Patient Protection and Affordable Care Act (ACA) and Health Coverage

The Issue

The AAMC has long advocated a number of key principles as fundamental cornerstones of any successful health care system:

  • High-quality, affordable health insurance should be available to all;
  • Programs to support the health care safety net must be maintained at least at current levels until other affordable and high-quality coverage expansions are available;
  • A growing demand for health care services requires investments in the physician workforce, and it is imperative to strengthen federal support for graduate medical education;
  • Payments to physicians and hospitals must be at sufficient levels to ensure that access to care is not compromised; and
  • Constraining health care spending in the long-term depends on innovation in the delivery system and research to facilitate health promotion, disease prevention, and care coordination.

The ACA has extended insurance coverage to 22 million Americans, including millions of Americans who under ACA became eligible for Medicaid, which provides health coverage to more Americans than any type of insurance. Without stable insurance coverage, these patients may delay or forgo necessary care, which can lead to more complex conditions and higher cost. More uninsured people also will drive up costs for the rest of the system.

Additionally, increasing numbers of uninsured patients without corresponding support for the safety net will threaten both urban and rural providers, creating a ripple effect on regional health care networks. Teaching hospitals will continue their commitment to care for these newly uninsured patients, but without replacement resources, they could be forced to limit their investment in job creation, critical services, and training the next generation of all health professionals.

The Solution

Medical schools and teaching hospitals are committed to informing policies that address opportunities and challenges in our health care system and to ensuring that all individuals receive the comprehensive insurance coverage and high-quality care they need.  To repeal the ACA without simultaneously enacting accompanying legislation specifically guaranteeing similar coverage would jeopardize the nation’s health care system, affecting not only individuals, but also medical schools and teaching hospitals that provide care to the most vulnerable patients. Likewise, as Congress considers changes to the Medicaid program and additional health care reforms, maintaining, and in some cases even improving, coverage and access for Medicaid beneficiaries to high-quality care will be essential.

Academic medicine has outlined three key aspects of any movement to repeal and replace the ACA:

  • Congress should commit to comprehensive reform immediately and enact accompanying legislation specifically guaranteeing similar or better coverage for those who will lose it. The leaders of the 115th Congress should express their commitment to patients and health care providers by repealing ACA provisions only as part of a comprehensive reform package, which would include meaningful replacement policies to maintain affordable coverage, stabilize the health care industry, and further propel health care innovation.
  • Congress should protect states, taxpayers, and Medicaid beneficiaries by not repealing the Medicaid expansion. Many states have achieved expansion using Medicaid waiver authority, which has allowed them to tailor programs according to state priorities. If the Administration wishes to empower state decision-making, the use of waiver authority combined with the resources provided by the ACA can successfully achieve this objective. Repealing the Medicaid expansion would leave states with fewer resources, threatening not only patients, but also the safety net providers who care for them.
  • Congress and the Administration should rely on the expertise of health care stakeholders to help develop any reform package. Such an effort would set the tone for collaborative policymaking discussions, and would quell uncertainty currently roiling the health care industry. The AAMC would approach such a discussion committed to finding solutions that maintain or improve upon current coverage levels and that also ensure affordability.

Resources

AAMC Statement on House Passage of the AHCA and Reccomendations for the Senate
AAMC President and CEO, Darrell G. Kirch, MD, released a May 4 statement on the House passage of the American Health Care Act and provided recommendations for the Senate as it examines ways to improve health care for all Americans.

AAMC Statement on the Upton Amendment to the American Health Care Act
AAMC President and CEO, Darrell G. Kirch, MD, released a May 3 statement on the Upton amendment and the AAMC's concerns with the American Health Care Act and its impact on individuals with preexisting conditions.

AAMC Statement on the MacArthur Amendment to the American Health Care Act
AAMC President and CEO, Darrell G. Kirch, MD, released a May 2 statement on the MacArthur amendment and the AAMC's concerns with the American Health Care Act.

AAMC Statement on the CBO Score of the American Health Care Act
AAMC President and CEO, Darrell G. Kirch, MD, released a March 13 statement on the CBO score of the American Health Care Act and the impact on patient care.

AAMC Medicaid letter to Senate Finance Chair Hatch
AAMC President and CEO, Darrell G. Kirch, MD, Jan. 18 a letter to Senate Finance Committee Chairman Hatch explaining the importance of the Medicaid program to beneficiaries, states, and providers.

Repealing ACA Withour Replacement Would Jeopardize Patient Care, Health Care System
AAMC President and CEO Darrell G. Kirch, MD, issued a statement about efforts to repeal the Patient Protection and Affordable Care Act (ACA).

AAMC Letter to President-elect Trump on Concerns over "Repeal and Delay"
Dr. Kirch Dec. 9 sent a letter to the incoming Trump administration expressing concerns over plans to repeal the Patient Protection and Affordable Care Act (ACA) without a comprehensive replacement measure in place.

AAMC Letter to Congressional Leaders on Concerns over "Repeal and Delay"
Dr. Kirch Dec. 9 sent a letter to congressional leaders expressing concerns over plans to repeal the Patient Protection and Affordable Care Act (ACA) without a comprehensive replacement measure in place.

Congress Passes Budget Resolution; Begins Repeal of ACAWashington Highlights
The Senate Jan. 12 passed the Fiscal Year (FY) 2017 budget resolution, which included reconciliation instructions paving the way for repeal of the Affordable Care Act (ACA).