Most doctors, even Trump supporters, oppose ACA repeal but favor changes

When it comes to repealing all of the Affordable Care Act (ACA), primary care physicians are even less supportive of the idea than their patients, according to a new survey published in the New England Journal of Medicine.

Surveying pediatricians, geriatricians, family practitioners and internal medicine physicians in December and January, only 15 percent of respondents wanted the ACA repealed in its entirety. A December poll from the Kaiser Family Foundation found only 26 percent of all Americans hope the law is completely eliminated.

Political ideology mattered among respondents: Not a single self-identified Democrat physician favored repeal, but neither did a majority of Republicans (32 percent) or those who reported voting for President Donald Trump (38 percent).

“Primary care physicians are on the front lines of health care—they are physicians that patients know best and turn to first when they are sick. With primary care physicians often helping patients navigate challenges with their insurance, it is critical to understand their perspectives on the repeal of the act,” said Craig Pollack, MD, MHS, associate professor of medicine at the Johns Hopkins University School of Medicine and lead author of the survey.

While full repeal was supported by few doctors, so was keeping the law as-is. Nearly 74 percent of physicians responding to the survey wanted to see the law changed in some way, with varying support for various reforms:

• Increasing use of health savings accounts: 69 percent in support.
• Government-run insurance option to compete with private plans: 67 percent.
• Pay physicians for value rather than volume: 62 percent.
• Tax credits for Medicare-eligible patients to purchase private plans: 59 percent.
• Make Medicaid expansion mandatory for all states: 47 percent.
• Expand Medicare eligibility to patients between ages of 55 and 64: 43 percent.
• Deregulate private insurance: 42 percent.
• Increase use of high-deductible insurance plans: 29 percent.

The same provisions of the ACA which Trump indicated he wants to keep saw broad support among physicians. 95 percent favored the ban on insurers denying coverage based on pre-existing conditions and 88 percent supported allowing children up to age 26 to stay on their parents’ plans.

The individual mandate, the least popular part of the ACA among patients, was slightly more popular among physicians, with just under 50 percent saying they support it.

"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," said co-author David Grande, MD, MPA, assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine and director of policy at Penn's Leonard Davis Institute of Health Economics.

Trump’s nominee for HHS Secretary, U.S. Rep. Tom Price, MD, R-Georgia, has said during his two congressional hearings that doctors have complained to him about the ACA, particularly its effect on accelerating the use of high-deductible plans leading to patients putting off necessary care.

He’s also a specialist, having run an orthopedics practice before joining Congress. An October 2016 New York Times story identified orthopedics as the most heavily Republican specialty.