The American Hospital Association announced Tuesday its opposition to the GOP's healthcare reform plan.

The hospital association is the first health industry group to expressly come out against the legislation, dubbed the American Health Care Act, which House GOP leadership unveiled on Monday.

“We ask Congress to protect our patients, and find ways to maintain coverage for as many Americans as possible,” Richard Pollack, the president and CEO of the American Hospital Association, wrote in a letter to House Republicans.

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“We look forward to continuing to work with the Congress and the Administration on [Affordable Care Act] ACA reform, but we cannot support The American Health Care Act in its current form,” he said.

The letter comes as many health industry groups have issued tepid responses to the bill or stayed silent altogether, while a number of conservative lawmakers and groups have come out in opposition to the GOP proposal in its current form.

The Trump administration and House Republican leaders were on defense Tuesday, the first full day of pitching their plans for health reform.

While opponents have pounced on different parts of the proposal, a sticking point has been a provision that would strike funding for states to expand Medicaid beyond 2019.

Pollack referenced the proposal in his letter, while Republican lawmakers on Capitol Hill from states that have opted to expand the program have called the proposal a non-starter.

Hospitals are further concerned with elements of the bill that give relief to other industries — largely through eliminating taxes imposed by ObamaCare — but offer no help for them.

Items like the tax on tanning salons, medical devices and an overall tax on healthcare plans have been scrapped entirely. But the GOP proposal leaves in place a reduction in Medicare payment levels for hospital services.

“If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured Americans,” Pollack said.

Early estimates have shown that, under the Republican plan, fewer Americans would be covered by health insurance. One preliminary analysis by rating agency Standard & Poor’s found as many as 10 million people could lose their coverage.

Changes to Medicaid top the list of concerns, including how the federal health insurance program for low-income individuals is funded.

The proposed restructuring refers to a GOP proposal to shift the funding of Medicaid, the government insurance program for low-income individuals.

Called a “per capita cap,” it would shift from a system where the federal government pays for the entirety of medical bills for a person on the program to one in which states would receive a set amount per Medicaid enrollee.

The effort, Pollack argued, will shortchange a program that already doesn’t provide enough funds to cover the actual cost of providing care.

He suggested other alternatives, such as greater use of federally approved waivers, which have given states a method to test out different ways to implement Medicaid that maintain the program’s objectives but do not follow federal rules.

“The expanded use of waivers with appropriate safeguards can be very effective in allowing state flexibility to foster creative approaches and can improve the program more effectively than through imposing per-capita caps,” Pollack said.

Pollack asked Congress to wait for the Congressional Budget Office (CBO) to score and release estimates on how many individuals the GOP version would cover before moving the ball forward.

A CBO score would provide a “level of analysis and needed transparency,” Pollack wrote to members of the House. “We urge that Congress should wait until an estimate is available before proceeding with a formal consideration.”

“We believe that any changes to the [Affordable Care Act] must be guided by ensuring that we continue to provide health care coverage for the tens of millions of Americans who have benefitted from the law,” he said in the letter. “We are pleased that so many in Congress also recognize the need to preserve patient coverage.”

“We believe the legislation needs to be reviewed through this lens, and carefully evaluated regarding its impact on both individuals and the ability of hospitals and health systems which are the backbone of the nation's health care safety net in terms of our ability to care for all of those who walk through our doors,” Pollack added.