What PCPs really think about repealing the ACA

A recent survey found most primary care physicians are in favor of keeping the ACA, despite that proponents of repeal say the law needlessly burdens physicians.

"What we heard is that the majority of primary care physicians are open to changes in the law but overwhelmingly opposed full repeal," Craig Pollack, MD, lead author and associate professor of medicine at Baltimore-based Johns Hopkins University School of Medicine, said in a statement.

The small survey, published in The New England Journal of Medicine, polled 426 primary care physicians from a random sample of the American Medical Association Masterfile between December 2016 and January 2017. Physician specialties included internal medicine, pediatrics, geriatrics and family medicine.

Here are three main findings from the survey.

1. Just 15.1 percent of PCPs want the entire ACA repealed. All respondents who wanted the law repealed in its entirety identified as Republican. They accounted for 32.4 percent of all Republican respondents. Among those who voted for President Donald Trump, 37.9 percent want the entire law repealed.

2. PCPs strongly support the regulations the ACA put on the insurance market. For example, 95.1 percent of PCPs said the provision that prohibits payers from denying coverage to those with preexisting conditions was "very important" or "somewhat important" for improving our nation's health. Other provisions that received support include tax credits for small businesses (90.8 percent), allowing young adults up to age 26 to stay on their parents' plans (87.6 percent), individual tax subsidies (75.2 percent) and Medicaid expansion (72.9 percent).

3. Despite support for provisions that expanded coverage to high-risk patients, roughly half of physicians favor the individual mandate and penalty. This reflects the sentiment of the general public as well, according to the report. "These results point to an important need to educate healthcare providers and the public about the fundamental inseparability of these provisions: policies that do not address adverse selection would lead to increased and unsustainable health insurance costs," the authors wrote.

4. Most physicians (73.8 percent) want parts of the law changed. In particular, PCPs said they favored proposals to increase consumer choice, such as a proposal to create a public option to compete with private payers, similar to Medicare. Physicians were also supportive of proposals to increase the use of health savings accounts (68.7 percent) and to provide Medicaid-eligible people with tax credits to purchase private insurance (58.6 percent). High-deductible health plans were the least popular, gaining support from just 29.4 percent of respondents.

 

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