I have copy and pasted the entire piece. My comments will be in red.
A View from the Front Line — Physicians’ Perspectives on ACA Repeal
The recent election of Donald Trump as President of the United States has created substantial uncertainty about the future of U.S. health policy. The incoming administration has sent mixed signals about the Affordable Care Act (ACA) — embracing some aspects of the law while campaigning against it and pledging to repeal it. The provisions that may be repealed or modified and the new policies that may be enacted are still unknown.
The perspectives of primary care physicians (PCPs) on the potential repeal of the ACA are important for informing the public debate, given PCPs’ central role in the health care system. Patients are most likely to have long-standing relationships with their PCPs and to rely on them to help make health-related decisions that affect their health care costs, quality of care, and outcomes. Moreover, proponents of repealing the ACA, including the nominee for secretary of health and human services, Tom Price, have argued that the law places an undue burden on physicians.1Although much is known about the general public’s perspective on the ACA, less is known about physicians’ attitudes toward health care reform and its potential repeal.
In a survey conducted between January and March 2015, PCPs were split, with approximately half having a favorable view of the law (48%) and the other half unfavorable (52%).2 A majority reported that they had seen an increase in the number of Medicaid or newly insured patients, without a decrease in their ability to provide high-quality care.
Given that the political and policy landscape changed dramatically over the ensuing months, and that physicians were gaining more experience with the ACA’s provisions, we performed our own survey, by mail, of PCPs from December 2016 through January 2017 to assess their perspectives on the ACA and specific policy options put forth in recent public debate. One thousand physicians, including physicians trained in internal medicine, pediatricians, geriatricians, and family practitioners, were randomly sampled from the American Medical Association (AMA) Masterfile, which contains information on AMA members as well as nonmembers. Physicians received up to two mailings and a telephone call, with an option to complete the survey online. A $2 incentive was provided in the first mailing. Overall, 426 physicians responded to the survey. After we excluded ineligible physicians, our adjusted response rate was 45.1%. Our survey has several limitations: nonresponse may limit the generalizability of the findings, and PCPs may have views that differ from those of other physicians, given differences in political affiliation according to specialty.3
So you polled less than 1,000 members of the premier association for America's health providers?
We found that in response to the question, “What would you like to see the federal policy makers do with the Affordable Care Act?,” 15.1% of PCPs indicated that they wanted the ACA to be repealed in its entirety. Responses varied according to the physicians’ self-reported political party affiliation; no Democrats wanted to see the ACA repealed, whereas 32.4% of Republicans did. Among physicians who reported voting for Trump, only 37.9% wanted the ACA repealed in its entirety. PCPs were less likely than the general public to want the law repealed. A Kaiser Family Foundation poll conducted after the election that used a question and response options similar to those in our survey showed that 26% of the general public wants the law repealed in its entirety.
I am very interested in this number because it doesn't match reality. Only 15.1% of respondents favored outright repeal but yet look to your own world. How many times have you had to switch a PCP because they didn't take your plan due to network participation? Granted that doesn't happen with Medicare Supplement but Medicare members who have Medicare Advantage have to deal constantly with network issues. If providers were that satisfied with the operations of the ACA, I doubt we would be dealing with such network issues.
When asked about aspects of the ACA as it currently exists, the physicians we surveyed almost universally supported the insurance-market regulations that prohibit insurance companies from denying coverage or charging higher prices on the basis of preexisting conditions (95.1% stated that the prohibition was “very important” or “somewhat important” for improving the health of the U.S. population). There was also strong support for other key provisions of the law, including allowing young adults to remain on their parents’ insurance plan until 26 years of age (87.6%), providing tax credits to small businesses (90.8%) and tax subsidies to individuals (75.2%), and expanding Medicaid (72.9%). A lower proportion — just under half — favored the tax penalty for individuals who do not purchase insurance (49.5%).
I do not for one second believe that 72.9% of responding providers favor expanding Medicaid. Try finding a provider that will accept NJ Family Care. It is nearly impossible. That's because Medicaid will only compensate Medicaid doctors and those reimbursements are so low it was said to me once by a provider "the minute that patient walks through my door, I am losing money". I have no doubt the providers support the Age 26 law because here in NJ, we used to have Age 31.
Among both physicians and the general public, there is a large gap in support between provisions that allow people to obtain insurance without respect to preexisting conditions and mechanisms for ensuring that both healthy and sick people enroll in coverage.4 These results point to an important need to educate health care 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.
Oh my goodness, this is so void of reality, it borders on malpractice. Once you mandate coverage for Pre-X, adverse selection doesn't matter because that carrier has now purchased that claim regardless. Your unsustainable costs stem from covering everyone and everything under the sun and then not charging the correct amount of premium based on risk management and actuarial science.
Although only 15% of PCPs want the ACA repealed, nearly three quarters (73.8%) favor making changes to the law. Physicians responded most favorably to policy proposals 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 consumers through high-deductible health plans. Less than half were in favor of proposals to decrease insurance-market regulations (by allowing insurance companies to sell across state lines), require states to expand Medicaid, or expand Medicare to adults 55 to 64 years of age.
This is far more realistic and even I have proposed expansion of Medicare to folks Age 55 and above with certain caveats. Physicians like the broker community oppose high deductible plans for consumers as they do not work. The member does not want to use their coverage because of that high deductible that needs to be met and so the opportunity for preventative care or getting ahead of an illness before it progresses is eliminated. No, there are better ideas out there.
In the next few months, the country will embark on another major debate about the future of U.S. health policy. According to recent estimates, the health insurance coverage of nearly 30 million people could be at risk if critical elements of the ACA are repealed and the nongroup-insurance market is disrupted.5 As policymakers consider changes to the ACA, they might consider the views of PCPs, given their unique role in the U.S. health care system. We found that PCPs strongly endorse key elements of the ACA that enable individuals to obtain insurance coverage and that very few support repealing the law.
While I support having the providers in this conversation, I also support having the insurance broker community in this conversation as well. We, like the providers are on the front line and see the results of this law on a daily basis. I think many of us support the replacement mores than the repeal because like I stated above, if you change the law enough to make it unrecognizable did you not in essence repeal it.
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