CHICAGO — In a letter to House leaders, the American Medical Association (AMA) today urged Congress to oppose the amended American Health Care Act (AHCA), as the proposed change would still result in millions of Americans losing their health care coverage and could make coverage unaffordable for people with pre-existing conditions. The AMA will continue working with Congress to provide Americans with access to quality, affordable health insurance coverage. The underlying bill and MacArthur Amendment push policy in the wrong direction.

The full text of the letter is below:

Dear Speaker Ryan and Leader Pelosi,

After reviewing the MacArthur Amendment to H.R. 1628, the American Health Care Act (AHCA), the American Medical Association (AMA) remains opposed to passage of this legislation. As we have previously stated, we are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage. Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill. The amendment does not offer a clear long-term framework for stabilizing and strengthening the individual health insurance market to ensure that low and moderate income patients are able to secure affordable and adequate coverage, nor does it ensure that Medicaid and other critical safety net programs are maintained and adequately funded.

The MacArthur Amendment would allow states to apply for waivers from critical consumer protections provided in the Affordable Care Act (ACA), including the age rating ratio of 3 to 1, the requirements that health insurers must cover certain essential health benefits, and the ban on health status underwriting. The current ban on health status underwriting protects individuals from being discriminated against by virtue of their medical conditions. Prior to the passage of the ACA, such individuals were routinely denied coverage and/or priced out of affordable coverage. We are particularly concerned about allowing states to waive this requirement because it will likely lead to patients losing their coverage. Although the MacArthur Amendment states that the ban on preexisting conditions remains intact, this assurance may be illusory as health status underwriting could effectively make coverage completely unaffordable to people with preexisting conditions. There is also no certainty that the requirement for states to have some kind of reinsurance or high-risk pool mechanism to help such individuals will be sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions.

We continue to strongly urge Congress to engage in a bipartisan, bicameral dialogue with stakeholders to work on policies that enhance coverage, choice, and affordability.


James L. Madara, M.D.

CEO and Executive Vice President, AMA

**Editor’s Note:

In January, the AMA released its health system reform objectives — primary among them that people who currently have insurance should not become uninsured — and shared them with Members of Congress. Last month, the AMA urged Congress to oppose the AHCA. Additionally, the “Envisioning Health Reform” series on AMA Wire looks deeper at the essential issues in the health system reform debate and provides updates on health reform discussions in Congress.

Last month, the AMA launched a website,, aimed at encouraging physicians and patients to join the effort to increase access to affordable, meaningful coverage for all Americans. The interactive site provides the latest information on health system reform legislation moving through Congress, as well as the AMA’s efforts to shape the future of U.S. health care.

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About the American Medical Association

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care.  The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.