Patient protections and access to care

AGA position: Congress must include provisions to ensure patient access to specialty care and other essential patient protections in any new health care legislation.

For years, health care reform has dominated the political stage. Since the start of the Obama administration to the present, Congress’ division on health care has only deepened. The Patient Protection and Affordable Care Act (ACA) was created to transform the U.S. health care system to ensure more patients have access to and coverage of quality medical care. In fact, an additional 20 million individuals obtained health insurance coverage under the ACA (1). Although the law has shown to be unstable in its current form, AGA opposes repealing the ACA unless a viable, equitable replacement is in place. Patients who have received coverage through the ACA should be able to maintain coverage without interruption.

Without protections, patients will lose access

AGA is deeply concerned that repealing the ACA without a viable replacement will result in millions of patients losing health insurance coverage. Additionally, with the rise of uninsured patients, providers, like gastroenterologists, stand to lose reimbursement in uncompensated care. We urge Congress to build upon what is working in our current health care system and protect those patients who are currently insured and whose lives depend on this coverage.

Replacement alternatives cut access

In May 2017, the House passed the American Health Care Act of 2017 (AHCA) by a vote of 217 to 213. Under its current form, the AHCA:

  • Repeals the individual mandate that requires individuals to purchase insurance or face a penalty.
  • Repeals the employer mandate that requires employers to provide health insurance to their employees.
  • Encourages people to buy insurance by penalizing those who go 63 days or longer without continuous coverage. They would pay a 30 percent higher premium when they buy insurance.
  • Repeals the subsidies to help people buy insurance and replaces them with tax credits tied to age to help purchase insurance. For example, people under the age of 30 would be eligible for a $2,000 tax credit, increasing to $4,000 for those over the age of 60.
  • Repeals the 3.8 percent tax on investment income and a 1.0 percent tax on wages for the highest earning incomes.
  • Repeals the medical device tax.
  • Freezes Medicaid expansion in 2020, and changes the way the federal government funds Medicaid to the states by capping funding based on how many people are enrolled.

Recently, the Senate failed to pass three different plans that would have repealed all or parts of the ACA. One version, the Better Care Reconciliation Act of 2017 (BCRA), failed by a vote of 43 to 57. The BCRA would have:

  • Continued the requirement that plans not discriminate against individuals with pre-existing conditions.
  • Made steep cuts to the Medicaid program.
  • Encouraged individuals to have continuous health insurance coverage by requiring a waiting period of six months if there is a gap in coverage longer than 62 days.

In a recent Congressional Budget Office (CBO) score of these bills, it was projected that $834 billion would be cut from the Medicaid program under AHCA (2) and $772 billion under BCRA (3). However, millions of Americans would lose coverage under both bills — under the AHCA, the number of uninsured would increase by 23 million and under the BCRA the number of uninsured would increase by 22 million.

The Senate also failed to pass a full ACA repeal bill, as well as a “skinny repeal” bill that would have repealed the individual mandate, the employer mandate and the medical device tax; defunded Planned Parenthood for one year; increased funding for community health centers; and allowed individuals to increase contributions to health savings accounts. However, the CBO estimated that the skinny repeal bill would have increased the number of uninsured Americans by 15 million in 2018 and increased premiums by 20 percent.

AGA’s patient protection provisions

AGA strongly urges Congress to include the following provisions in any health care replacement package:

  • Ensure patient access to and coverage of specialty care.
  • Ensure patient access to and coverage of evidence-based preventive screenings without cost-sharing.
  • Insurers cannot discriminate because of a pre-existing condition.
  • Insurers cannot discriminate based on gender.
  • Parents should be allowed to keep their children on their plans until age 26.
  • A ban on annual and lifetime caps.

  • AGA urges Congress to return to regular order and work in a bipartisan manner to stabilize the individual insurance market and make improvements to health care legislation to ensure that patients have access to and coverage of quality health care. We call on Congress to enact legislation that contains these essential patient protections and other improvements to ensure affordability, accessibility and quality health care for all Americans.


    1. Uberoi, N., Finegold, K., & Gee, E. Health insurance coverage and the Affordable Care Act, 2010-2016. United States Department of Health and Human Services. 2016. ACA2010-2016.pdf

    2. Congressional Budget Office. Cost estimate for H.R. 1628, the American Health Care Act of 2017. Washington, DC. 2017. publication/52752.

    3. Congressional Budget Office. Cost estimate for H.R. 1628, Better Care Reconciliation Act of 2017. June 26, 2017.

Reviewed: September 2017