The initial reaction to the American Health Care Act (AHCA), the legislation to repeal and replace the Affordable Care Act (ACA) introduced by Republican leaders in Congress and supported by President Donald Trump, is negative across several major medical organizations, including the American Medical Association and the Federation of American Hospitals.

The AMA called the bill “critically flawed,” saying while the ACA was “imperfect,” the organization supported its goal of increasing health insurance coverage. The Republican bill, wrote AMA President Andrew Gurman, MD, would do the opposite.

“As drafted, the AHCA would result in millions of Americans losing coverage and benefits,” Gurman said in a statement. “By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive—if not out of reach—for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written.”

Gurman opposed a number of the bill’s provisions, including rolling back the Medicaid expansion, repealing the Centers for Disease Control and Prevention’s Prevention and Public Health Fund and eliminating Medicaid funding from Planned Parenthood.

Some groups were more measured in their criticism. The American Hospital Association, for example, repeated many of the same concerns, but concluded its letter to Congress by saying it “recognizes this measure represents the first step in a process.”

Of all the medical groups commenting on the legislation, none said it would support the bill as written.

America’s Essential Hospitals said, while it appreciates the legislation’s move to restore cuts to Medicaid disproportionate share hospital (DSH) payments, the per-capita caps on Medicaid would lead to public and nonprofit hospitals “scaling back services and eliminating jobs.” The American College of Physicians said the proposed 30 percent surcharge on customers who lose coverage for 63 days or more would harm patients with pre-existing conditions.

All the above groups advised the House to slow down the process of moving the legislation through Congress. Committees won’t be waiting for a report from the Congressional Budget Office on the bill’s impacts on the federal budget and insurance coverage. Without that CBO score, “there are too many unknowns,” according to America’s Essential Hospitals President and CEO Bruce Seigel, MD, MPH.

Beyond industry opposition, the bill is being also bashed by conservative groups previously allied with House Speaker Paul Ryan. According to POLITICO, groups like the Heritage Foundation and the Cato Institute came out against the legislation.

Some said provisions of the bill, like the 30 percent charge for not maintaining continuous coverage, could create the very situation that Republicans have claimed necessitates the repeal of the ACA.  

“Once you create that rule, you create a different incentive structure—people who are healthy have an incentive to stay uninsured, and people who are very sick have an incentive to pay the 30 percent penalty,” said Avik Roy, president of the Foundation for Research on Equal Opportunity, who called the charge a “recipe for adverse selection death spirals.”