In an unprecedented move, three of the country’s largest medical organizations demanded on Thursday that President Trump declare the coronavirus outbreak a national emergency.

The letter to Vice President Mike Pence from associations representing the country’s hospitals, nurses, and doctors asked that Trump declare a national emergency under the 1988 Stafford Act, which frees up resources and cash for states to more effectively respond to the crisis.

Trump’s ongoing refusal to make the declaration has stunned and frustrated state officials either struggling to contain or planning for inevitable outbreaks of the highly contagious respiratory disease. Politico reported on Wednesday that Trump did not want to declare an emergency for fear of contradicting his earlier statements that the virus was similar to the seasonal flu, and that he had instructed son-in-law and adviser Jared Kushner to research the issue.

The fact that health care providers felt that it was necessary to send the letter underscores the need for a declaration.

The letter emphasizes that an emergency declaration is needed to to allow states to petition the Department of Health and Human Services to make changes to their Medicaid programs to respond to outbreaks, known as section 1135 waivers.

Washington State’s top public health official told TPM on Tuesday that the state needed a 1135 waiver to alleviate hospitals overflowing with coronavirus patients, while North Carolina’s Medicaid director told TPM on Thursday that the state’s plans for responding to an outbreak hinged on receiving a 1135 waiver.

The medical associations said in the letter that issuing a declaration would “provide the support we need in our collective mission to support the well-being, health and safety of patients by allowing flexibility at a time when it is needed most.”

The American Hospital Association, American Nurses Association, and the American Medical Association authored the letter.

“It is of upmost importance that any concerns about costs for testing and care be removed so that individuals can be screened and if necessary treated,” the letter reads. “Medicare and Medicaid programs, as well as commercial payers, have agreed to cover screening and treatment for COVID-19. While not part of waivers that can be implemented by HHS, we ask for federal assistance in covering costs for the uninsured, consistent with responses to several previous emergencies and natural disasters.”