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Make no mistake. The Obamacare repeal-and-replace bill speeding through the U.S. Senate toward an expected July vote is less a health reform bill than a major overhaul of one of the nation’s most vital safety net programs: Medicaid.

This popular program, jointly funded by the states and the federal government, provides medical care for more than 30 million children and pays for the bulk of long-term care for the elderly and disabled. Along with Social Security and Medicare, the federally run medical care program for seniors, Medicaid represents the conscientious commitments made by this country to protect its most vulnerable citizens.

Yet politicians who wouldn’t dare touch Social Security or Medicare for fear of political backlash are now moving furtively to weaken the Medicaid program. The American Health Care Act passed by House Republicans last month calls for $834 billion in cuts to the program and, more alarmingly, permanent caps on federal funding that would shift more of the financial responsibility of paying for the program to ill-prepared states. The caps in particular show how the Republican bill is more than just rolling back Obamacare’s Medicaid expansion.

While text for the Senate Republicans’ bill has not been released, reports indicate that Medicaid is still in the political cross hairs. It is an outrage that the text of the bill has not yet been made public. The rush job and secrecy amount to congressional malpractice. Tinkering with Medicaid without public hearings or input should alone be reason to vote against the bill, especially when the nation’s leading medical provider groups oppose the legislation.

Minnesota’s two senators, both Democrats, are not expected to vote for this harmful legislation. But families who depend on Medicaid in neighboring states could well have their Senate representatives cast a party-line vote in favor of the bill. South Dakota and Iowa each have two Republican senators; North Dakota and Wisconsin each have one.

That’s troubling when the Medicaid data show how important the program is to Upper Midwest states.

In North Dakota, 1 in 4 children are covered by Medicaid, as well as 1 in 3 disabled people and 1 in 2 nursing home residents. In South Dakota, 1 in 3 children get care through Medicaid. So do 50 percent of nursing home residents and 40 percent of those who are disabled.

In Iowa, Medicaid covers 40 percent of children and 40 percent of those with disabilities, as well as half of nursing home residents. In Wisconsin, 60 percent of nursing home residents depend on Medicaid. So do 1 in 3 Wisconsin children and 1 in 2 Wisconsin citizens with disabilities. (In Minnesota, it’s 1 in 4 children and half of nursing home residents and people with disabilities.)

It is cynical at best to say that a phased-in approach to Medicaid changes — an approach the Senate is reportedly considering — will be less harmful. The destination is the same: a weaker Medicaid program less able to help families. Saying that federal budget concerns demand Medicaid reductions is laughable. Most of the savings would go to fund tax cuts for industry and the wealthy.

The Senate was supposed to be the backstop for the House’s thoughtless health care legislation — a bill that the Congressional Budget Office said would leave 23 million fewer people insured than the Obama reforms. Iowa’s Chuck Grassley and Joni Ernst, South Dakota’s Mike Rounds and John Thune, Wisconsin’s Ron Johnson and North Dakota’s John Hoeven should be among those counseling caution and care. It is sadly unclear at this point where they stand.