Impact on Access, Quality, and Cost of Possible Proposed Changes to ACA Offered by American College of Physicians

Washington (March 1, 2017)  The American College of Physicians (ACP) today addressed a letter to House and Senate leadership offering its thoughts – including concerns – about the impact on access, quality, and cost of possible proposed changes to the ACA.  Previous letters to Congress from ACP emphasized that any changes to current law, including to the ACA, Medicaid and the Children’s Health Insurance Program should “first, do no harm” to patients and actually result in better coverage and access to care for essential medical services.  ACP also developed 10 key questions that should be asked of any legislation that would alter the coverage and consumer protections under current law.

“We now write to share our observations about how some of the policies reportedly being considered by the congressional leadership and authorizing committees may fall short in satisfying the criteria for improvement set out in those questions,” said Nitin Damle, MD, MS, MACP, ACP’s president, 

ACP’s letter acknowledged that there is not yet agreement among the Congressional leadership on actual legislation to amend the ACA, CHIP and Medicaid, yet published reports on options that are under consideration have led ACP to conclude that now is the time to weigh in, before decision are made on actual legislative language.  The letter notes that ACP’s intent is to provide constructive input on the policies under consideration. 

Dr. Damle, a practicing internist in Rhode Island, sent the three-page letter on behalf of the 148,000 member ACP.  The letter offered the following recommendations:

  • Medicaid: Continue funding to states that have expanded or wish to expand the program as authorized by current law. Also, replacing current federal financing for both expansion and non-expansion states with per capita spending caps or block grants could force states to drop eligibility and coverage for many of the 74 million people who are currently enrolled.
  • Essential Health Benefits: Preserve current federal law requirements for coverage of Essential Health Benefits (EHB); repeal of such guarantees would return us to the pre-ACA days when insurers regularly excluded coverage for preventive services, doctor visits,  hospital care, prescription drugs, maternity and contraceptive services, and mental and behavior health treatment including substance abuse treatment.
  • Pre-existing conditions: Potential changes should not weaken the ACA’s prohibition on insurers declining coverage or charging more for patients with pre-existing conditions.  The letter noted that replacing this with a “continuous coverage” requirement would likely lead many of the 27 percent of Americans with pre-existing conditions having no access to affordable coverage in the individual insurance market if they lose their continuous coverage. Before the ACA, in all but five states, common conditions like diabetes, arthritis, asthma or a cancer diagnosis was considered “declinable” in the individual insurance market.
  • Premium and cost-sharing subsidies: Ensure that the value of current law premium and cost-sharing subsidies are preserved; replacing existing income-based subsidies with age-based tax credits could make coverage unaffordable for many older and sicker and other vulnerable patients.

Dr. Damle also noted that in his remarks to Congress last night, “President Trump expressed support for continuing to ensure that patients with preexisting conditions have access to coverage and that states be given resources to maintain Medicaid coverage, goals ACP supports.  However, the President’s call to ‘repeal and replace’ the ACA could result in tens of millions of patients, many of whom are seen by internists like myself, losing essential coverage, benefits and consumer protections, if any of the so-called ‘replacement’ policies addresseed in our letter are adopted.” 

Today’s letter concluded by saying that ACP “strongly believes in the ‘first, do no harm’ principle.  We urge you [Congress] to ensure that any legislation to amend current law not eliminate or weaken key gains in coverage and consumer protections, lead to fewer people having access to affordable coverage, and/or loss of such protections in the future.”


The American College of Physicians is the largest medical specialty organization in the United States. ACP members include 148,000 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,