"Repeal" of ACA Without "Replace" Would Bring Chaos, Doctors Tell Congress

Four professional groups representing nearly 400,000 doctors and medical students called on Congress on Tuesday to protect Americans’ access to “comprehensive health benefits,” and keep the insurance market stable as they ponder repeal of the Affordable Care Act (ACA).

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians (ACP), and the American Congress of Obstetricians and Gynecologists asked Congress to not allow the number of insured Americans to creep back up again after having reached the historically low level of 8.6%, including only 5% of all children.

A joint statement from the 4 groups can be found here. The full letter to leaders in both the Senate and the House of Representatives can be found here.

“We support consideration of proposals to stabilize insurance markets by providing eligible persons more choice of insurance plans that offer coverage that is comparable to the benefit, cost-sharing, and consumer protections established by current law, and that encourage younger people to participate without undermining protections for older and sicker persons,” the joint letter stated.

After Donald J. Trump is sworn in as president on January 20, 2017, Congress is expected to move quickly to repeal the ACA, but it is unclear what will come in its place. President Barack Obama’s landmark healthcare law did away with many direct subsidies to hospitals that provided care to the uninsured, and instead shifted resources to providing direct coverage for the working poor and those who had been hard to cover in the past, including people with chronic conditions.

President-elect Trump has said he favors an item called for by the doctors: retaining the ban on denying coverage based on preexisting conditions. He also has said he supports the ACA provision that lets parents keep adult children on their health plans through age 26.

Physician and hospital groups fear that repealing the ACA without spelling out how to care for the uninsured will bring disastrous results for those who treat high numbers of poor or extremely sick patients.

The groups also called for:

• Ensuring a viable safety net for poor Americans and children.
• Preserving affordability through premium assistance, other financial subsidies, or continued Medicaid expansion. The groups that benefit from these under the ACA include the working poor, as well as middle-class Americans.
• Retaining bans on denying coverage due to preexisting conditions, disability status, or family medical history.

In ACP’s letter to Senate leadership, President Nitin S. Damle, MD, MS, MACP, wrote that repealing the ACA through the budget reconciliation process—without a viable replacement plan—would bring “chaos” to the insurance market, “causing plans to pull out of the markets with more than 7 million losing coverage in 2017 alone.” He wrote that any replacement plan must be evaluated based on its effect on “quality, access, and coverage.”

The internists’ group said it was willing to work on a replacement bill despite its lack of support for Senate plans to cancel key parts of the ACA through the budget resolution process.

“While we acknowledge that the ACA is not perfect (and no law is), and improvements to it can and should be made, our continued support for the ACA is grounded in the fact that it has reduced the uninsured rate to the lowest ever, a major stride toward providing affordable coverage to all Americans,” Damle said.

“We encourage Congress to first put forward ideas for improvements rather than committing to a process that would repeal the ACA’s coverage and protections for many millions of people,” he wrote.

Hours after the 4 groups released their statement, the American Medical Association (AMA) released a letter from Chief Executive Officer James L. Madara, MD, calling on Congress to maintain the number of Americans with health coverage. The letter states that the AMA supported healthcare reform because its primary goal was to make coverage accessible to all. “We also recognize that the ACA is imperfect and there are a number of issues that need to be addressed,” the letter states.

The AMA has been under fire from some of its members for endorsing the nomination of US Representative Tom Price, R-Georgia, to be HHS secretary. Price is a vocal opponent of the ACA; a letter signed by a group of physicians chastised the AMA for supporting a nominee who also sought funding cuts for the Children’s Health Insurance Program, which enjoys bipartisan support.