Medical Organizations Raise Concerns About ACA Replacement Bill

Leaders of several prominent medical organizations have voiced their opposition to the American Health Care Act (AHCA), the proposed bill aimed at replacing the Affordable Care Act (ACA).

In a letter addressed to key representatives, American Medical Association (AMA) CEO and executive vice president James L. Madara, MD rejected the AHCA out of concerns that the bill could leave many of the over 20 million patients who gained insurance under the ACA vulnerable to losing their coverage.

Noting that the AMA generally supports the use of refundable tax credits as a means to offset the costs of private health care coverage, Dr. Madara added that such credits should be inversely proportional to income, rather than related to age as indicated in the AHCA.

He also criticized the bill’s proposed rollback of the ACA’s Medicaid expansion, as well as its repeal of the Prevention and Public Health Fund.

“As you consider this legislation over the coming days and weeks, we hope that you will keep upmost in your mind the potentially life-altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated,” Dr. Madara concluded.

In a separate letter, American College of Physicians (ACP) president Nitin S. Damle, MD, MS, MACP, asserted that the AHCA fails to live up to the essential health principle of “first, do no harm.” Expressing similar concerns as Dr. Madara about the bill’s use of tax credits, cap on federal Medicaid contributions, and potential for coverage loss or reduced access to care, he specifically addressed the possibility that patients who lose continuous coverage after 63 days would not be able to afford the 30% premium penalty should they get sick.

“The changes that the AHCA would make to our healthcare system would adversely impact tens of millions of our patients, especially older, sicker, and poorer ones,” Dr. Damle wrote. “We sincerely hope that you and Congress would still be willing to slow down the legislative process to work with us on ways to improve current law without undermining essential coverage and consumer protections for millions of patients as this proposal does.”

While both the AMA and the ACP maintained that ACA should be improved, they emphasized that any such changes or replacements should not come at the cost of the coverage gains achieved under the bill.

“We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand,” said AMA president Andrew W. Gurman, MD, in a press release. “We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.”