderate-income citizens in these states, including 3.7 million Californians in my own state, are less likely to postpone important care and report having fewer medical bills they cannot pay. Nearly half of Republican governors, including Vice President Pence, have chosen to accept federal Medicaid funding as well, putting their citizens’ health ahead of partisan politics.

The idea of fewer rather than more people having health care they can count on frightens my nurse colleagues and me and defies common sense. Americans seem to agree: Recent public polling indicates that a clear majority of Republicans, Independents and Democrats favor states having the option to expand Medicaid coverage to more low-income, uninsured adults.

I am also keenly aware of state budget cycles as a public health nurse. The frightening reality about the timing of a health-care repeal vote in January that radically alters the Medicaid expansion is that most states finalize their Medicaid budgets in July. This means that states would only have five months to deal with whatever changes Congress hands down to them, and only that much time to try to find solutions for the millions who could lose access to care. Nonprofits would likely be similarly strapped for plans and money. As a result, states simply won’t have enough funding or time to stop the resulting chaos. If leaders in Congress vote to repeal the Medicaid expansion with no real plan to replace it, the harmful consequences will be immediate and painful.

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But those are just the facts and numbers. What will happen from a nurse’s perspective is, on the other hand, very human. Mothers — who, as I once did, need help with their health-care costs — will lose vital prenatal care and coverage for births and delivery; children — just like my kids — won’t get essential checkups and preventive care. Individuals trapped in our nation’s horrifying opioid epidemic in states like West Virginia, Maine and Tennessee will lose access to recovery treatment that could save their lives. Patients living with mental illness won’t be able to afford their medications and individuals who have the right kind of care to manage common chronic diseases like diabetes, asthma or high blood pressure could lose access to the medicines that keep them healthy and alive. Hospitals and health-care clinics, a primary source of good jobs in many communities, may be forced to close their doors.