Even if a watered-down version of House Republicans’ health-care legislation becomes law, states are probably going to be on the hook for billions of dollars of health-care costs, especially for the poor and sick. And that means they’re going to have to make some hard choices: Do you find a way to raise taxes/cut other services to keep your most vulnerable population insured? Or do you just stop insuring them?

That’s the heart of the question facing all 50 states as Republicans in Washington unwind the federal government’s involvement in health care. Legislatures trying to answer it could get ugly.

States just don’t have the money right now to make up for the health insurance subsidies the federal government could cut back on. Thirty-one states started 2017 with deficits – a couple are closing in on $1 billion, according to a MultiState Associates study.

But the House Republicans’ health-care plan would whack almost every state’s budget in potentially big ways:

“We’ll have a crisis for states as they confront this without a federal partnership,” said Judy Solomon, vice president of health-care policy for the nonpartisan Center on Budget and Policy Priorities.

Democratic- and Republican-controlled states seem split on what to do about it. In California, one of the most liberal states in the nation, Democratic lawmakers already think they’ll try to make up the cost for people who could lose their insurance under this plan. But trying to stretch out a safety net for those people could cost the state at minimum $20 billion, an amount that could wreck the state’s budget.

It’s still early, but as Washington barrels toward changing how involved it gets in health care, state leaders are just now grappling with what to do about it. And so far, there are no easy answers.