Older Californians could face increasing financial hardship and difficulty finding health care if Republican-led efforts to overhaul the nation’s health care system move forward, state officials and advocates agreed.

The American Health Care Act (AHCA) passed by the House of Representatives last month and now under consideration in the Senate, along with President Trump’s proposed budget, would drastically cut federal funds used by states to provide health services to poor and disabled seniors. The budget slashes funding to Medicaid, the federal insurance program for low-income people, known in California as Medi-Cal.

Under the AHCA proposal, federal Medicaid funding to California would drop by nearly $5.5 billion in 2020. Cuts will total $24 billion by 2027, according to the Department of Health Care Services.

The AHCA would also roll back Obama-era protections that have helped keep health care costs down, particularly for older adults not yet eligible for Medicare. For those who are eligible for Medicare—seniors 65 and older and certain younger people with disabilities—the bill threatens to reduce funding for the program by over $100 billion over 10 years through tax cuts, according to an AARP analysis.

In California, home to almost 1 in 9 American seniors, the potential impact of these cuts is huge.

“About one quarter of the people living in California in 2030 will be in that 60 plus age group. One quarter. And in some counties it will be much higher than that,” said Bonnie Burns, a policy specialist with California Health Advocates, a non-profit education and advocacy organization for people on Medi-Cal.  “At the very time when the aging population is increasing, it seems really foolish to be cutting the very resources that those people are going to need.”

In a statement, the Department of Health Care Services said the AHCA and the President’s budget proposal “would shift billions in additional costs to states over the next decade, representing a fundamental change in the federal-state partnership that has existed since Medicaid was created more than 50 years ago.”

Blanca Castro,* director of advocacy for AARP California, said the House-approved health bill would weaken Medi-Cal and drive up health care costs dramatically for people over 50.

“We need to do everything we possibly can as Californians and as voters and engaged citizens to try to prevent the repeal of the Affordable Care Act (President Obama’s signature health care law),” she said. “We are hopeful and we’re not giving up. We’re not talking about this as if it’s happening, we’re talking about this as it can’t happen.”

While the proposals have generated concern for seniors across the board, advocates are particularly concerned about the potential effects on people ages 50 to 64. This population makes up 12 percent of Californians who buy health insurance on the individual market. The AHCA would allow insurance companies to charge this age group five times more than what other people pay for the same coverage. It also reduces tax credits to help pay for premiums.

To exacerbate the situation, Trump’s budget proposes a $72 billion cut to disability benefits. The health care bill could also allow states to waive mandatory coverage of certain health care services, and protection from premium hikes for people with pre-existing conditions.

Burns said all these changes together could drive 50 to 64-year-olds into poverty before they even reach retirement age, particularly in California with its notoriously high cost of living.

“It may make them poor for the rest of their lives,” she said.

Taken together, the AHCA provisions and Trump budget represent a multi-pronged affront on seniors, said Anthony Wright, executive director of the advocacy group Health Access California.

“If you really wanted to make things intentionally worse for older people in health care, you could not design a better set of policies,” he said. “It’s multiple polices that, each one, make it worse for older Americans.”

*The story has been updated to correct an error in identifying Blanca Castro.