ST. PAUL — Minnesota officials are bracing for billions of dollars in additional health care expenses if congressional Republicans enact a plan they’re discussing to replace the Affordable Care Act, according to a draft document obtained by The Associated Press.

The planning document shows that the GOP proposal, a draft of which was circulated last week, would cut $1.3 billion next year from the state’s low-income health care program that covers roughly one-sixth of its 5.5 million residents. By 2021, the losses would accumulate to more than $5 billion, eventually costing the state $6 billion a year starting in 2029. That analysis was prepared by the state’s Department of Human Services, which runs those programs.

It illustrates the uncertainty states across the nation are grappling with over how President Donald Trump and Congress will reshape the health care law championed by President Barack Obama. And it provides one of the first concrete estimates of what the emerging GOP plan would cost a state that expanded Medicaid.

Some states fear that the final product will force states to choose between cutting popular health care programs for low-income residents or picking up far more of the tab. Democratic and Republican governors alike have expressed alarm about potential changes to Medicaid as members of Congress have faced backlash at town halls in their home districts.

The possibility that Minnesota could be on the hook for more federal costs is weighing heavily on some state lawmakers as they start assembling a new, two-year budget.

If the Medicaid changes were passed, a top Minnesota Democrat said it would undoubtedly trigger cuts to critical coverage for elderly and sick residents.

“We’re making promises we’re not going to be able to keep,” state Sen. Tony Lourey said Thursday.

Minnesota is one of 31 states — plus the District of Columbia — that participated in Medicaid expansion, a marquee part of Obama’s health care law that helped expand coverage to an additional 10 million low-income residents.

The draft legislation would end that expansion and reduce overall spending by providing states with a fixed, annual amount per recipient in response to Republican criticism that states currently have little incentive to keep expenses under control. Minnesota Department of Human Services Commissioner Emily Piper said that was a grave mistake, calling it “code for cuts to programs for the poor, elderly, and people with disabilities.”

The financial hit that states may face varies drastically based on how many residents are covered on Medicaid and to what extent the federal government currently covers those costs. In a letter last week, a group of seven Republican governors urged Trump and Congress not to shift the financial burden to states.