WASHINGTON -- Repealing and replacing Obamacare was always going to be a messy, combative, internecine battle. And that's what it has become.
As House Speaker Paul Ryan's blueprint headed into the two legislative committees this week for its preliminary fine-tuning, the bill came under fierce attack from a host of opponents: Democrats, of course, but also conservatives, the health insurance industry, free-market forces and the American Hospital Association, to name a few.
To be sure, Ryan's American Health Care Act (AHCA) had a lot of good things in it. Gone was the federal government's oppressive mandate requiring all Americans who do not have health coverage to pay a stiff penalty.
Also eliminated: the employer mandate on large- to mid-sized businesses to offer health insurance benefits, and insurance premium subsidies for moderate- to low-income people, which would end by 2020.
In place of the Obamacare subsidies would be income-based refundable tax credits. That would be one of the tax code's largest and most expensive tax breaks, swelling the budget deficit.
Here's what the Club for Growth, a hard-core, free-market campaign finance group, said about the AHCA:
"The problems with this bill are not just what's in it, but also what's missing: namely the critical free-market solution of selling insurance across state lines," said Club for Growth President David McIntosh.
"Such an injection of competition would lead to hundreds of billions of dollars in savings, nullifying any argument by congressional Republicans that this provision cannot be included in the current bill," McIntosh said. "Republicans should be offering a full and immediate repeal of Obamacare's taxes, regulations and mandates, an end to the Medicaid expansion, and inclusion of free-market reforms, like interstate competition."
What's also missing from the GOP's reform plan is any estimate of its cost to taxpayers, to the uninsured and to the health care industry. That's because the Republicans are moving ahead on the legislation at warp speed without running its provisions through a full-scale accounting by the nonpartisan Congressional Budget Office.
"What this bill needs is some extreme vetting," said Rep. Lloyd Doggett of Texas, who unsuccessfully sought a week's delay in the tax-writing Ways and Means panel to study CBO's budget projections. That vetting, presumably, could come sometime next week or even later.
A key factor in the growing opposition to the bill was its provision to end Medicaid as an open-ended entitlement program offering matching federal funds to the states. And that issue is one of the driving forces that could doom it in the Senate.
As things stand now, at least four GOP senators are against the House bill: Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah, who say they want a more complete repeal of Obamacare, and Susan Collins of Maine, who said the House bill would "not be well received" in the Senate and stands no chance of passing.
Another powerful opponent of the bill is the American Medical Association, one of the most influential medical lobbies in the country.
"We cannot support AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," said the AMA's chief executive officer, James L. Madara, in a letter to the House committee's leadership.
Some House leaders said they were "shocked" that so many of the nation's health care associations have come out against the bill. But they shouldn't have been.
The pair of bills was rushed through the drafting process over a mere few weeks, behind closed doors, with not a lot of consultation with national health care groups.
"It doesn't seem like the industry got any heads-up or was involved. We definitely were not," said a spokesman for Molina Healthcare, which has about a million customers under Obamacare's exchanges.
This is why GOP Sen. Tom Cotton of Arkansas tweeted Thursday that House Republicans should "start over" and rewrite its reform bill.
"House health-care bill can't pass Senate (without) major changes. To many of my friends in the House: Pause, start over. Get it right, don't get it fast," Cotton wrote.
Reprimanding his party's leadership for its haste and "arbitrary" approach, he said the "GOP shouldn't act like Democrats did in O'care. No excuse to release bill Mon. night, start voting Wednesday. With no budget estimate!"
Republicans won back the White House and held on to the Congress by promising voters to repeal and replace Obamacare, not by promising "Obamacare Lite."