Anger over proposed cuts was loud and sharp across the deep-blue Philadelphia region Thursday as Senate Republicans unveiled their health-care plan.

New Jersey Hospital Association CEO Betsy Ryan denounced the proposal as having "callous disregard." Across the river, 18 people lay on the sidewalk outside Republican Sen. Pat Toomey's Philadelphia office — "Every one of you represents someone who is going to die if they pass this bill," a speaker said — as hundreds rallied against the measure.

Others weighed in by email.

"Morally obscene," said State Sen. Daylin Leach (D., Montgomery).

"This health-care scheme sells out the middle class, hurts seniors and children, and devastates individuals with disabilities to finance tax breaks for the very rich," said Sen. Bob Casey, Toomey's Democratic counterpart.

Even the traditionally staid Hospital and Healthsystem Association of Pennsylvania, which seven weeks ago declared itself "disappointed" by the House's health-care bill, pulled off the gloves. That bill "jeopardizes coverage, weakens Medicaid, and undermines critical protections," hitting Pennsylvania "harder than other states," president and CEO Andy Carter said. The Senate proposal "does not change this outlook."

Dayle Steinberg, CEO of Planned Parenthood of Southeastern Pennsylvania, which would lose all federal funding for at least a year under both GOP proposals, called the effort "the worst bill for women's health in a generation."

GOP plans for repealing and replacing the Affordable Care Act would be especially painful in Pennsylvania and New Jersey, which use a higher proportion of their Medicaid dollars on the elderly and disabled than almost any other states.

In a conference call with reporters, Pennsylvania Health Secretary Karen Murphy predicted a "devastating impact" for many citizens' insurance coverage, and public health programs that benefit everyone, such as Lyme disease monitoring. Hospital reimbursements would drop. Overall, "hundreds of thousands of jobs" would be lost, Murphy said.

Wolf administration officials on the call said the state could not possibly make up for the $4.5 billion a year that funds expanded Medicaid coverage for 700,000 Pennsylvanians. Around 175,000 have received addiction treatment through both the expansion and the private insurance plans sold on the ACA exchange. The law's mandatory coverage benefit is optional under the GOP plans. "Ultimately it could cost people their lives," said Jennifer Smith, acting secretary of the Department of Drug and Alcohol Programs.

Toomey, one of 13 senators who worked in secret to draft the new proposal, said in a call with reporters that he was "likely" to vote in favor. "We are trying to deal with the full-scale collapse of Obamacare that's happening all around us," he said. The changes to Medicaid would turn it into a "conventional" federal-state cost-sharing arrangement, he said.

As Toomey spoke from Washington, a crowd of more than 200 gathered outside his offices on Chestnut Street, kicking off a series of 24-hour vigils across the state. The event alternated between spirited political rally — "Where's Pat Toomey?" the crowd chanted — and faith-based spirituals reminiscent of civil rights-era protests.

The Rev. William Barber II, an NAACP leader from North Carolina, told protesters lying on the sidewalk that they were "putting their bodies on the line" for health care.

Helene Pollock, 70, standing at the edge of the crowd, reflected on how the bill might affect her personally.

"I realized that a lot of people around me are on Medicaid," said Pollock, who lives in Germantown. "My people. My family."

Staff writers Stacey Burling and Marie McCullough contributed to this article.