SAEM Comments on Better Care Reconciliation Act


The Society for Academic Emergency Medicine (SAEM) has over 6500 members. Our members work 24 hours a day, 7 days a week; they not only deliver amazing emergency care to the U.S. population, but also are responsible for teaching the next generation of providers, and researching ways to deliver better care. U.S. emergency departments see 130 million patient encounters annually – or approximately 4 in 10 persons in the U.S.  Due to EMTALA federal law, we evaluate and stabilize everyone without consideration of insurance status or ability to pay.  We are commonly described as the “safety net” of U.S. health care.  Our society is dedicated to the improvement of care for acutely ill and injured patients by improving research and education.  Thus, our focus is on patients in their most critical time of need.  

Changes to, or replacement of, the Affordable Care Act are likely to continue through the summer.  The CBO recently released an estimate of the proposed Senate Bill, termed the “Better Care Reconciliation Act."  The SAEM Board of Directors, along with a long list of other medical and health organizations, strongly opposes this legislation in its current form.

First, we are highly critical of legislation that will result in the loss of adequate insurance coverage for millions of Americans, thereby harming their health.  The CBO estimates that an additional 22 million people will be uninsured by 2026.  Based on prior research conducted by SAEM members, we can predict that with passage of this bill, many of the newly-uninsured Americans will delay preventative or maintenance care, will be more severely ill when arriving at emergency departments, and will suffer preventable long-term harm.  The harm from the bill is not limited to those who lose their insurance: the CBO estimates that increases in out of pocket expenses, deductibles and premiums are likely, particularly for low income and older pre-retirement patients. 

Second, we must condemn the current bill’s effect on treatment options for patients struggling with opioid abuse, addiction, and mental illness.  The current bill will reduce care options for the treatment of patients suffering from opioid abuse and addiction, despite the fact that we are in the midst of one of the largest public health crises our nation has faced.   As emergency doctors we provide lifesaving care for these patients on a daily basis, and actively research and educate providers and patients on ways to decrease opioid addiction and abuse.  If passed, the BCRA would decimate attempts to mitigate opioid abuse.  Our patients deserve better.

Finally, we decry the hallmark feature of this bill - its significant lasting permanent reductions in Medicaid.  This bill will likely have significant impact on children, as Medicaid is the single-largest source of insurance for children in the U.S.  Parents should not have to choose between meeting their living expenses, and providing treatment for their children’s diseases, ranging from the common (asthma, diabetes, and childhood infections) to the rare (congenital cardiac anomalies, childhood cancers).  We expect that, if this bill passes, the need for pediatric critical care in emergency departments will grow – and American children’s health will worsen. 

The future U.S. emergency doctors who we are training and will continue to prepare for a changing world will be available for decades to come, at all hours, to care for acutely ill and injured patients.  We hope that they will be able to practice in a world where our patients can receive care OUTSIDE of our doors, where they aren’t bankrupted by common illnesses, and where we have adequate resources to help our patients at their time of need.