American College of Physicians Urges Senate to Vote No on Tax Bill

Washington (November 30, 2017)— Provisions in the Senate tax bill that would eliminate the Affordable Care Act’s (ACA) requirement that persons purchase qualified health insurance coverage (individual mandate) and lead to deep cuts to Medicare and other federal health programs will do great harm to tens of millions of the most vulnerable patients including seniors, said the American College of Physicians (ACP) in a letter sent to Senate leadership this afternoon.  In the letter, Jack Ende, MD, MACP, president, ACP, urged the Senate to vote no on the Tax Cuts and Jobs Act under consideration.

The letter went on to detail the consequences that would result from repealing the individual mandate, citing a Congressional Budget Office (CBO) report that showed the number of uninsured would increase by four million in 2019 and 13 million in 2027. 

“Repeal of the individual mandate that individuals obtain health insurance violates our criteria that any proposed changes to the ACA should first, do no harm to patients,” said Dr. Ende. “The ACA, with the individual mandate, has been an effective tool in reducing the uninsured rate to its lowest level in decades, from 18.2 percent in 2010 to 10.3 percent in 2016.” 

The letter went on to outline the ways in which that the offsets the bill contains would negatively impact other federal health programs. Under a 2010 law called Statutory Pay-As-You-Go Act (SPAYGO), any law that that will add to the federal deficit must be paid for with spending cuts, increases in revenue or other offsets.  Automatic cuts are imposed if Congress does not enact offsets to prevent them.

“The College strongly believes that tax cuts and other initiatives should not come at the cost of automatic cuts to programs that serve individual and public health, including Medicare, Medicaid, the Centers for Disease Control and Prevention, and other agencies,” continued Dr. Ende.

The letter cited a CBO report that showed that the SPAYGO cuts trigger by the bill would result a $25 billion cut to Medicare in 2018.  SPAYGO would cause additional cuts to Graduate Medical Education, lab fees, and hospital payments. It would also cut or entirely eliminate hundreds of other federal programs that are critical to health including those within the CDC, the Health Resources and Services Administration, and the Prevention and Public Health Fund. 

“Rather than continuing the effort to repeal current-law coverage under the ACA through budget reconciliation measures, or otherwise, we urge Congress to work together in a bipartisan manner to improve coverage and lower costs,” concluded Dr. Ende. “Repealing the individual insurance mandate, as part of this legislation or any other, would only result in harm to our patients as would any cuts to Medicare or other vital health programs.”


About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 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: Jackie Blaser, (202) 261-4572,