In November 2000, the College's Board of Trustees approved the "ACC Statement of Principles on Health System Reform and the Uninsured." The development of this statement was driven by several influences: the strong encouragement of the College leadership to assume a more active role in reforming the health care system, the perception of an increasingly ripe social and political environment for health system reform, and the absence of consensus among College members about the myriad issues involved with reform.

The College's statement supports universal coverage through a system that emphasizes a public-private partnership in which the federal and state governments would maintain a role in providing health care coverage for low-income and poor individuals, and encourages eventual movement away from an employer-based system. In addition, the current draft calls for an individual mandate, i.e., all individuals would be required to obtain health care coverage.

In the past, the College has worked through coalitions to support health system reform efforts. In 1999-2000, the College supported, in principle, an American College of Physicians-American Society of Internal Medicine statement. That statement supports an incremental plan of reform to provide coverage to the uninsured up to 200% of poverty through a combination of tax credits and public program expansions. In addition, the College signed onto an American Medical Association statement that very generally calls for universal health care coverage, including a benefits package that must "reflect generally accepted standards of medical practice, supported by outcomes-based evidence-based data regarding clinical appropriateness, where available."

Since its adoption of the principles for Health System Reform and the Uninsured, the ACC has been seeking opportunities to increase its role and to participate with other groups in pursuing enactment of reforms consistent with its principles. Both Congress and the White House have indicated they will not begin to consider the issue until April 2001 at the earliest; however, there have been clear indications that some measure of relief for the uninsured will be considered this year. The Bush Administration has put a placeholder in its budget blueprint for coverage of the uninsured through refundable tax credits, a popular bipartisan incremental approach. Another possible incremental approach is the expansion of the State Childrens' Health Insurance Program to cover more children and low-income adults. The ACC intends to pursue the formation of a coalition to discuss strategies for achieving these goals.

Most recently, Immediate Past President Arthur Garson, M.D., M.P.H., M.A.C.C., participated in a press conference with Families USA, a national, non-profit consumer advocacy organization upon the release of a report on the uninsured. Dr. Garson illustrated the deleterious impact that a lack of health insurance has on people with heart disease. The event, led by John Pollack, Executive Vice President, Families USA, was used to release the findings of a Families USA-sponsored study, which revealed in part, that uninsured people with heart disease are four times more likely to not receive care because they cannot afford it. The study looked at care for five common chronic conditions: heart disease, hypertension, arthritis, high cholesterol and lower back pain. Information about the College's principles on the uninsured is available at the ACC's Advocacy Issues Center.