DES PLAINES, Ill. – Without significant changes to address access to care for emergency department patients, the Emergency Nurses Association is opposed to the passage of the recently-released legislation designed to repeal and replace the Affordable Care Act proposed by Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson.

The current proposal contains many of the same deficiencies of previous Senate ACA-repeal bills, which we set forth in a June 16 letter to Senate leaders.

Specifically, ENA is concerned by the provision in the new legislation that eliminates the guarantee of health insurance coverage for emergency care. The ACA included emergency services as an essential health benefit, and we urge that any replacement bill maintain this requirement. As we wrote in our June letter, “patients should not be financially penalized for having an emergency.” Unfortunately, the Graham-Cassidy-Heller-Johnson proposal does away with the guarantee of coverage for emergency services.

Further, the significant cuts to the Medicaid program in the Senate legislation will inevitably lead to a sharp rise in uninsured patients utilizing our nation’s emergency departments. Under the federal Emergency Medical Treatment and Labor Act, anyone coming to an emergency department must be treated. Approximately 32 percent of emergency department visits are covered by Medicaid. The Graham-Cassidy-Heller-Johnson proposal would leave many of these patients without health insurance of any kind.

We are also concerned about the disproportionate impact of the loss of coverage for patients suffering from mental illness or substance abuse. Medicaid is the single largest payer of mental health services in the United States, accounting for approximately 25 percent of mental health spending in the United States.

Likewise, Medicaid pays for more than one-fifth of all substance abuse treatment costs. As our nation faces an unprecedented opioid crisis and record number of deaths from drug overdoses, Congress should be looking to improve care for those suffering from substance abuse disorders instead of considering cuts to the very program that provides critical services for these patients.

As Senators debate the Graham-Cassidy-Heller-Johnson legislation in the coming days, we urge them to incorporate language that protects access to care for emergency department patients, as well as for individuals in need of mental health and substance abuse treatment.