Editor’s note: In an update to this article, the Supreme Court on Monday agreed to hear a challenge from red states that the ACA is unconstitutional, with the case likely to be heard this fall.
It’s been almost 10 years since the Affordable Care Act (ACA) became law, and U.S. physicians are still divided about its future.
A survey that asked doctors their views on critical healthcare issues found physicians were split over the ACA, which was signed into law on March 23, 2010, by then-President Barack Obama.
Eighty percent of physicians said they think the ACA will be defunded, and 74% said they believe the law will remain in place despite recent court rulings, according to InCrowd’s fifth annual U.S. physician sentiment and predictions survey.
The survey demonstrated growing optimism about the ACA’s future, as the statistics show a jump from the 60% of respondents in 2019 who believed the country would retain the ACA. The preexisting conditions coverage provision of the law, one of its most popular features, likely will remain in place, according to 78% of respondents.
Although it’s been almost a decade, there’s still uncertainty about the law, which expanded insurance coverage and changed how healthcare is paid for and delivered.
Physician opinions on healthcare
Physicians were cynical about change to the healthcare system:
—The majority of respondents predict no change at all occurring in U.S. healthcare in 2020.
—Nearly 30% predict rising drug prices in 2020, the highest percentage in the five years InCrowd has conducted the survey.
—Concerns over profit-driven behaviors of the pharmaceutical industry remained, with 32% in 2020, up from 21% in 2019, saying the pharmaceutical industry should stop unnecessary price increases.
—55% of physicians advocated for pharmaceutical companies to spend less on marketing, including direct-to-consumer advertising, as a way to reduce costs.
—Only 4% expect greater transparency in pricing in the coming year.
—Two-thirds see opioid addictions stabilizing or declining. Respondents advocated for better mental health programs, removal of physician satisfaction surveys and the proliferation of alternative medicines to further address the epidemic.
—Two-thirds also said patient privacy concerns will rise as 2020 will bring growing use of technology in medicine, with many physicians citing data issues as inevitable.
The Supreme Court in January declined to hear a lawsuit from 17 red states that seek to dismantle the controversial healthcare law. The court said it will wait for a federal appeals court to decide on the constitutionality of the ACA, meaning a final decision on the law won’t come before the 2020 election.
A group of 20 blue states and the District of Columbia are fighting the lawsuit and had asked the Supreme Court to intervene in the case and circumvent a likely lengthy review by an appellate court.
In a blow to the ACA, a three-judge panel of the Fifth Circuit Court of Appeals in New Orleans decided in December that the ACA’s individual mandate, which requires Americans to carry health insurance or face a penalty, was unconstitutional. However, the court declined to decide on whether the rest of the law should go down with the mandate, which the red states’ lawsuit is requesting.
InCrowd surveyed 200 physicians, including generalists and specialists, between Dec. 30 and Jan. 2.
Many of the doctors surveyed verbalized fears for the millions of Americans who would be left without coverage without the ACA, InCrowd said. However, many others reported poor experiences with the ACA and believed the impact of its eradication will be minimal.
“People like the ACA now. Repeal of protections for preexisting conditions is political suicide. Medicare for All is not that popular across the spectrum when people learn it means enormous tax increases and losing current health insurance coverage,” said a specialist from California.
As healthcare reform dominates the political discourse, only 18% of physicians said they expect universal healthcare, such as “Medicare for All,” to be enacted in 2020. Some Democratic candidates for president are advocating for a change to a single-payer system, including front-runner Sen. Bernie Sanders of Vermont.
The idea is controversial, and some candidates have now backed away from Medicare for All and are advocating for a public option plan that keeps the current system of private insurers and makes Medicare available to those who want it.
Many physicians, however, said they support universal healthcare, suggesting a gradual rollout that builds on an existing system (such as Medicaid) would allow for both public and private options to coexist and would provide physicians with adequate reimbursement.
The survey found physicians are significantly more frustrated with healthcare affordability and access issues in 2020 than they were in 2019.
Over half of physicians ranked affordable therapies and wider access as their top priorities for the U.S. healthcare sector in 2020 versus the development of innovative new treatments—a statistically significant jump over 2019.
Only 22% of respondents in 2020 thought bringing innovative new therapies to market faster was important this year, compared with expanding affordability (96%) and improving wider access to available therapies (52%).
“What’s interesting about this year’s data is that we’re seeing less emphasis on the importance of bringing innovative, new therapies to market faster, often too costly and out of reach for patients, with only one in five prioritizing it, versus expanding affordability, which was nearly a unanimous top priority for respondents,” said Daniel Fitzgerald, CEO and president of InCrowd.
While doctors think new treatments will become available, they won't help patients if they can't afford them.
“I think we will continue to see new, promising drugs emerge but will be financially out of reach for patients. Or patients will be initially able to afford them with discounts, but those will then become unavailable and then patients will be forced to switch,” said a specialist from Missouri.