Most primary care doctors ‘strongly endorse’ key elements of the Affordable Care Act
PHILADELPHIA – Proponents of repealing the Affordable Care Act, including President Donald Trump's nominee for Secretary of Health and Human Services, Tom Price, have argued that the law places an undue burden on physicians. However, according to new research, while nearly 74 percent of physicians surveyed favor making some changes to the law, only 15 percent favor repealing the legislation in its entirety. Additional results of the survey, published in the New England Journal of Medicine, show that participants almost universally support prohibiting insurance companies from denying coverage or charging higher prices on the basis of pre-existing conditions, and allowing young adults to remain on their parents' insurance plan until 26 years of age.
"Tens of millions of people could be at risk of losing health insurance if critical elements of the Affordable Care Act are repealed. Given the central role physicians play in the health care system, their views of the legislation are important for informing the public debate," said co-author David Grande, MD, MPA, an assistant professor of Medicine at the Perelman School of Medicine and director of Policy at Penn's Leonard Davis Institute of Health Economics. "We don't yet know what provisions may be repealed or modified, but we have started to see signs of what could be coming, and what has been absent in the conversation so far is how physicians feel the law has impacted their patients' and the care they are able to deliver."
Given the rapidly and dramatically changing political landscape, the authors conducted a survey of more than 400 physicians randomly selected from the American Medical Association's Masterfile from December 2016 through January 2017 to gauge perspectives of the ACA and specific policy options put forth in recent public debate. Though responses varied according to the physicians' self-reported political party affiliation (no Democrats wanted to see the ACA repealed, while 32 percent of Republicans did), among all participants, only 37.9 percent of those who reported voting for Trump wanted to repeal the ACA in its entirety.
In general, participants responded most favorably to policy changes that might increase choice for consumers, such as creating a public option resembling Medicare to compete with private plans, providing tax credits to allow people who are eligible for Medicaid to purchase private health insurance, and increasing the use of health savings accounts. Physicians responded most negatively to policies that would shift more costs to consumer through high-deductible health plans, and less than half were in favor of proposals to decrease insurance-market regulations, require states to expand Medicaid, or expand Medicare to adults 55 to 64 years of age.
"With his new executive order, President Trump has sent a message that he may try to unravel key elements of the ACA," said lead author Craig Pollack, MD, MHS, an associate professor of General Internal Medicine at the Johns Hopkins University School of Medicine. "By and large, primary care physicians are open to modifications of the law, but believe several aspects of the ACA with its focus on increasing insurance coverage are important to patient's health. They worry about changes that rely on high deductible health plans that require patients to shoulder more health care costs."
The paper was also co-authored by Katrina Armstrong, MD, chair of the department of Medicine at Massachusetts General Hospital.
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