NNU Letter to U.S. House of Representatives Urging Opposition to AHCA

As the American Health Care Act (AHCA) comes to a vote on the House floor, NNU nurses have sent a letter to representatives urging a “No” vote—given that the AHCA poses a mortal threat to the health and wellbeing of patients, and to the health security of this country. Read NNU’s letter for full details on how this legislation will harm patients, while perpetuating a system built around private insurance, rather than genuine access to healthcare. RNs reject the flawed, deadly AHCA, and instead say yes to improved, expanded Medicare for All.

March 21st 2017

U.S. House of Representatives
Washington, D.C. 20515

Dear Representative,

On behalf of the 150,000 Registered Nurse members of National Nurses United, we urge you to oppose the American Health Care Act when it comes to a vote on the floor of the House of Representatives.

Registered Nurses care for Americans in their most difficult hours. More than any other profession, we see the personal effects of a flawed healthcare system in the hospital every single day. Our primary responsibility is to protect the health and wellness of our patients by providing care at the bedside.

The American Health Care Act poses a mortal threat to the health and well-being of our patients, and to the health security of our country. Last week, the Congressional Budget Office reported that 24 million Americans will lose insurance coverage under the original legislative text. The plan would increase the number of uninsured people by 78% in 2020, and by 86% in 2026. This reality is in stark contrast to one of the key campaign promises made by the President this past year - instead of providing “insurance for everybody”, this healthcare bill will dramatically reduce the number of insured Americans. The President also promised not to cut Medicaid or Medicare – but the AHCA includes drastic cuts to both programs.

There is not a single aspect of this legislation that will benefit our patients who lack the health care services that they need. Specifically, the legislation will:

  • Eliminate the Prevention and Public Health Fund, which will worsen the health of our communities, spread infectious disease, and increase health system costs;
  • Phase out coverage for Medicaid expansion in Medicaid expansion states beginning in 2020, while preventing new states from receiving enhanced Federal Medical Assistance Percentage in order to expand Medicaid;
  • Institute a per capita cap for Medicaid, along with the option for states to use a block grant instead. Both options will reduce coverage for the most vulnerable, shift care from clinics to emergency rooms, increase system costs for the chronically ill as they defer treatments because of cost, and unfairly shift the burden of costs to the states;
  • Empower individual states to determine eligibility, scope and benefits for Medicaid as per their own discretion, but there will be no increase in federal monies to cover expanded eligibility;
  • Eliminate funding to Planned Parenthood which will worsen women’s health, and create burdens for women, families and society from unsafe pregnancies and other health conditions no longer treated;
  • Eliminate the definition of “essential benefits” – a move that makes all patients vulnerable to the distortions and marketing games of insurance companies;
  • Repeal the cost-sharing subsidies of the ACA, and destroy the ability of 80% of people currently buying insurance on the Exchanges to maintain coverage;
  • Open the door for junk insurance. The bill includes a penalty for lack of continuous coverage, creating a big incentive for patients to buy low-cost, no-coverage plans;
  • Fail to encourage low-cost coverage, because the legislation shifts thousands of dollars in spending from insurance company spending to the individual’s out of pocket costs;
  • Reproduce the failed “high – risk pools” of the 1990’s and 2000’s, through the “Patient and Stability Fund”. It is inevitable that the number of eligible patients will overwhelm the resources of these high risk pools;
  • Repeal the Medicare Hospital Insurance Tax, which will reduce funding and destabilize for the Medicare program that our nation’s seniors rely on;
  • Allow insurers to charge seniors five times the amount of a younger person. This revision will prove to be deadly for our nation’s seniors, and it reveals the extent to which this reform will benefit the profit margins of insurance companies, at the expense of patients’ lives.

Our experience at the bedside, coupled with analysis from health policy researchers, confirm our conclusion that this bill does not address the primary concerns of our patients: getting the care they need when they need it, without overwhelming financial burdens.

Over many years, with the notable exception of the passage of Medicare in 1965, the United States has built a patchwork health system around private insurance access, rather than genuine access to health care. This legislation, if enacted, will perpetuate this system while undermining gains made in the Affordable Care Act. Given the ultimate reductions in Medicaid, and the other reversals in the bill, there is literally nothing in this legislation that provides our patients with the care they need.

In order to effectively address the health system problems in this country, legislators must move beyond a private health insurance company dominated system. Health policy research, and the experience of every other wealthy nation, shows that a single-payer health care system is the most successful model to use. In the United States, Medicare is an example of how successful such a system can be. If the goal of our health system is to provide quality care for all Americans at the lowest cost possible, then we must transition to a single payer healthcare system – or Medicare For All.

The principal effect of the American Health Care Act, on the other hand, will be the loss of existing health coverage for tens of millions of people without any restraints on healthcare industry pricing practices. This legislation will result in overwhelming health insecurity for the American people.

On behalf of registered nurses across the country, we urge the rejection of this flawed, and deadly, proposal. We urge you to instead support guaranteed healthcare for all, through an improved, expanded Medicare for All program.


Deborah Burger, RN
President, NNU

Jean Ross, RN
President, NNU

Download PDF Letter