"It is deeply disappointing to many Americans that, in modifying the American Health Care Act to again attempt a vote, proponents of the bill left in place its serious flaws, including unacceptable modifications to Medicaid that will endanger coverage and affordability for millions of people," said Bishop Frank J. Dewane of Venice, Florida, chairman of the bishops' Committee on Domestic Justice and Human Development.

Sister Carol Keehan, president and CEO of the Catholic Health Association, similarly said an amendment to the legislation was "a giant step backward that should be resisted," noting that it would "take significant funding allocated by Congress for health care for very low-income people and use that money for tax cuts for some of our wealthiest citizens."

The proposed amendment to the health care legislation was approved by the House Freedom Caucus April 26, a group of conservative representatives who rejected the House plan to repeal President Barack Obama's Affordable Care Act in March when it was withdrawn by House Republicans because it fell short of the necessary votes for passage.

Changes to the bill were introduced by Rep. Tom MacArthur, R- New Jersey, who co-chairs the Republican caucus known as the Tuesday Group, along with Rep. Mark Meadows, R- North Carolina, Freedom Caucus chairman.

The amendment leaves in place some of the ACA mandates but also says that states can be granted waivers to eliminate minimum insurance requirements, such as maternity care coverage and mental health treatment, if they can prove their premiums will go down and more people will get insurance.

Sister Keehan, a Daughter of Charity, said changes to the bill, "intended to make it more palatable to those who did not support it initially, are even more disastrous for people who have just gotten health care."

In an April 26 statement, she also said these changes "would seriously undermine health security and leave many individuals with substandard protection" because they would take away protections for people with pre-existing conditions and allow insurers to set annual and lifetime caps on the care they cover.

Bishop Dewane, in an April 27 statement, said the proposed changes designed to give states flexibility "lack apparent safeguards to ensure quality of care" and could "severely impact many people with pre-existing conditions while risking for others the loss of access to various essential coverages."

Sister Keehan heads an organization of more than 600 hospitals and 1,400 long-term care and other health facilities in the United States. She was consulted multiple times on the drafting of the ACA, which was signed into law seven years ago. In a previous interview, she told Catholic News Service that the health care law is "far from perfect," but to its credit, it provided 20 million Americans insurance who had previously been uninsured.

She said the efforts to repeal the ACA have been "crafted largely behind closed doors, with almost no input from providers of health care." As she sees it, both political parties should work together to make improvements to the proposed legislation and work to strengthen gains made by the ACA.

When the ACA was being drafted, some Catholic organizations opposed key elements of the measure and since it became law, more than 40 lawsuits have been filed to challenge the subsequent Department of Health and Human Service's mandate requiring that insurance plans include coverage for artificial birth control, sterilization and drugs that lead to abortion.

In a March 17 letter to House members about the AHCA, Bishop Dewane said the inclusion of "critical life protections" in the House health care bill is laudable, but other provisions, including those related to Medicaid and tax credits are "troubling" and "must be addressed."

"The ACA is, by no means, a perfect law," Bishop Dewane said in his letter. "The Catholic bishops of the United States registered serious objections at the time of its passage. However, in attempting to improve the deficiencies of the ACA, health care policy ought not create other unacceptable problems, particularly for those who struggle on the margins of our society."

In his current statement, the bishop warned that the AHCA, as it now stands, "creates new and grave challenges for poor and vulnerable people, including immigrants. The House must not pass the legislation as it is. Members should insist on changes, especially for the sake of those who are struggling in our communities."