Internists Reaffirm 'Strongest Opposition Possible' to The Better Care Reconciliation Act (BCRA) of 2017

Attributable to:
Jack Ende, MD, MACP
President, American College of Physicians

 Revised bill more flawed and even more harmful to patients

Washington (July 13, 2017)—On behalf of the American College of Physicians (ACP), today ACP wrote Senate leaders to reaffirm our strongest possible opposition to the Better Care Reconciliation Act (BCRA) of 2017, despite the changes released today, as part of a revised bill. We believe these changes, especially Title III, will make the bill even more flawed and therefore even more harmful to our patients by creating new and perhaps insurmountable coverage barriers for patients with pre-existing conditions and by severely weakening or completely eliminating requirements that insurers cover essential health benefits (EHBs) and abide other protections like a community rating.

In a June 22nd letter, ACP detailed many of the reasons why the original version of the BCRA will undermine the coverage, the benefits, and consumer protections for millions of people and lead to 22 million losing their coverage entirely, including 15 million of our most vulnerable citizens in Medicaid. The BCRA, with today’s revisions, continues to fall far short of meeting the criteria that ACP established that any reforms to current law, including the Affordable Care Act (ACA), the Medicaid program, and the Children’s Health Insurance Program should first, do no harm to patients.

We are deeply concerned by the anticipated impact of the new Title III, which would allow insurers to sell non-ACA compliant health plans in a state as long as the insurer also offered ACA-compliant plans in that state. This is similar to the MacArthur-Meadows amendment that ACP objected to in the American Health Care Act (AHCA). Title III however is potentially worse because it would split the risk pool and create two markets, one where older and sicker individuals(with pre-existing conditions) would pay (or try to pay) for more expensive ACA-compliant policies, and the other where younger and healthier individuals purchase skimpier and cheaper, non-ACA compliant policies.

Today’s letter includes our comments on:

  • Pre-existing conditions
  • Essential health benefits
  • Substance-use disorder and opioids
  • Market stabilization
  • Medicaid and process concerns

ACP strongly believes in the first, do no harm principle.  The course of the Senate is not pre-determined—there is still time to forge a new path.  The BCRA—even with modifications—will not preserve and improve essential coverage, benefits and consumer protections, and access to care for both currently insured and uninsured individuals, children and families.  Therefore, we strongly urge that the Senate move away from the fundamentally flawed and harmful policies that would result from the BCRA.

We urge the Senate to set aside or vote down this legislation and instead start over and seek agreement on bipartisan ways to improve and build on the ACA and to make other improvements in patient care, as proposed in ACP’s Prescription for a Forward-Looking Agenda to Improve American Health Care.  ACP welcomes the opportunity to share our ideas for bipartisan solutions for improving current law that would help make health care better, more accessible, and more affordable for patients.


The American College of Physicians is the largest medical specialty organization in the United States. ACP members include 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.