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ACP expresses 'strongest opposition' to Better Care Reconciliation Act of 2017

June 22, 2017

The American College of Physicians (ACP) expresses our strongest possible opposition to the Better Care Reconciliation Act (BCRA) of 2017, legislation to repeal and replace the Affordable Care Act (ACA). In a letter we sent earlier today to the Senate, ACP explains that the BCRA does not meet -- or come close to meeting -- the criteria that ACP established that any reforms to current law should first, do no harm to patients. The BCRA would radically change how Medicaid is financed, reduce premium and cost-sharing subsidies for people who most need them in the individual insurance market, and significantly weaken essential consumer protections for the most vulnerable patients.

ACP has already expressed our great concern about the lack of regular order in drafting the BCRA and our deep opposition to using the flawed policies of the American Health Care Act (AHCA) as passed by the House of Representatives on May 4, 2017. While ACP in the coming days will continue to analyze and review the BCRA as well as any Congressional Budget Office (CBO) report and other independent analyses of the BCRA, ACP urges the strongest possible opposition to the bill and asks all Senators to vote against this harmful legislation.

Specifically, we are greatly concerned that:
  • BCRA maintains, and in some ways actually worsens, the AHCA's radical changes to the Medicaid program's structure and financing.

  • BCRA will allow states to obtain waivers to opt-out of federal requirements that ensure people have access to comprehensive essential health benefits and are protected from excessive co-payments and deductibles.

  • BCRA discriminates against providers of women's health services, cutting funding for in the awarding of federal grant funds and/or Medicaid and Children's Health Insurance Program funding to women's health clinics that are qualified under existing federal law for the provision of evidence?based services including, but not limited to, provision of contraception, preventive health screenings, sexually transmitted infection testing and treatment, vaccines, counseling, rehabilitation, and referrals.

  • BCRA would dramatically reduce federal subsidies to help people afford coverage in the individual insurance market, phase out subsidies at a lower income level, and benchmark them to health plans with higher deductibles than under the ACA.


ACP strongly believes in the first, do no harm principle. Therefore, we strongly urge that the Senate vote down the BCRA. Radically cutting and restructuring Medicaid and ending federal funding for expansion, allowing states to waive essential benefits; discriminating in the awarding of federal funds to women's health clinics; and replacing the ACA's premium and cost-sharing subsidies with insufficient tax credits that make coverage unaffordable for those who need it most will not fix or improve the healthcare system. The BCRA will not preserve and improve essential coverage, benefits and consumer protections, and will reduce access to care for both currently insured and uninsured individuals, children and families.

We urge the Senate to reject the BCRA and instead start over and seek agreement on bipartisan ways to improve and build on the ACA and to make other improvements in patient care, as proposed in ACP's Prescription for a Forward-Looking Agenda to Improve American Health Care. ACP welcomes the opportunity to share our ideas for bipartisan solutions for improving current law that would help make health care better, more accessible, and more affordable for patients.
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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.

American College of Physicians

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