On Monday, the American Medical Association slammed the Senate's health-care bill in a scathing letter to Senate leadership. The largest physicians group in the nation declared that it could not support the Better Care Reconciliation Act introduced last week because it "violates" the medical standard of "first, do no harm" on "many levels." Based on the "combination of smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of important protections such as required benefits, actuarial value standards, and out of pocket spending limits," the AMA predicted that "low and middle income patients" will face "higher costs and greater difficulty in affording care." In particular, the AMA cited concerns about the plan's proposed changes to Medicaid via a formula it declared was "arbitrary and unsustainable" and "extremely difficult and costly to fix." "We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system," the AMA wrote.