It’s the job of Sen. Dick Durbin, D-Illinois, as the Senate minority whip to know where every member of his caucus stands on major pieces of legislation. When it comes to the American Health Care Act (AHCA), the Republican-sponsored plan to repeal and replace the Affordable Care Act (ACA), he said to HealthExec “no” Democrats in the chamber would support the bill as-is.

What about the 10 Democratic senators from states which President Donald Trump won and are up for re-election in 2018? They’re all still no votes on the AHCA, Durbin reiterated.

Their opposition would match that of many major medical organizations, which Durbin mentioned at a press conference at the Chicago chapter of cancer patient support group Gilda’s Club. Groups like the American Medical Association are actively opposing the proposal because of its projected impact: 24 million more people without insurance by 2026.

Within his own state, Durbin said hospitals and providers are most concerned about rolling back the expansion of Medicaid and how it could affect access to care in rural areas.

“They struggle to survive and it’s important they survive because they’re basically the kind of care centers that you don’t find for 10, 20, 30, 40, 50 miles. So they need to have something... to protect critical-access hospitals.” Durbin said.

The Illinois Hospital Association has said the state would lose up to $40 billion in Medicaid funding over the next decade under the AHCA. With that drop would come a rise in uncompensated care costs and eventually, cutbacks in staff, since the IHA said 40 percent of the state’s hospitals are either losing money or operating on thin margins.

While the bill and Trump’s proposed budget don’t make changes to Medicare, there is concern the AHCA will lead to ones down the road.

“Specifically, we’re concerned that the American Health Care Act will weaken the fiscal sustainability of Medicare and would open the door to what are called vouchers,” said AARP Illinois Director Bob Gallo. AARP had been among the groups opposed to the bill because of the increased costs for insurance it would bring to those just below Medicare age, as it allows insurers to charge people between the ages of 50-64 up to five times as much as younger customers.

Durbin said he and other Democrats are open to discussing healthcare reforms “if (Republicans) are willing to take (ACA) repeal off the table.” When asked by HealthExec if any element from the AHCA is worth considering, Durbin said changes to the ACA should try to address rising pharmaceutical costs.

“Blue Cross Blue Shield came to see me, and in Illinois, they are spending more money on paying for pharmaceuticals than for inpatient hospital care,” Durbin said. “So am I willing to sit down with Republicans or anyone to find some way to have a sensible policy on pricing in pharmaceuticals? Count me in.”