That's exactly what could happen if Republican leaders in Congress get their way. And that's just the risk for the Americans lucky enough to have health care coverage. For those Americans without coverage, the message is even worse.

There are 46 million Americans living without health insurance, and every day 4,000 more Americans fall into the ranks of the uninsured. With the costs for providing health care to employees skyrocketing, every day we hear stories of employees being laid off, benefits being reduced and other painful cutbacks. With these soaring costs, the number of small businesses offering their employees health care has dropped to less than 60 percent.

Congress can and must act to make affordable health care accessible to small businesses and all Americans, and we have a real opportunity to cross partisan lines and get the job done. But to do so, we have to meet our responsibility to protect consumers and not undermine hard-fought state protections already in effect.

Under the guise of helping small businesses, there's a movement in Congress to pass legislation that would ultimately strip away important state mandates that ensure affordable access for our most vulnerable citizens. They've taken doomed Association Health Plans and renamed them Small Business Health Plans.

No one should be fooled by this wolf in sheep's clothing; striking down decades of consumer-advocacy protections at the state level will prove to be a boon for the insurance industry, not small businesses and not the American people.

The fact that 49 states have already passed regulations on which health care benefits must be covered tells us something. They recognize that without these state-mandated benefits, insurance companies will have incentives to cherry-pick the youngest and healthiest workers to keep their costs down. Those most in need of health insurance will be left on their own with sky-high premiums.

It's for this reason that 39 state attorneys general have come out against the Republican plan. ``Allowing health insurers to abandon mandated benefits . . . will result in an increasingly ill population and higher health care costs as the health care system treats a growing number of consumers in crisis,'' they wrote in a letter to federal lawmakers.

In 2004, I argued that every American should have access to the same high-quality health care enjoyed by members of Congress. We can do that by providing small employers with the same benefit plans and premiums available to members of Congress and 8 million federal employees while still protecting every state mandate on the books. This would allow small businesses to get lower rates using the powerful negotiating clout of the federal government.

A real start for helping small businesses with the cost of health care premiums is to give those with fewer than 50 employees a refundable tax credit. And we should set reasonable rules on what insurers can charge so they can't price-out our most vulnerable citizens.

Affordable health care should be a right for all Americans, not a privilege for the elected and the connected. But in our eagerness to fix the problem, we cannot let America's hard-working entrepreneurs, our small-business owners, be used as a political pawn to move legislation that will put health care beyond the reach of the very people who need it most. It is time for Congress to address this problem with meaningful solutions, not empty sound bites. It is time to pass true small-business health reform.

JOHN KERRY of Massachusetts is the ranking Democrat on the Senate Committee on Small Business and Entrepreneurship. He wrote this article for Knight Ridder.