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74% of PCPs Prefer Affordable Care Act Changes Over Repeal

With only 15 percent of primary care providers favoring a repeal, most said they prefer Affordable Care Act changes, such as expanding health plan options.

Almost two-thirds of primary care providers favor Affordable Care Act changes versus an entire repeal, survey shows

Source: Thinkstock

- Only about 15 percent of primary care providers favored a complete repeal of the Affordable Care Act, a recent New England Journal of Medicine study stated.

While some of the 426 primary care providers surveyed between December 2016 and January 2017 wished to see the law eliminated, about 74 percent of the providers preferred Affordable Care Act changes over a complete repeal.

Researchers stated that lawmakers should consider primary care provider opinions on the Affordable Care Act during the potential repeal process under the Trump Administration because many value-based care models place primary care at the center of care delivery.

“The perspectives of primary care physicians (PCPs) on the potential repeal of the ACA [Affordable Care Act] are important for informing the public debate, given PCPs’ central role in the healthcare system,” wrote study authors. “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.”

Even though most primary care providers preferred Affordable Care Act changes over a complete repeal, researchers revealed that the providers were split on if the law was beneficial to the industry. In a survey from January 2015 to March 2015, 48 percent of primary care providers viewed the Affordable Care Act as favorable, while 52 percent said the healthcare reform law was unfavorable.

Despite a substantial gap in views on the law, the more recent survey found several existing Affordable Care Act provisions that ranked favorably among primary care providers.

The majority of physicians approved of health insurance market regulations that stopped insurance companies from denying coverage or up-charging consumers because of preexisting conditions. About 95.1 percent viewed the regulations as “very important” or “somewhat important” for healthcare.

Most providers also supported the following Affordable Care Act provisions:

• Giving tax credits to small businesses (90.8 percent of providers in favor)

• Allowing young adults to stay on a parent’s health insurance plan until they are 26 years old (87.6 percent of providers)

• Providing tax subsidies to individuals to pay for health coverage (75.2 percent of providers)

• Expanding Medicaid (49.5 percent of providers)

The Affordable Care Act aspect with the least provider approval, however, was the tax penalty for individuals who do not have or maintain healthcare coverage. Only 49.5 percent favored the individual mandate tax penalty.

Affordable Care Act tax penalties, including the individual mandate tax, could be relaxed in the next year. President Trump signed an executive order earlier this month allowing federal agencies to “waive, defer, grant exemptions from, or delay the implementation of” any Affordable Care Act provision that imposes fiscal burdens on states and other healthcare stakeholders, such as providers, payers, and patients.

While providers generally approved of some Affordable Care Act aspects, many still wanted to see some changes to the healthcare reform law. Surveyed providers expressed the most approval for policy proposals that aimed to expand healthcare consumer options for health plans, such as a Medicare-like public option to compete with private health plans.

NEJM Graph on PCP Survey Responses on Potential Healthcare Reform

Source: The New England Journal of Medicine

The other top policy proposals favored by providers included a boost in health savings accounts use and a tax credit to individuals who are eligible for Medicaid that allows them to buy private health plans.

On the other side, more providers expressed negative views on policy proposals that would transfer more healthcare costs to consumers, especially via high-deductible health plans.

More than half of the providers also did not support policy proposals that included Medicaid expansion requirements, a Medicare age limit decrease from 64 to 55 years of age, and insurance market regulation reductions, such as permitting insurance companies to sell plans across state lines.

Researchers noted that provider perspectives on Affordable Care Act changes and potential solutions demonstrated a tension between ensuring coverage under the law and actually providing it.

“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,” wrote researchers. “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.”

Despite some knowledge gaps, the study’s authors emphasized that primary care provider perspectives should be included in Affordable Care Act repeal discussions.

In addition to value-based reimbursement models placing primary care at the center of care delivery, some healthcare stakeholders have also argued the law imposes burdens on providers. A possible repeal or changes could substantially impact provider workflows and primary care delivery.

Among those claiming that Affordable Care Act programs impose burdens on providers is President Trump’s pick for Department of Health and Human Services (HHS) Secretary, Tom Price (R-GA). Representative Price along with two other House representatives contended in an October 2016 JAMA Forum post that the healthcare law placed quality reporting burdens on providers.

“Our fellow physicians are making great efforts to navigate a set of constantly shifting metrics—some of which are directly attributable to the ACA,” the representatives wrote. “It’s frustrating to hear from so many of our physician colleagues about how much more difficult it is to practice medicine and the troubles they have navigating the changing healthcare landscape.”

Representative Price also called out CMS in October 2016 for overstepping its authoritative powers by requiring Medicare providers to participate in alternative payment models, such as the Comprehensive Care Joint Replacement and Cardiac Bundled Payment models.

Any compulsory alternative payment models must receive Congressional approval before expanding its scope, stated Representative Price and over 170 other representatives.

With the Trump administration reportedly planning a “prompt repeal” of the Affordable Care Act, according to the recent executive order, the debate on the law’s possible repeal or modification is in full swing. But the primary care provider voice should be heard by lawmakers as they decide how to proceed with healthcare reform, the study noted.

“As policymakers consider changes to the ACA, they might consider the views of PCPs, given their unique role in the US healthcare system,” concluded the study. “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.”

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