The second-largest health insurer in the U.S., Anthem, has come out in support of provisions in the Republican-sponsored replacement for the Affordable Care Act (ACA), going against the opposition expressed by the American Medical Association (AMA) and concerns from its own industry group.

In a letter to Republican leaders on the congressional committees that advanced the American Health Care Act (AHCA), Anthem President and CEO Joseph Swedish reiterated that without changes to the ACA exchanges, the insurer would have to “significantly extract” itself from the individual market next year.

Swedish expressed support for several AHCA provisions, like repealing the ACA’s health insurance tax, extending the law’s cost-sharing subsidies and allowing customers to receive tax credits for coverage purchased off the exchanges. He went a step further by openly expressing support for the bill overall.

“The American Health Care Act addresses the challenges immediately facing the Individual market and will ensure more affordable health plan choices for consumers in the short term, including through the expanded use of health savings accounts,” he wrote.

This is a more positive opinion than what other health insurers have offered. Molina Healthcare CEO Mario Molina said the legislation could “destabilize the marketplace,” and America’s Health Insurance Plans (AHIP), the trade group for which Swedish serves as its chairman, expressed concerns about the impact of basing the tax credits more on age than income and eliminating the individual mandate penalty for not buying insurance.

The Blue Cross and Blue Shield Association actually asked lawmakers to completely drop one provision: the 30 percent surcharge on premium for customers who allow their coverage to lapse for more than 63 days.

Outside of health insurers, reaction to the AHCA has been almost uniformly negative among major medical groups, with the AMA, American Hospital Association, the Federation of American Hospitals and the American College of Physicians opposing either all or most of the legislation.

As noted by POLITICO, which first reported on the letter, Anthem is still looking for federal approval for its $54 billion merger with Cigna, which had been successfully challenged in court on antitrust grounds in a case which began under the Obama administration.