BOSTON (AP) — The GOP-backed health care bill before the U.S. House could cost Massachusetts at least $1.5 billion in annual federal payments within five years, and undermine the state’s ability to provide near universal coverage for its residents, Gov. Charlie Baker wrote Tuesday in a letter to the congressional delegation.

Baker, a Republican, provided his administration’s first detailed estimate of the likely financial impact of the bill on Massachusetts, based in part on an analysis released last week by the Congressional Budget Office.

The state would stand to lose at least $1 billion by 2020 and $1.5 billion by 2022, Baker wrote. Those figures include reductions in federal reimbursements to MassHealth, the state’s Medicaid program, and reduced subsidies for private insurance purchased through the state’s Health Connector.

“Overall, our analysis indicates that the (bill) would increasingly strain the fiscal resources necessary to support the Commonwealth’s continued commitment to universal health coverage,” Baker said in the letter to the state’s all-Democratic delegation.

The House is scheduled to debate and vote on the health care overhaul that would repeal former President Barack Obama’s landmark law on Thursday. The bill is supported by House Speaker Paul Ryan and President Donald Trump.

By 2022, the state could also lose up to $475 million in additional federal revenue if the Trump administration scraps a Medicaid waiver that Baker signed with the Obama administration last year, the governor warned.

The state currently receives about $10.5 billion in annual federal Medicaid payments, a little more than half of the state’s total $19 billion in Medicaid spending.

Baker’s letter did not provide any estimate of how many state residents might lose health insurance under the GOP bill. He noted that the state’s 2006 health care law, which served as a blueprint for the current U.S. law, includes provisions that could “mitigate” the impact of changes at the federal level.

Massachusetts, for example, retains an individual health insurance mandate that would remain in place even if Congress repeals the federal individual mandate, Baker wrote.

Massachusetts has the lowest uninsured rate of any state, with about 97 percent of residents covered.

The governor’s letter did not explicitly ask members of the delegation to oppose the bill, but they apparently need little persuasion to do so. Many have already lashed out at the measure, including Rep. Joe Kennedy, who called it an “act of malice,” and Rep. Seth Moulton, who said the bill “shifts the tax burden to seniors and hardworking Americans who will be forced to make a choice between paying for lifesaving treatment or paying their electric bill.”

Democratic Sen. Elizabeth Warren, in a recent tweet, called the bill “heartless & irresponsible.”

Baker said the Trump administration, in conversations with governors, has indicated a “general openness” to providing states with more flexibility on health care, and he said his administration would pursue additional steps to ensure that the state’s residents continue to have access to quality care.

[graphiq id=”fNuaFkHyiLr” title=”Change in US Government Spending on Medicare and Health Programs” width=”600″ height=”520″ url=”https://w.graphiq.com/w/fNuaFkHyiLr” link=”https://www.graphiq.com/vlp/fNuaFkHyiLr” link_text=”InsideGov | Graphiq” ]

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