The Republican plan to replace the Affordable Care Act hit a wall of fierce conservative opposition on Tuesday, less than a day after it was introduced.

The American Health Care Act is already being denounced by many influential conservative groups and is meeting widespread skepticism among Republicans on Capitol Hill.

Major rightwing advocacy organizations rushed to denounce the legislation. The Club for Growth president, David McIntosh, said the group, which keeps scorecards of how Republicans vote on certain key issues, would downgrade Republicans who support the House bill: “If this warmed-over substitute for government-run healthcare remains unchanged, the Club for Growth will key vote against it.” FreedomWorks dubbed it “ObamaCare Lite”, using another name for the Affordable Care Act.



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The concerns of the right-wing outside groups about the bill are shared by many conservatives on Capitol Hill, putting the future of the proposed legislation in immediate doubt - Republicans can’t have more than two defectors in the Senate and 21 in the House if the legislation is to pass.

The bill would eliminate the individual mandate, which requires Americans to have health insurance or pay a fine; cut the number of people insured under Medicaid; and allow insurance companies to charge the elderly up to five times more than the young. It would require insurers to cover so-called pre-existing conditions, but would allow them to add a 30% surcharge to premiums if people go without insurance for too long.

On Capitol Hill, many Republican senators were wary about commenting in detail and insisted to reporters that they hadn’t read it. Pat Roberts of Kansas, would not even say if he thought the bill was on the right track. “It’s on some track,” he said. Roy Blunt of Missouri was also skeptical about the bill’s prospects of success. “I’m going to be very anxious to hear how we get to 51 votes and how the House gets to 218,” said the former House Republican whip, referring to the number of votes needed to pass the bill.

Conservatives opposed to the bill present a major challenge for the bill’s prospects. Intransigence from the right has plagued leadership in both houses of Congress for over a half-decade and there is no indication that they would become more accommodating under a Republican president. “Do we need to lower the bar about what we believe in as conservatives simply because a Republican is now in the White House?” asked congressman Mark Sanford of South Carolina.

At a press conference, some conservative lawmakers said they saw the proposed bill as a framework for negotiation and not a take it or leave it proposal. Sanford described it as “an opening bid” for conservatives to counter and Rand Paul, the Kentucky senator, saw considerable negotiating power for conservatives if they stuck together and denied the current proposal from reaching a majority in either chamber.

Mark Meadows of North Carolina, the leader of the hard right Freedom Caucus in the House, told reporters that the message he was given by vice-president Pence is that they were “still open for negotiation and certainly for modification” on the bill.

Representative Jim Jordan of Ohio derided it as “Obamacare in a different form” and warned that many of its provisions were not consistent with Republican pledges to repeal and replace Obamacare. Jordan in the House, along with Paul in the Senate, will introduce an alternative bill on Wednesday that will represent a clean repeal of Obamacare rather than any attempt at modification. A bill repealing Obamacare passed both chambers of Congress in 2016 but was promptly vetoed by Obama.

Other Republicans were skeptical for narrower policy reasons. Four members of the Senate GOP caucus insisted that unless changes were made to the draft bill’s provisions to roll back the expansion of Medicaid, they could not support it. Senators Rob Portman, Shelley Moore Capito, Cory Gardner and Lisa Murkowski published a letter that warnedthe proposal “does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.”

Senator John Thune of South Dakota, the third ranking Republican in the Senate, conceded that his party is divided on how to replace the law, but said he expects the bill will eventually pass both chambers.

“Everybody right now is trying to leverage their position – help shape and influence the bill in the shape and direction they want to see it go before it is ultimately voted on. But when push comes to shove... it’s going to be a vote for the status quo or a vote to repeal this and to move to a better way.”

House speaker, Paul Ryan insisted the healthcare bill would earn enough support to pass the House.

Facebook Twitter Pinterest Paul Ryan holds a copy of the new healthcare bill introduced by Republicans. Photograph: UPI / Barcroft Images

“This is the beginning of the legislative process; we’ve got a few weeks,” Ryan said. “We will have 218 when this thing comes to the floor; I can guarantee that.”

Republican leadership in the Senate wholeheartedly backed the bill. The Senate majority whip, John Cornyn, warned his colleagues: “I think every senator, every congressman, needs to ask themselves the question, ‘Did you run on repealing and replacing Obamacare or not?’ And if you did, is it important to keep your promises? And to me, it’s not a whole lot more complicated than that.”



A glossary of key terms in US health care policy Co-pay

Out-of-pocket expenses ​for ​paid by patients for doctors’ visits, drugs or procedures. Deductible Amount a patient must pay out of pocket for prescriptions or healthcare before their insurance coverage kicks in. Healthcare exchanges The name for state insurance marketplaces created under the Affordable Care Act. Individuals shopping for health insurance can see what subsidies they may qualify for and sign up for a plan. ​But in some areas shoppers face a lack of options. ​ Individual mandate A penalty for people who don’t carry health insurance policies. ​As such it’s unpopular. But it’s also the linchpin to the Barack Obama health care law; w ​Without it, not enough healthy people would carry insurance to make a market. Medicaid A joint federal and state program that helps with medical costs for some people with limited income and resources. ​One of the largest payers for healthcare in the United States, with 70m enrollees. Spending accounted for 10% of the federal budget in 2015. Established by the Social Security Act, signed into law in 1965. ​ Medicare A federal health insurance program for people who are 65 or older, certain younger people with disabilities and others. ​The biggest public health care program by cost ($540bn in 2015, or 15% of the federal budget) with an enrollment of about 57m. Established by the Social Security Act, signed into law in 1965. ​ Premium If you need insurance, this is what it will cost you. The premium is a periodic payment for health or prescription drug coverage. Single-payer A pie-in-the-sky (for America) system in which a single payer, the government, would pay all health bills. Could that possibly work? The UK’s NHS is exhibit A. –Tom McCarthy

Senate majority leader Mitch McConnell called the bill a “dramatic improvement from the status quo” and said he anticipates the Senate will take up the bill before mid-April if the House is able to pass it in the next few weeks.

The White House has also come out wholeheartedly behind the legislation. In a tweet on Tuesday morning, Donald Trump described it as “our wonderful new Healthcare bill”.

In the afternoon, he further praised the bill while meeting at the White House on with the congressional whips assigned to rally support. “I am proud to support the replacement plan released by the House of Representatives,” Trump said. “It follows the guidelines I laid out in my congressional address.”

And in the evening, he targeted Rand Paul for his skepticism about the proposed bill. Trump tweeted: “I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!”

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Vice-president Mike Pence, emerging from a lunch with Senate Republicans, said the repeal-and-replace legislation is “the framework for reform” of the nation’s healthcare system, while also disclaiming that he is open to “improvements” and “recommendations”.

Dismissing criticism of the bill by members of the Republican party, Pence predicted that Republicans would eventually rally around it.

There was also a wall of opposition from Democrats. Branding the new bill “Trumpcare”, they argued that by eliminating minimum coverage for health plans and decreasing the availability of tax credits, the plan would drive up insurance costs for average Americans by at least $1,000 a year and see 15 million squeezed out of insurance policies.

Speaking on the Senate floor, Chuck Schumer, the Democratic minority leader, said: “After seven years of talking about the same thing over and over again, you’d think the Republicans would have been able to come up with a better plan than this.”

Schumer added: “Trumpcare will make health insurance in America measurably worse in just about every way and likely leave more Americans uninsured. It does, however, greatly benefit the very wealthy and special interests.”

“Well, Trumpcare is here, and you are going to hate it,” Senator Chris Murphy of Connecticut told reporters. “This is a dumpster fire of a bill that was written on the back of a napkin behind closed doors because Republicans know this is a disaster.”