Internists Reaffirm ‘Strongest Possible Opposition’ to Graham-Cassidy-Heller-Johnson Proposal

ACP says revised bill is even more flawed and harmful to patients

Attributable to:
Jack Ende, MD, MACP

President, American College of Physicians

Washington (September 25, 2017)— In a letter to Majority Leader Mitch McConnell and Minority Leader Charles Schumer today, the American College of Physicians (ACP) reaffirmed its  strongest possible opposition to the Graham-Cassidy-Heller-Johnson (GCHJ) proposal, especially considering changes released last night to the bill that would be even more harmful to patients. These changes will create new and perhaps insurmountable coverage barriers for patients with pre-existing conditions, for Medicaid enrollees, and for many of the millions of Americans that will be priced out of coverage, or will pay more for less coverage. In a September 13 letter, ACP detailed many of the reasons why the original version of GCHJ will undermine the coverage, the benefits, and consumer protections for millions of people and could lead to losing their coverage entirely, including many of our most vulnerable citizens in Medicaid.  GCHJ, with the 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.

ACP is alarmed by the anticipated impact of the new provisions of this version because they will do even more harm:

  • States will be able to more easily opt out of Essential Health Benefits and could also allow annual and lifetime limits on patient coverage, resulting in bare-bones coverage. 
  • States will only have to submit to the Department of Health and Human Services (HHS) a broad, undefined statement that they “shall” provide access to affordable coverage with insufficient or non-existent guardrails of what that is or requirements to ensure that such coverage is truly affordable.  States could offer plans with lower or no “actuarial equivalent” standards, meaning higher deductibles and out of pocket costs for patients.
  • GCHJ still has devastating cuts and caps on Medicaid and puts an end to the program’s expansion.  The bill also is a massive redistribution of funding from states that expanded Medicaid coverage to the most vulnerable to those that did not, resulting in billions of dollars in cuts to Medicaid expansion states. 
  • Any temporary increases in funding to a few states does not make up for the damage that will be done to their residents, and those of other states, resulting from eliminating essential patient protections and capping and cutting Medicaid. 
  • The bill discriminates against Planned Parenthood and the right of patients to choose their own source of care, by denying Planned Parenthood access to federal funds, reducing access to primary and preventive care for millions of women.

ACP remains dismayed at the violation of regular order because the Congressional Budget Office (CBO) will have no time to do a reasonable cost and coverage estimate of GCHJ impact by the time a vote is taken, there will be no committee mark ups, and no time for other independent analyses and meaningful input from patients, physicians, nurses, hospitals, and the states. 

ACP strongly believes in the first, do no harm principle. The GCHJ proposal—especially with the latest 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 GCHJ.  ACP urges the Senate to vote down this legislation and instead return to seek agreement on bipartisan ways to improve and build on the ACA and to make other improvements in patient care, such as the efforts that were taking place in the Committee on Health, Education, Labor and Pensions and as proposed in ACP’s statement for the record to the HELP Committee and in ACP’s Prescription for a Forward-Looking Agenda to Improve American Health Care. 


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.

Contact: David Kinsman, APR (202) 261-4554,