California risks losing $114.6 billion in federal funds within a decade for its Medicaid program under the Senate health care bill, a decline that would require the state to completely dismantle and rebuild the public insurance program that now serves one-third of the state, health leaders said Wednesday.

The reductions in the nation’s largest Medicaid program would start at $3 billion in 2020 and would escalate to $30.3 billion annually by 2027, according to an analysis released by the state departments of finance and health care services.

“It is not Medicaid reform,” Jennifer Kent, director of the state Department of Health Care Services, said in an interview. “It is not entitlement reform. It is simply a huge funding reduction in the Medicaid program. We are deeply concerned what that means for the long-term viability of the program as it stands today.”

Medicaid — called Medi-Cal in California — covers almost 14 million low-income residents in the state — children, people with disabilities, nursing home residents and others. About 4 million of them, many of whom are chronically ill, became eligible for coverage under the Affordable Care Act, commonly known as Obamacare.

California would face the biggest losses of any state, according to a report issued Wednesday by the consulting firm Avalere Health. Federal funding would drop by 26 percent over 10 years, the report said. Many states, including Alabama, Georgia, Texas and Florida, would face a drop of less than 10 percent.

The Senate bill to repeal and replace the ACA would be a “massive and significant fiscal shift” of responsibility from the federal government to states, according to the analysis. It would force difficult decisions about who and what to cover and how much to pay doctors, hospitals and clinics, the report said.

Meanwhile, the day after Senate Republicans pulled plans to vote on their health care bill this week, President Donald Trump promised a “surprise” on the matter, though he did not elaborate.

“Health care is working along very well. … We’re going to have a big surprise,” Trump told reporters at the White House on Wednesday. “We have a great health care package.”

Asked whether he might negotiate with Senate Minority Leader Chuck Schumer, who on Wednesday challenged the president to invite all 100 Senators to a meeting and hash out a bipartisan plan, Trump said, “I don’t think he’s serious.”

“He hasn’t been serious. Obamacare is such a disaster,” said Trump. “And he wants to try and save something that’s hurting a lot of people. It’s hurting a lot of people.”

Senate Majority Leader Mitch McConnell is aiming to send a revised version of his health care bill to the Congressional Budget Office as soon as Friday, according to Capitol Hill aides and lobbyists.

California’s Medi-Cal director, Mari Cantwell, said Republican proposals present a fundamental problem that can’t be solved by making cuts around the edges.

In addition to expanding its Medi-Cal population early and vigorously under Obamacare, the state began covering undocumented immigrant children last year. Medi-Cal also provides dental care and other services that are optional under federal Medicaid rules.

“Nothing is safe — no population, no services,” Cantwell said. “It is really disheartening and honestly horrifying to think about the world under this Senate bill and what it would mean.”

The losses are more than what was predicted under the House bill. The analysis said that’s because the cost shift increases over time under the Senate proposal.

Ken Bascom, 62, who lives in Venice, said he lost his job and his employer-based insurance during the recession. Soon after he became eligible for Medi-Cal in 2014, he was diagnosed with kidney cancer. Now cancer-free, Bascom said he often thinks about what would have happened if he hadn’t been able to get health care.

“More likely than not, I would’ve been dead,” said Bascom. “It’s very scary.”

GOP leaders in Congress have been trying to repeal the ACA for seven years, deeming it disastrous public policy that costs too much and leaves consumers with rising premiums and too few choices for care.

The Senate bill would overhaul Obamacare in several ways. Besides revamping the Medicaid program, it would dramatically change the system of tax credits used to help low-income Americans get health coverage. The Congressional Budget Office concluded that the bill would cut the federal deficit by $321 billion over the next decade while leaving 22 million more Americans without health insurance.

Under the legislation, the federal government would pay a fixed amount to states for Medicaid expenditures, a per capita rate, instead of paying for a share of all expenses incurred.

State health leaders predict that the state’s costs would outpace the federal government’s allocation, meaning California would have to come up with an additional $37.3 billion between 2020 and 2027.

“Whether it’s drugs or cost of living going up or new technologies in health care, there are costs we can’t control,” Cantwell said.

The proposed financial caps would have a “devastating and chilling effect” on spending in the Medi-Cal program and would pinch providers further, the analysis said. California already ranks near the bottom for how much it pays Medi-Cal providers.

The Senate’s overhaul of Obamacare would also force hospitals and clinics serving the poor and uninsured to live within the new financial limits, leading to “uncompensated care in the hundreds of millions, if not billions annually,” according to the analysis.

In addition, the Senate bill would phase out funding for the expansion of Medicaid, which enabled almost 4 million single, childless adults and others in the state to qualify. Under the Affordable Care Act, the federal government pledged to pay for 90 percent of their costs, but the Senate bill would reduce that to 50 percent beginning in 2024.

Without the promised federal funds, California would have to spend five times more than previously estimated to continue covering those newly eligible. By 2027, the cumulative cost to California would be $74.1 billion, according to the analysis.

Kaiser Health News reporter Ana Ibarra and the Washington Post contributed to this report.