Linda Lundergan Morenz, MD, MPH, is a staff physician at the Campus Health Service for the University of Arizona. Anna Morenz is a third-year medical student at Harvard Medical School.

Pre-existing conditions are more common than many folks imagine — that inhaler you use when the pollen counts are high, that pill you take for “a little bit of high blood pressure,” and the chronic back ache that you see the chiropractor for “every now and then.” Or more seriously, cancer, either in treatment or remission, diabetes, or heart disease. Even something you saw a physician for but then decided not to treat is a pre-existing condition.

Pre-existing conditions affect 20 percent to 50 percent of Americans under age 65, according to the U.S. Health and Human Services Report of 2011. But the Affordable Care Act, or colloquially, “Obamacare,” improved the outlook for people with these health issues by making insurance possible at no additional charge – suddenly insurance companies could no longer “lemon drop” patients who might be costly.

The American Health Care Act (AHCA) recently passed by the House threatens these protections. It was hastily passed before the Congressional Budget Office (CBO) scored its impact. That score came out May 24, and the news is not good. In states that adopt a waiver of Obamacare’s protections for people with pre-existing conditions, insurance companies could charge considerably more. The CBO concluded that “People who are less healthy (including those with pre-existing or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under (the AHCA) to help reduce premiums.”

Another target of the House bill is Medicaid. Who is served by Medicaid? Children make up 50 percent of the Arizona Medicaid population and two-thirds of the costs of Medicaid come from services for the disabled or the elderly. That special needs child on your block is probably getting Medicaid support. Medicaid is often paying for your friend’s elderly grandmother who is in assisted living or receives home assistance.

Arizona’s decline in the number of uninsured from 18 percent of our state to 11 percent under Obamacare is partly due to the Medicaid expansion for low-income persons. The CBO estimates that nationally 23 million more people would be uninsured after 10 years with the House bill than under our current system. Over half of those imperiled would come from the bill’s $834 billion in cuts to Medicaid. States such as Arizona, which expanded Medicaid, would be hit especially hard. The AHCA imposes caps on federal Medicaid dollars: as health care costs and the number of residents in need increase, the states will be forced into hard choices resulting in a decrease in services, a decrease in the number of patients cared for, and increased wait times.

So, as is becoming too familiar a tale: our low-income, most marginalized citizens, including the chronically ill, the elderly and the disabled, will be those most adversely impacted. But also, the relatively healthy, pegged with the “pre-existing condition” label for using an inhaler in the springtime, could be impacted. The Center for American Progress estimates that 460,000 Arizonans would lose their coverage within the next 10 years if the AHCA becomes law, half of them because of Medicaid cuts. It is unacceptable and unjust for Arizona to lose ground on this progress.

The Senate has announced that they are crafting their own bill. So far there have been no committee hearings seeking input from professional or patient organizations and no whisper of the bill’s content. Arizona Senators John McCain and Jeff Flake, we expect you to protect Arizonans. We need a bill that will continue to improve, not degrade, our uninsured rates — one that will protect, not imperil, persons with pre-existing conditions, that will preserve Medicaid, and that will make health care a human right, not a luxury.

Linda Lundergan Morenz, MD, MPH, is a staff physician at the Campus Health Service for the University of Arizona. Anna Morenz is a third-year medical student at Harvard Medical School.