The U.S. House of Representatives today passed an amended version of the American Health Care Act (AHCA) without an official estimate of the bill’s costs or its impact on the insurance coverage that more than 20 million people have gained in recent years. The 217–213 vote came after a deal that was struck early this week to capture wavering Congressmen added $8 billion in funding over five years to provide assistance to individuals who may be subject to increased premiums because of a pre-existing condition.

The latest amendment to the AHCA, offered by Michigan Rep. Fred Upton, came in addition to federal funding of more than $100 billion over nine years that could be used for high-risk pools and other purposes. High-risk pools, which operated in 35 states prior to the ACA, were “not a panacea for Americans with pre-existing conditions,” noted AMA President Andrew W. Gurman, MD. If this version of the AHCA becomes law, patients with pre-existing conditions “will be stuck in second-class health care coverage” if they can secure coverage at all, Dr. Gurman added, citing a February American Academy of Actuaries report on the history and impact of high-risk pools.

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” Dr. Gurman said.

“Action is needed, however, to improve the current health care insurance system. The AMA urges the Senate and the administration to work with physician, patient, hospital and other provider groups to craft bipartisan solutions so all American families can access affordable and meaningful coverage, while preserving the safety net for vulnerable populations.”

The timing and process for Senate action on legislation to repeal and replace the ACA using the reconciliation process have yet to be determined. There is a broad consensus that the House bill will be substantially altered in the Senate. In particular, several Republican senators have expressed concerns about the size and timetable for Medicaid cuts in the House bill.

The House put the bill to a vote before the Congressional Budget Office (CBO) had time to determine how the latest changes would affect the federal budget or the numbers of Americans who will go without health insurance coverage. Twenty Republicans voted against the bill; no Democrats voted for it. In March, the CBO projected the AHCA would result in 24 million more uninsured Americans by 2026 when compared with current law. A core principle guiding the AMA’s discussions on health-system reform is that proposals should not cause people who have health insurance coverage now to lose it.

The recent tweaks to the AHCA, as embodied in the Upton amendment and an earlier amendment proposed by New Jersey Rep. Tom MacArthur, do little to fix the “serious harm to patients and the health care delivery system” that would be inflicted if this version of the AHCA becomes law, Dr. Gurman said.

After the MacArthur amendment was proposed in late April, the AMA sent a letter to the House renewing its opposition to the AHCA because the changes did not remedy the shortcomings of the underlying bill, which would cause millions of Americans to lose their health insurance coverage. Additionally, the AMA is concerned that although the MacArthur amendment states that the ban on exclusions for pre-existing conditions remains intact, this assurance may be illusory as health-status underwriting could make coverage unaffordable for people with pre-existing conditions.

The AMA will continue to engage in the health-system reform discussion taking shape in the nation’s capital as well as in exam rooms, boardrooms and town halls across the country. The AMA has collaborated with a vast array of patient advocacy groups, physician organizations, hospitals and other health care stakeholders in raising core objections to the AHCA’s underlying approach to fixing the imperfections of the ACA on behalf of patients, physicians and the entire health system.

As the U.S. Senate takes up consideration of the AHCA, the AMA’s discussions with lawmakers will continue to be guided by the comprehensive vision for health-system reform that has been refined over more than two decades by the AMA’s House of Delegates, which is composed of representatives of more than 190 state and national specialty medical associations. That vision is guiding the AMA as it works, on a nonpartisan basis, with Congress and the Trump administration to improve the nation’s health system.

In addition to ensuring that the coverage gains and key consumer safeguards that took effect in recent years are protected, the AMA also is calling for reforms that:

  • Stabilize and strengthen the individual insurance market.
  • Ensure that low- and moderate-income patients are able to secure affordable and adequate coverage.
  • Ensure that Medicaid, CHIP and other safety net programs are adequately funded.
  • Reduce regulatory burdens that detract from patient care and increase costs.
  • Provide greater cost transparency throughout the health care system.
  • Incorporate common-sense medical liability reforms.
  • Continue the advancement of delivery reforms and new physician-led payment models to achieve better outcomes, higher quality and lower spending trends.

More information is available at, which offers patients and physicians an easy way to learn about the AMA’s policy priorities and make their voices heard on these vital issues. The AMA Wire® special series, “Envisioning Health Reform,” details the policy foundations of the AMA’s health reform objectives.

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