House Republicans passed a health care bill Thursday to replace Obamacare, but red states could stand to lose the most under the new plan.

That’s because, according to a CNN analysis of a 2016 study by the nonpartisan Kaiser Family Foundation, the 11 states with the largest percentages of people under age 65 with pre-existing conditions not covered by pre-Affordable Care Act health care all voted for Donald Trump.

The American Health Care Act, Republicans’ new plan, would allow states to opt-out of the Obamacare mandate for insurers to charge everyone the same amount for health insurance. Insurers would still technically be required to cover people with pre-existing conditions, but they could potentially charge them much more.

That could cause a particular problem in these top 11 states, each of which has 30% or more of residents under age 65 with a pre-existing condition, above the national rate of 27%. The state with the highest rate is West Virginia at 36%, followed by Mississippi, Kentucky, Alabama, Arkansas, Tennessee, Oklahoma, Louisiana, Missouri, Indiana and Kansas.

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Write to Tessa Berenson at tessa.berenson@time.com.