The exact number of people who would lose care under the bill is unknown; Republicans have indicated that they will not wait for a score from the nonpartisan Congressional Budget Office. But it is not difficult to see that the effects would be vast. In his letter to the Senate, the president of the American Medical Association, James Madara, wrote that the bill would destabilize insurance markets and decrease access to affordable coverage and care. He expressed particular concern over the loss of small-business tax credits, cost-sharing reductions, and the replacement of current Medicaid expansion with “inadequate” grants (which would phase out entirely by 2026).

Over the course of 2017’s string of hasty Republican bills, the rhetoric of these organizations has escalated. Physician groups have actively implored their members to reach out to legislators directly. This week, the AMA wrote that doctors cannot support the bill as it “violates the precept of ‘first do no harm’”—a guiding tenet of the profession.

This is a call for the entire profession to clarify its fundamental principles, and to recognize where policies are doing harm, and to engage with the political system in a way consistent with the ethos of being a doctor.

These groups are not historically liberal—not progressive idealists who demand universal coverage. The AMA has been critical of the Affordable Care Act, and this week asks only that Congress “work in a bipartisan, bicameral manner to increase the number of Americans with access to quality, affordable health insurance.” Similarly, the mental-health professionals wrote, “the APA is ready to work with members of both parties to craft a bipartisan solution that stabilizes the health-insurance market and ensures Americans have access to quality, affordable health care.”

A bipartisan approach had seemed like the next step. Even Mitch McConnell had said it was time to involve Democrats in drafting a bill. Recall the Senate majority leader standing on the Senate floor in the early morning hours of July 27. “This is clearly a disappointing moment,” he said, pausing to find the next words after John McCain had marched in and pointed his thumb to the floor, ending the third attempt to unilaterally pass a health-care bill with no input from Democrats.

“From skyrocketing costs to plummeting choices and collapsing markets, our constituents have suffered through an awful lot under Obamacare,” McConnell said, echoing what has been the Republican narrative for the last eight years: The only solution is to repeal the law and start over. But he then let slip an unprecedented concession, that he was open to a bipartisan deal.

“I imagine many of our colleagues on the other side are ... pretty happy about all this,” he said. “So now I think it’s appropriate to ask: What are their ideas? It’ll be interesting to see what they suggest as the way forward.”