Despite more challenging practice environment, physician support for the ACA grew in 5 years

Document titled, Affordable Care Act
Since its implementation, physician support has increased for the Affordable Care Act. (Getty/Designer491)

Physician support for the Affordable Care Act (ACA) grew over five years, with 53% of doctors now agreeing it could turn healthcare “in the right direction.”

A survey of physicians reported in Health Affairs found that in 2017, 53% of respondents agreed that the ACA, “if fully implemented, would turn United States healthcare in the right direction.” That is an 11-percentage-point increase from a similar survey in 2012 when only 42% of respondents agreed with that positive view of the ACA.

“Over the five-year period from 2012 to 2017, during which key provisions of the ACA were both celebrated and criticized as they were rolled out, U.S. physicians’ support for the ACA increased markedly,” said the study authors, which included researchers from the Mayo Clinic and other institutions.

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Both the 2012 and 2017 surveys were mailed to a random but completely different sample of U.S. physicians. Researchers said they decided to repeat the survey five years after the initial study in 2012, which was conducted to gauge initial reaction to the law’s implementation, to see whether physician attitudes about the ACA had changed. The ACA passed in 2010, and it is estimated more than 30 million Americans have gained access to health insurance coverage through the law.

RELATED: 60% of ACA exchange insurers plan to broaden participation in 2020—survey

Of the 445 physicians who responded to the survey in the summer of 2017—when Republicans in Congress and the White House were trying unsuccessfully to repeal large portions of the law—a majority (60%) said the ACA had improved access to care and insurance along with improved access to care for patients with preexisting conditions (73%).

On the negative side, many (43%) said that it had reduced the affordability of health insurance coverage, and 34% believed it had a negative impact on the ability of their practices to meet patient demand. (The survey got a greater response rate in 2012 and by comparison had 2,560 responses.)

Why the difference in attitude about the ACA? Researchers speculated that increased familiarity with the law and experience with its impact on their professional practice may have partly assuaged earlier concerns. For instance, the percentage of physicians who believed that ACA implementation would make physician reimbursement less fair decreased from 44% in 2012 to 34% in 2017.

RELATED: 49% of doctors support 'Medicare for All'—poll

More doctors supported the ACA despite a perceived worsening in several practice conditions over the same period. Those included an increase in the amount of time spent on administrative issues related to insurance (67%), less time available to spend with each patient (59%), the inability to recruit or retain clinical staff (42%) and excess time spent managing patients’ opioid use (34%).

chart showing physician support for the ACA

In an interview with FierceHealthcare, Lindsay Riordan, a medical student in the Mayo Clinic Alix School of Medicine and the lead author of the study, said it was both interesting and surprising that while “hassle factors” for physicians worsened, there was an increased level of support for the ACA.

Although the study didn’t get into the causes behind the change in physicians’ attitudes, Jon Tilburt, M.D., an internist at the Mayo Clinic and senior study author, said the shift is notable given the fact doctors are working in a more challenging practice climate. “They are not walking around with a rosy picture of medicine and their view of the ACA is just a reflection of that rosy picture. It’s kind of the opposite,” he said.

Despite the fact challenges have increased in their own practices, “they still think this thing is probably at least, with all things considered, not as bad for patients as we use to worry it might be,” Tilburt said.

“In 2012, you could wonder if it was kind of anticipatory anxiety about how the ACA would play out. In 2017, it’s more of a moderated impression of how the reality actually did play out, which was not so catastrophic,” he said.

According to the study authors, physicians’ positive attitudes about the ACA increased across all specialties. The survey results indicated that physicians in surgical and procedural specialties, more of whom identified as Republicans and in 2012 reported less support for the ACA compared to primary care physicians, increased their support for the law over time more than even primary care doctors.

“We speculated this is related to potential fears about how the ACA might revolutionize practice. Maybe some of that fear abated,” said Riordan.

After adjusting for specialty, political party affiliation, practice setting type, perceived social responsibility, age and sex, the researchers said that only party affiliation was a significant predictor of support for the ACA in the 2017 survey. Doctors who identified as Republicans were markedly less likely to support full implementation of the ACA (18%), compared to Independents (51%) and Democrats (86%).

In other surveys, physicians have also increasingly supported the idea of a single-payer health insurance system. A separate poll of healthcare workers earlier this year found that almost half of physicians said they support "Medicare for All." Physicians were more likely than other healthcare professionals to support the proposal to replace private health insurance with a new, federally financed healthcare system.

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