Five major medical organizations have written to congressional leaders warning a repeal of the Affordable Care Act (ACA) would have significant consequences on uninsured rates, coverage for low-income Americans and the affordability of health coverage.

One of the letters was jointly sent from four groups: American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the American College of Physicians (ACP).

“We are urging caution with respect to current calls for the repeal of the (ACA),” the groups wrote. “We are concerned that such actions would have a profoundly negative impact on our health care system and the more than 200 million people who currently have health care coverage through the individual, small group and employer-based markets, as well as Medicaid.”

In particular, the groups asked for Congress to base any reforms on the following principles:

• Not increasing the number of uninsured, including taking away coverage from expanded Medicaid beneficiaries.
• Ensuring “a viable healthcare safety net,” like continuing incentives to states to expand Medicaid.
• Keeping patient protections like prohibiting lifetime or annual caps on coverage by insurers or discrimination based on pre-existing conditions, gender or race, providing free preventive services and continuing the ACA’s subsidies for buying insurance.
• Protecting the individual and small group markets, which liberal advocates of the ACA say could “unravel” if the law is repealed.

In a separate letter to Congress, American Medical Association CEO James Madara, MD, emphasized the same concerns about insurance coverage gains being rolled back by repeal, though he left out any mention about expanded Medicaid or regulations on insurers.

Madara did ask that congressional leaders detail the replacement for the ACA now, before the law is eliminated.

“Consistent with this core principle, we 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,” he wrote. “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.”

A day after the four-group letter was sent, ACP President Nitin Damle, MD, MS, sent his own, more strongly worded letter to congressional leaders. He referenced the already-begun process to repeal parts of the law through budget legislation, warning such an approach to cause 7 million people to lose their coverage in 2017 alone after insurers pull out of markets.

“Accordingly, our commitment to ensuring that patients have access to affordable coverage and medical care obligates us to urge the Senate to vote no on the budget resolution,” Damle wrote. “While we cannot support the budget resolution, the [ACP] welcomes dialogue on constructive, bipartisan approaches to improve on the ACA by making coverage even more affordable and accessible.”