ACEP's Health Care Reform Positions: A Letter to the ACEP Council

March 15, 2010

Dear ACEP Councillor,

As you know, the American College of Emergency Physicians exists to promote quality emergency care and to advocate for emergency physicians and their patients. To that end, ACEP has a well-established process for establishing policy and developing positions on issues critical to emergency care. Traditionally, ACEP focuses on patient access to the essential community service of emergency medicine and on support of emergency physicians in their various practice environments.

In recent years, there has been an increasing focus on the need for comprehensive reform of America’s health care system. With almost 50 million uninsured Americans and sharply rising costs in health care, the current system is unsustainable. There is, however, considerable disagreement and controversy over how to fix the severely challenged health care system.

In 2009, major bills passed the House of Representatives and the U.S. Senate that would, if enacted, result in comprehensive changes in the health care system. These bills are thousands of pages long, contain hundreds of provisions, and involve substantial cost. For the past year, there has been a constantly shifting landscape of proposed reforms. Currently, President Obama is making a concerted effort to get Congress to pass a comprehensive reform package with additional elements he favors. The fate of this effort is unknown at the time of this writing due to the deeply divided opinions in Congress. ACEP has not endorsed any of the bills pending before Congress.

The divisions in Congress reflect the deep divisions within the American public, where there is concern not only about specific provisions of the reform proposals, but whether the reform effort in total would in fact restrain costs, improve quality, have adequate revenue to pay for expansions in coverage, and implement appropriate changes. There are deep divisions within the larger House of Medicine and within ACEP’s membership about the  major aspects of the proposed health reform bills .

Over the past three years, ACEP has conducted various surveys and discussions with its officers, Board of Directors, the Council, the members of the Federal Government Affairs Committee, the State Legislative/Regulatory Committee and other key committees concerning elements of comprehensive reform. These elements have included, but are not limited to, a single payer system, health savings accounts, health information technology, community rating, guaranteed issue, benefits, deductibles, and mandates. There has been significant variability of opinion in many of these areas, but these dialogues and inputs have guided the ACEP Board in taking the positions it has taken.

In 2008, the ACEP Council adopted Substitute Resolution 24(08): "RESOLVED, That the Board of Directors derive a list of essential components to be included in any new healthcare system and create a white paper." Understandably, ACEP’s members and the ACEP Council wish to know ACEP’s "official" positions with regard to health care reform. To that end, please find attached an  information paper designed to convey the essential components of reform that exist in ACEP’s policies and positions  and a brief summary of the history and/or strategy employed with regard to the current mutable health care reform debate. Also, please bear in mind that in many cases there is agreement on a principle, but not agreement on the specific mechanisms or ways in which to accomplish that principle.

In addition, ACEP does not have official positions on many of the elements being proposed for reform.

The American College of Emergency Physicians is a representative democracy, and your disagreement with any of the policies can and should be addressed in the form of a resolution to the Council, to be debated with and by your peers who represent a diversity of geography, practice environment and specialized interests. In addition, policy can be influenced by participation on committees, in sections, and in your local chapter. I encourage you to make your voice heard by contributing to the solutions. Emergency physicians are innovators and problem-solvers and I have absolute confidence that our specialty and our members have significant contributions to make in the effort to provide better health care for all Americans.


Angela F. Gardner, MD, FACEP

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