Just 15% of primary care doctors want ACA repealed, survey finds

Kate Wallis MD, Fellow in Developmental-Behavioral Pediatrics, Children’s Hospital Philadelphia speaks as a "Save My Care" cross-country bus tour stops in Philadelphia for a rally to save the Affordable Care Act, Wednesday January 25, 2017. ( DAVID SWANSON / Staff Photographer )

Primary care physicians overwhelmingly oppose full repeal of the Affordable Care Act, a new survey finds, and a majority disagree with Republican proposals like selling insurance across state lines.

Opinions of the 426 respondents to the national survey, published as a perspective piece Wednesday in the New England Journal of Medicine, varied according to political affiliation but no subset wanted Obamacare gone: 38 percent of Trump voters supported repeal, as did 32 percent of Republicans generally. Not a single Democrat in the survey wanted the law repealed in full.

Asked about specific parts of the ACA as it currently exists, "the physicians we surveyed almost universally" — 95 percent — "supported the insurance-market regulations that prohibit insurance companies from denying coverage or charging higher prices on the basis of preexisting conditions," wrote the physician-authors, Craig Evan Pollack of Johns Hopkins, Katrina Armstrong of Massachusetts General Hospital, and David Grande of the University of Pennsylvania.

Half of physicians even favored keeping the tax penalty for individuals who don't buy insurance, a provision that is strongly opposed by Republicans and the general population. 

The survey was conducted by mail from December 2016 to January 2017; "a $2 incentive was provided in the first mailing."

Physicians in past decades have often strongly opposed various types of health-care reform, seeing it as a threat to their livelihoods.

Nearly 74 percent of respondents in the latest survey favored making some changes to the ACA, but not necessarily those that have been proposed by Republicans in Congress or mentioned by President Trump. 

"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," the authors wrote. One area of agreement with Republicans was on increased use of health savings accounts — 69 percent were in favor.

"Physicians responded most negatively to policies that would shift more costs to consumers through high-deductible health plans," according to the paper, with less than half favoring proposals to decrease insurance-market regulations by, for example, allowing insurance companies to sell across state lines, an idea that gets consistent support among congressional Republicans and was often touted by Donald Trump during the campaign.

Another survey published as a perspective paper in Wednesday's New England Journal examined support among the general public for Medicaid expansion, a key part of the ACA that is credited with providing insurance to 12 million of the 20 million who have been estimated have gained coverage under the law.

The paper, by Benjamin D. Sommers and Arnold M. Epstein, both at Harvard, examined opinions in four states, including three that had accepted the optional expansion and  one that had not.

"By far the strongest predictors of positive attitudes toward the law were whether a respondent lived in an expansion state and whether that person had Medicaid or ACA marketplace coverage (as opposed to being uninsured)," they wrote.

"Even among one of America's reliably conservative groups, Southern whites," the proportion reporting beneficial  experiences with the law in two expansion states, Arkansas and Kentucky, signficantly exceeded those reporting harm. In Louisiana, which expanded Medicaid more  recently, white respondents were split. Texans, whose state did not expand Medicaid, reported more harm from the ACA. 


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