This article is more than 5 years old. Information may no longer be current.

ACP: Graham-Cassidy proposal would cause ‘unacceptable’ spike in uninsured patients

Jack Ende

The American College of Physicians recently sent two separate letters, one to Senators Lindsey Graham (R-S.C.) and Bill Cassidy, MD, (R-La.) and the other to Senate Majority Leader Mitch McConnell and Minority Leader Charles Schumer, conveying its strong opposition to the Graham-Cassidy proposal to ‘repeal and replace’ essential aspects of the Affordable Care Act, including Medicaid expansion and premium and cost-sharing subsidies.

“Substantial cuts to Medicaid authorized by this legislation would cause a significant increase in the number of uninsured patients and that it would undermine essential benefits provided for patients insured under current law,” Jack Ende, MD, MACP, president of the American College of Physicians (ACP), wrote in the letters.

Ende stressed any legislation that would modify the coverage and consumer protections under the ACA should follow its criteria to “first, do no harm” to patients and ultimately improve coverage and access to essential care. He argued that the Graham-Cassidy bill “falls well short” of meeting these established criteria.

In the letters, ACP specified several areas of concern of the Graham-Cassidy proposal. The ACP is concerned that its elimination of the enhanced federal match, block grant funding structure and allowance of states to impose work requirements would eliminate or weaken coverage for millions of Medicaid-insured individuals, especially the most vulnerable.

There will be a decrease in funding for individuals to purchase health insurance in the individual market if the ACA’s premium tax credits and cost-sharing subsidies are replaced with a discretionary formula, and these funds could be used by states for a wide variety of health care purposes, with essentially no standards to ensure affordable meaningful coverage, according to ACP. Consumer protections, including essential benefits currently guaranteed by the ACA, may also be weakened by the Graham-Cassidy proposal by allowing waivers for state innovation and vital health benefits, according to ACP.

The association is also concerned that eliminating the individual insurance requirement would allow individuals to wait until they are ill to purchase insurance, forcing insurers to increase premiums to compensate.

“In July of this year, the Senate failed to garner the necessary votes in the process of moving forward with legislation to repeal and replace the ACA in a budget reconciliation bill,” Ende concluded the letters. “Rather than continue with an effort to repeal and replace the ACA, ACP urges you to set aside this legislation and instead, focus on bipartisan efforts to stabilize the health insurance marketplaces, create competition among insurers and lower the costs of health care for all Americans. We also urge that any legislation to amend current law should be developed through regular order, with hearings, debate and committee mark-ups, and with sufficient time for independent analysis by the Congressional Budget Office, independent experts, and the clinicians and patients directly affected by the proposed changes.”

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.