Adding to opposition already expressed by physician and hospital groups, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) came out against the Graham-Cassidy legislation to repeal and replace the Affordable Care Act (ACA).

Both groups warned the bill, which replaces the ACA’s funding for insurance subsidies and Medicaid expansion funding with block grants and loosens waivers for essential health benefits, could reduce health insurance coverage and undermine protections for those with pre-existing conditions. BCBSA did say in its statement it supports the larger goal of “greater flexibility” for states in insurance regulations.

“Blue Cross and Blue Shield companies are committed to ensuring that all Americans have access to health insurance coverage and the peace of mind that comes with it,” the group said in a statement. “The current market is not working, and we will continue to work with lawmakers on a bipartisan basis to improve the individual insurance marketplace with the goal of making coverage more affordable and accessible for all.”

In a letter to Senate leaders, AHIP President and CEO Marilyn Tavenner said the Graham-Cassidy plan doesn’t meet its goals for fixing problems within the ACA, such as guaranteeing cost-sharing reduction subsidy (CSRs) payments to insurers or offering some mechanism to encourage people to maintain insurance coverage. The bill eliminates the CSRs and the individual and employer mandates.

Tavenner also referred to fears conservatives have expressed that the block grant funding to states could be used to set up state-run single-payer systems.

“To best serve every American, we need both a strong private market and an effective role for and partnerships with government,” she wrote. “Building on the choice, competition and innovation of the private sector and the strength, security and dependability of public programs is a far more effective solution than allowing states to eliminate private insurance.”

AHIP and BCBSA have been opposed to other repeal-and-replace efforts introduced by Republicans this year, though not as consistently as other healthcare groups like the American Medical Association and the American College of Physicians. The most significant support any of the plans enjoyed from within the industry did come from an insurer, however, when Anthem CEO and President Joseph Swedish supported the first version of the American Health Care Act.