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A View from the Front Line — Physicians’ Perspectives on ACA Repeal

ARTICLE: A View from the Front Line — Physicians’ Perspectives on ACA Repeal

AUTHORS: Craig Evan Pollack, Katrina Armstrong and David Grande

JOURNAL: N Engl J Med. 2017 Feb 9;376(6):e8. doi: 10.1056/NEJMp1700144. Epub 2017 Jan 25.

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 The provisions that may be repealed or modified and the new policies that may be enacted are still unknown.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.1 Although 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

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Kelsey Bennett