"These are the conservative solutions we campaigned on and these are the conservative solutions the American people asked us to deliver," Trump said at a National Republican Congressional Committee fundraiser Tuesday night.

Funding limits in the bill could result in 14 million people losing Medicaid coverage in a decade, according to an earlier CBO analysis. At least five Republican governors have said the caps, where much of the proposal’s estimated cost savings come from, could harm beneficiaries of the joint federal-state program, which also covers nursing home care for many people.

Unnerved investors

“The American Health Care Act shifts significant financial risk and cost from the federal government to states without providing sufficient flexibility,” Michigan Governor Rick Snyder said in letters sent to each member of his state’s Washington delegation. “While reforming the nation’s health care system is vital, it is imperative that gains in health coverage and access to care are maintained.”

The cuts are unnerving health-care investors, too. Hospital stocks swooned Tuesday amid concerns that an increase in the number of uninsured patients could stick hospitals with more unpaid bills. Community Health Systems Inc. lost 7.7 percent to $8.22 at the 4 p.m. close in New York, while Tenet Healthcare Corp. slumped 6.2 percent to $16.44. Major lobbying groups for hospitals and doctors, such as the American Medical Association and the American Hospital Association, also oppose the overhaul.

“It’s hard to be supportive seeing the size of cuts,” Jeff Myers, chief executive officer of Medicaid Health Plans of America, said in an interview. “It does call into question whether those services can be provided or whether states are going to see massive disruption.”

Myers said the current bill would do harm, and his group supports moving Medicaid over time to per-capita caps, a more limited form of funding that’s an option in the AHCA. Members include Aetna Inc., UnitedHealth Group Inc., Centene Corp. and Cigna Corp.

Paying customers

“We agree that the Medicaid program is not sustainable financially over time,” he said. “We want to make sure that any financial restructuring be done in a way that doesn’t destabilize our state partners or create problems for enrollees.”

Although many large insurers have quit offering plans in the ACA’s individual markets because of financial losses, the bill could still cost the companies millions of paying customers. On the other hand, it also offers insurers tax cuts.

America’s Health Insurance Plans, the industry’s main lobbying group, has praised the proposal for steps it says would increase stability in the individual market. The bill should do more to help the poorest stay covered, and its Medicaid funding formula “could result in unnecessary disruptions in the coverage and care beneficiaries depend on,” according to an AHIP statement on Tuesday.

The group wants to keep working with lawmakers to “make sure affordable coverage options are available for all consumers, especially those with low incomes or who rely on Medicaid,” according to the statement.

Coverage concerns

The Blue Cross Blue Shield Association, which represents health insurers that offer coverage under that brand, recommended in a March 7 letter that lawmakers ensure Medicaid payments are adequate to cover costs, “so that states can properly invest in Medicaid improvements such as adoption of managed care.”

The Alliance of Community Health Plans, whose members include Kaiser Permanente and other insurers that are linked with their own doctors and hospitals, said it’s concerned about widespread coverage losses.

“More work needs to be done to ensure there is adequate financing for our most vulnerable, hard-working Americans,” the group said in a statement.

Some conservative groups are also opposed, including Heritage Action and Americans for Prosperity, which tweeted “without major changes, we’ll key vote against it & stand with those that stand with us.” The U.S. Chamber of Commerce said it supports the repeal bill.

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