The American College of Emergency Physicians (ACEP) is deeply concerned by the Senate’s passage of the “One Big Beautiful Bill” reconciliation package. As written, this legislation will carry serious, long-term consequences for the emergency care safety net, the broader health care system, and most importantly the patients we serve.

Congress’ proposed changes to Medicaid threaten access to care for millions, including children, pregnant patients, seniors, and people with disabilities, and will have dangerous ripple effects that impact anyone in need of lifesaving emergency care.

Across the country, emergency departments are at, and in many cases beyond, their breaking point due to the patient boarding crisis, where patients are held in the emergency department for extended periods while waiting for inpatient beds or placement. Emergency care teams are already strained to their limits under factors outside of their control.

The additional strain that this bill will impose by substantially increasing the number of uninsured or underinsured individuals will result in millions of patients with no other option to access care than the emergency department, further crowding already overburdened EDs, delaying care, and driving up costs for everyone.

By both oath and law, emergency physicians treat anyone, anytime, regardless of their insurance status or ability to pay. We will, as we always do, continue to uphold this commitment. However, the impact of these massive changes to Medicaid will hinder our ability to provide timely care today and will reverse years of important progress in increasing access to health coverage.

While we appreciate that the Senate version includes badly needed, albeit temporary, relief from Medicare physician payment cuts, it is important to recognize that this partial and short-term fix is not enough to offset the significant, harmful changes elsewhere in the package, particularly for emergency medicine. This relief, while welcome, cannot be viewed in isolation from the broader threats posed by this package, and we urge lawmakers to prioritize meaningful, long-term solutions that fully support physicians and the patients who rely on them.

ACEP strongly urges Congress to reject the most damaging provisions in this reconciliation package—particularly those that would increase the number of uninsured, further strain emergency departments, and diminish the pipeline of future emergency physicians. We remain committed to working with Congress and the Administration to protect access to emergency care for all.

###