By Noam N. Levey, KFF Health News When congressional Republicans pushed to repeal the Affordable Care Act and slash Medicaid in 2017, dozens of physician groups, patient advocates, hospitals and others rallied to defend the law and the safety-net program. Eight years later, however, two major indust ry groups have been notably restrained as GOP lawmakers consider sweeping new Medicaid cuts: the American Medical Association and the American Health Care Association, which represents nursing homes. At the same time, the two groups are lobbying Republicans as they seek support on other priorities. The AMA is lobbying lawmakers to reverse a nearly 3% cut in Medicare’s fees for physicians. And the AHCA has pushed Congress to roll back regulations enacted under President Joe Biden that mandate better staffing ratios at nursing homes. Representatives of the two groups declined to comment on the record about any connections between the Medicaid fight and their other legislative priorities. But AHCA spokesperson Rachel Reeves said the nursing home group, which has issued a statement defending Medicaid, is communicating with lawmakers about the importance of the program for people with low incomes and disabilities. “We will make sure that the voices of our community are heard and that the message is loud and clear,” she said. “Congress must protect our seniors who rely on Medicaid.” Medicaid is the primary payer for nursing home care, covering more than 6 in 10 nursing home residents. Nevertheless, other advocates and congressional Democrats said they’re frustrated by the two groups. “The time to speak out is now,” Sen. Ron Wyden, the senior Democrat on the Senate Finance Committee, told KFF Health News. “Americans will know which organizations stood up against harmful cuts to Medicaid when this fight is over.” Medicaid, a state-federal insurance plan that, together with the related Children’s Health Insurance Program, covers about 80 million Americans, is in the crosshairs as congressional Republicans seek to trim several trillion dollars in federal spending to offset the $4.5 trillion cost of extending tax cuts enacted in President Donald Trump’s first term. Medicaid cuts on the scale being contemplated would put coverage for millions of Americans at risk. That has alarmed advocates who work with people covered by the program, including children, Americans with disabilities and low-income older adults. Other advocacy organizations that work with these patients have been much more active. Earlier this month, for example, more than 400 pediatricians traveled to Washington, D.C., to speak to members of Congress about the importance of Medicaid. More than 100 leaders of safety-net hospitals that serve low-income patients around the country did the same. Patient advocates, such as the American Cancer Society’s affiliate Cancer Action Network, have defended Medicaid. Last month, state medical societies sent a letter to congressional leaders warning of dire consequences if Medicaid cuts are enacted. And last week, more than 750 members of the American College of Obstetricians and Gynecologists were in Washington, where the group lobbied to preserve Medicaid funding. “Slicing hundreds of billions of dollars from federal funding will force states to cut the care children and families depend on or raise taxes on hard-working Americans,” said Chip Kahn, chief executive of the Federation of American Hospitals, another trade group fighting to defend Medicaid. Building coalitions was critical in previous health care debates, said Ron Pollack, the former head of patient advocacy group Families USA. Pollack helped lead the push for the 2010 Affordable Care Act. “We succeeded in the past because we stuck together,” he said. Eight years ago, the AMA and AHCA were key members of the coalition that turned back Republican efforts to repeal the Affordable Care Act, often called Obamacare. The AMA, the nation’s largest physician group, sent multiple letters to Congress throughout 2017. In a March 17, 2017, letter, for example, the group warned that Congress should “keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans.” And the AHCA’s president was a leading voice opposing repeal, which at one point he called “the biggest threat that the sector has faced in at least 20 to 25 years.” This year, the AMA hasn’t sent a single letter or issued any news releases opposing Medicaid cuts. By contrast, the group has issued seven news releases since January on the lack of congressional action on physician fees. The AHCA, meanwhile, issued its first public defense of Medicaid in this year’s debate — in a document it called a fact sheet — only the day after House Republicans adopted a budget resolution that threatens the program’s funding. When the group issued its 2025 policy priorities last week, priority No. 1 focused on staffing, including repealing the Biden-era staffing mandate. Protecting Medicaid was Priority No. 2. The Medicaid debate will likely drag on for months as GOP leaders in the House of Representatives and Senate try to cobble together a bill to extend tax cuts. Medicaid’s defenders say they’re still looking for more voices to speak up. “Republicans have said outright that silence is consent,” Wyden said. “If health care organizations don’t speak out against the GOP’s plans to cut health care, Republican lawmakers are going to assume those organizations are on board with their agenda.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. 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