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    September 22, 2017

    The Honorable Mitch McConnell
    Majority Leader
    United States Senate
    Washington, D.C. 20510

    The Honorable Chuck Schumer
    Minority Leader
    United States Senate
    Washington D.C. 20510

    Dear Majority Leader McConnell and Minority Leader Schumer:

    The Medical Group Management Association (MGMA) writes to express our concerns with the CassidyGraham-Heller-Johnson Amendment to H.R. 1628, the American Health Care Act. While we agree that much can be done to improve our nation’s ailing healthcare system, this amendment as currently drafted exacerbates problems with the ACA and poses new risks that could ultimately affect medical group practices’ ability to treat patients. As a result, MGMA cannot support this legislation.

    MGMA represents more than 40,000 medical practice administrators, executives, and leaders and 12,500 organizations of all sizes, types, structures and specialties. In March, we shared our core principles for healthcare reform with Congressional leadership. After analyzing this proposal, we do not believe it would reform our healthcare system in a manner consistent with these principles, namely ensuring continuity of patient care and meaningful coverage, protecting patient choice, transparency and adequate provider reimbursement and, above all, minimizing disruptions to the nation’s healthcare delivery and payment system.

    We are concerned this amendment would destabilize insurance markets and result in patients losing meaningful healthcare coverage. Insurers are already raising deductibles and restricting provider networks, actions which could be exacerbated under these proposals. Premiums are rising at an unsustainable rate, and we support Congress in its important work exploring ways to keep insurance affordable. However, we are concerned this proposal goes too far in the other direction, and could lead insurers offering bare-bones products that cover less than the cost of medical treatments, leaving patients in debt and medical practices chronically underpaid for their services.

    MGMA also has concerns with the amendment’s proposal to reduce Medicaid funding, amounting to cuts in certain states from 2020-2026, before block grants cease in 2027. This proposed formula raises numerous questions, potentially limiting the rate of spending growth below medical inflation. State flexibility may be an important strategy to efficiently allocate limited federal resources, but capping federal funding could lead to reductions in access or coverage or both, as well as even lower Medicaid reimbursement rates for providers, which are already well below Medicare and barely sustainable. If Medicaid reimbursement rates to physicians take further hits, many practices would be forced to make the difficult choice between closing their doors to Medicaid patients or going out of business, leading to a shortage of access to medical services for this vulnerable population.

    This legislation represents a missed opportunity for Congress to support business-friendly policies to reduce the excessive administrative burden currently faced by medical group practices. According to an MGMA survey conducted on more than 750 group practices, nearly half estimated they spend more than $40,000 annually per full-time physician to comply with federal regulations. MGMA outlined several suggestions in this letter, which we echoed to the House Ways and Means Committee in response to a request for feedback on ways to deliver statutory and regulatory relief.

    Ultimately, a bi-partisan solution is needed to create lasting reforms to our healthcare system. MGMA is disappointed by the closed door approach by which this amendment was crafted, which failed to solicit adequate stakeholder input for legislation that would have a significant impact on medical group practices.

    As the voice for the country’s medical group practices, MGMA remains committed to promoting policies that enhance the ability of our members to provide high-quality, cost-effective care to the millions of patients they serve. Should you have any questions, please contact Anders Gilberg, Senior Vice President, Government Affairs at or 202-293-3450.

    Halee Fischer-Wright, MD, MMM, FAAP, CMPE
    President and CEO, MGMA

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