An emergency room entrance at a hospital in Santa Clarita, Calif. (Jason Redmond/AP)

The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

The two main trade groups for U.S. hospitals dispatched a letter to the incoming president and Capitol Hill’s top four leaders, saying that the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients.

The letter, along with a consultant’s study estimating the financial impact of undoing the Affordable Care Act, makes hospitals the first sector of the health-care industry to speak out publicly to try to protect itself from a sharp reversal in health policy that Trump is promising and congressional Republicans have long favored.

When it was enacted in 2010, the health-care law was a product of a delicate balancing act among various parts of the health-care industry. Each essentially agreed to sacrifices in exchange for the prospect of millions of Americans gaining insurance to help cover their medical expenses.

Since Trump’s election last month, most health-industry sectors have quietly been trying to glean — and influence — the thinking within Congress’s GOP majority and the president-elect’s transition team.

Post reporter Amy Goldstein walks us through what changes health care will face under a Trump presidency. President-elect Donald Trump campaigned on his promise to repeal and replace the Affordable Care Act. (The Washington Post)

America’s Health Insurance Plans (AHIP), the insurers’ main lobby, has been holding private meetings with members of Congress. According to an AHIP spokeswoman, the group is urging that a repeal of the Affordable Care Act avoid disrupting newly gained coverage, eliminate certain taxes the law placed on insurers and replace the requirement that most Americans carry insurance with strong financial incentives for coverage.

In contrast, the American Hospital Association and the Federation of American Hospitals (FAH) convened a news conference Tuesday to release the study’s findings and draw attention to their concerns.

Charles N. “Chip” Kahn III, president of FAH, a for-profit group, said the amount of money that hospitals could lose under a repeal of the Affordable Care Act was “unsettling.”

Joann Anderson, president of Southeastern Health, a financially fragile rural hospital in Lumberton, N.C., one of that state’s most economically depressed areas, said the prospect of repealing the health law without a replacement to keep people insured is “gut-wrenching. . . . We cannot take additional cuts.”

The study, by the health economics consulting firm Dobson DaVanzo, used as its starting point a bill that is the only Affordable Care Act-repeal legislation that Congress has produced. It was vetoed early this year by President Obama. That legislation would have eliminated crucial parts of the health law — among them, federal subsidies for health plans people buy through insurance marketplaces created by the law, penalties for violating its insurance requirements, and the expansion of Medicaid that 31 states have adopted.

Borrowing from Congressional Budget Office estimates, the study says a similar repeal would cause an additional 22 million people to be uninsured by 2026. By then, it predicts, hospitals would lose $165 billion as a result — and $102 billion more unless the government reverses payment cuts the law made to hospitals that treat many uninsured patients.

The hospital groups say that if Trump and Congress repeal the Affordable Care Act without replacing it right away, they should also restore government payments for hospital care of Medicare and Medicaid patients to what they were before the 2010 law. When it was enacted, the premise was that hospitals could absorb lower payments if more people were insured.

A spokeswoman for House Speaker Paul D. Ryan (R-Wis.) noted that Ryan has said he favors a transition period to phase out the law but has not specified how long he prefers. A spokesman for Senate Majority Leader Mitch McConnell (R-Ky.) said that the senator has held over 100 meetings with hospital leaders, employees and patients “to hear firsthand about the damage the law is doing.”

Spokesmen for the Trump transition team did not answer repeated requests for a reply, except for a note that said: “We have received your request. Due to the volume of requests coming in, response time may be slower than usual.”