Academy of Nutrition and Dietetics Letter on AHCA

May 2, 2017

The Honorable Paul Ryan Speaker
U.S. House of Representatives
232 United States Capitol
Washington, DC 20515

The Honorable Nancy Pelosi
Democratic Leader
U.S. House of Representatives
204 United States Capitol
Washington, DC 20515

Nutrition services save money, improve chronic disease outcomes and save lives. For this reason, the Academy of Nutrition and Dietetics, the nation's largest organization of food and nutrition professionals, remains opposed to H.R. 1628, the American Health Care Act (AHCA) as amended by the MacArthur amendment.

The Academy and our 75,000-plus members believe that all Americans should have both coverage and access to high-quality health care. The Academy urges Congress to support measures that include nutrition services and prevention that reduces the cost of health care and improve patients' lives.

The new proposal set forth in the AHCA not only fails to improve the health of all Americans, but it will worsen patient care and public health by removing vital resources that are currently effective in improving health across the country.

This legislation continues to eliminate investments in prevention and public health, reverse advancements made in disease prevention and chronic care management, and according to the Congressional Budget Office, would result in the loss of health care coverage for at least 24 million Americans.1 Allowing states to waive pre-existing conditions and essential health benefits will lead to decreased coverage and utilization of vital nutrition services.

Individuals with chronic disease such as diabetes and hypertension benefit from medical nutrition therapy and nutrition services to lower their blood sugar and blood pressure, while reducing reliance on expensive medications. The cost of these services is inexpensive and replaces more costly interventions that are necessary as chronic disease progresses with many complications.

The Academy holds five key tenets for analyzing any legislation to reform health care:

  1. The health of all Americans should improve as a result of our health policy choices. Sufficient resources must be made available to ensure optimal health.
  2. Access to quality health care is a right that must be extended to all Americans.
  3. Nutrition services, from pre-conception through end of life, are an essential component of comprehensive health care.
  4. Stable, sufficient and reliable funding is necessary for our health care system to provide everyone access to a core package of benefits.
  5. Health care must be patient-centered.

Affordable access to care is an ongoing challenge that any reform legislation should address. Although this legislation purports to provide access, it fails to make coverage more affordable; unaffordable access to coverage is really not coverage at all. The proposal fails to maintain a core package of benefits that improve the health of Americans, by removing a basic floor of services that should be provided without cost-sharing to the Medicaid population.

Additionally, the new proposal would allow states to opt out of requiring that health plans cover the Essential Health Benefits which help reduce longer term health care costs, allow insurers to charge people higher premiums based on pre-existing conditions like nutrition related diseases like diabetes and heart disease and increase out-of-pocket costs for vulnerable older adults.

By repealing the Prevention and Public Health Fund, the proposal eliminates the sole federal investment in prevention, which will harm our state and local communities that depend on these effective public-private partnerships to improve the health of their communities.

The AHCA as currently drafted fails to meet the Academy’s five tenets, and therefore we cannot support the passage of these proposals.

The Academy urges Congress to not hold future votes without an evaluation of the proposed amendments from the Congressional Budget Office estimating the budgetary impact of the amended legislation and the anticipated effect on coverage for Americans. We look forward to continued collaboration to improve the health and nutrition for all Americans.


Lucille Beseler, MS, RDN, LDN, CDE, FAND
President, 2016-2017

1 Congressional Budget Office Cost Estimate of American Health Care Act, March 13, 2017.