Americans have been conflicted about the Affordable Care Act from the start.

They like the rule that insurance companies cannot deny individuals dealing with prior medical conditions coverage, even though they present a higher risk. They like being able to keep their kids on mom’s or dad’s company health insurance through age 26.

And most people, at least, back the compassionate goal of a law intended to assure everyone can get health insurance and, by extension, health care.

But many Americans didn’t like the provisions that made those good things possible. They included the mandate that everyone obtain health insurance or face penalties at tax time, and the assessment of various taxes to pay for Medicaid expansion.

And of late, many did not like it when their premiums spiked and the size of the deductibles they had to accept expanded.

After running against the Affordable Care Act for four straight elections, and refusing to entertain any changes to address its problems, the Republicans, in control of Congress and the presidency, finally have the opportunity to repeal and replace.

However, in maintaining what Americans like about the health law, while jettisoning the mandate, and in eliminating the taxes to appease the party’s most ardent fiscal conservatives, yet maintaining, at least for a time, the coverage those taxes pay for, Republican leaders have produced a Frankenstein monster of disparate parts that it appears few can love.

Fiscal conservatives are dismissing it as Obamacare Lite, a program that still entwines the public and private sectors and maintains many of the ACA elements through 2020 and beyond. Adherents to a free-market approach, even if that approach leaves millions without access to insurance, do not like this replacement. An assessment by the Congressional Budget Office as to how much this will drive up the deficit could further erode support from true fiscal hawks.

Yet the American Health Care Act does sufficiently gut the ACA, and assure that millions who now have health insurance will lose it, that it has received near unanimous condemnation from organizations focused on providing health care.

The American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association, the American Nurses Association, the American Medical Association, and the politically feared American Association of Retired Persons all oppose the bill championed by House Speaker Paul Ryan, R-Wisconsin.

Hospitals again face the prospects of millions of patients showing up in their emergency wards without health insurance, a situation the ACA did not eliminate but vastly improved.

Without a mandate, millions of young, healthy adults will take the chance of going without insurance. That will further drive up premiums for everyone else, particularly with insurers still mandated to sell insurance to all, including people with costly medical histories.

In place of the mandate, and to discourage people from waiting to get insurance until they get sick, the new law would allow insurers to charge a 30 percent premium for those who don’t maintain coverage. That will persuade more people to go without insurance and simply show up in ERs for “free” care, disregarding the credit-destroying bills that result.

According to the Kaiser Family Foundation, the Republican bill sets up winners and losers in a fashion that turns compassion on its head. Its configuration of tax credits, tied only to age and not income or the cost of insurance in a particular location, means those with higher incomes and in areas with lowest insurance costs will benefit, while the low income living in states with high insurance costs will suffer the most.

Expanded Medicaid remains available through 2020 for incomes up to 138 percent of the federal poverty standard, $33,900 for a family of four, but with landmines that will drop millions from Medicaid. If a family rises above the requirement income and loses Medicaid, they cannot return to the plan if income later goes below it again. New, more frequent paperwork rules would dump others off Medicaid.

Two things can happen. Enough Republicans could revolt, with the prospects higher in the Senate, to kill this Frankenstein and force Congress to re-evaluate. Or leadership will hold the votes together and pass it on a straight-line partisan vote, Republicans for and Democrats against. In other words, a complete reversal of how Obamacare passed; only this time Republicans will own it.

In becoming law, the American Health Care Act would cause so many disruptions and drive so many from insurance, while generating bigger deficits, that Americans may decide what they really want is what the rest of the Western World has — a one-payer, Medicare system for all.