The American Medical Association to Congress on ACA: First, do no harm. And let’s see the detailed “replace” plan before any “repeal.”

Something important happened yesterday. The AMA released a letter to congressional leaders on Tuesday that is a big deal.

First, the AMA calls on Congress to preserve coverage for the twenty million Americans who became insured through the Affordable Care Act. The letter reminds Congress that the AMA supported ACA’s passage “because it was a significant improvement on the status quo at that time,” adding: “It is essential that gains in the number of Americans with health insurance coverage be maintained.” Do no harm.

Most important, the AMA calls upon Congress to release a properly detailed “replace” plan before ACA is repealed:

[W]e believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.

This is a big deal. The current Republican strategy is to quickly pass a $346 billion tax cut for people with annual incomes exceeding $200,000, alongside the nameplate ACA repeal. They would offer unspecified promises of a later replacement.

There’s good reason for the vagueness. Republicans have reached no genuine consensus on a detailed replacement plan. When they do reach consensus, and provide the AMA’s requested detail, their plan will likely be scored by nonpartisan authorities such as the Congressional Budget Office as exploding the deficit and leaving millions more Americans uninsured relative to current law. Republican plans may also include deep cuts to Medicaid for aged and disabled Americans that go well beyond even ACA repeal.

Although liberals aren’t overjoyed by this, the AMA retains unique authority in American life. A large body of research–notably important work by Alan Gerber and Eric Patashnik–indicates that most Americans regard the AMA as representing America’s doctors–and that doctors are the uniquely respected authority on matters of health policy and medical care.

The AMA is not particularly close to the Democratic Party. It is not coded in public opinion as some liberal Democratic advocacy group, either. Indeed the AMA supports President-elect Trump’s nomination of Tom Price, an arch-conservative figure despised by most Democrats.

If the AMA is telling Republicans to slow down, this is an important development.


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