US Physicians Increasingly Support the ACA

Nicola M. Parry, DVM

September 03, 2019

Support for the Affordable Care Act (ACA) among US physicians has substantially increased since its implementation despite concerns about administrative burden, a study published online September 3 in Health Affairs has shown.

"To our knowledge, this study is the first analysis of how physicians' opinions about the ACA have changed over the course of its implementation," write Lindsay Riordan, a medical student from the Mayo Clinic Alix School of Medicine, Rochester, Minnesota, and colleagues.

"A slight majority of US physicians, after experiencing the ACA's implementation, believed that it is a net positive for US health care."

Since being signed into law in 2010, the Affordable Care Act has remained a contentious issue among politicians, the public, and healthcare providers.

Physicians' opinions of the ACA are especially crucial because health reform policy substantially affects their practices. As such, they hold key input about how well the different policy components work for them and their patients.

However, studies of physicians' opinions of the ACA have been limited.

In a 2012 survey, also conducted by some of the authors of the new study, physicians' responses to the ACA were linked to their specialties, political affiliations, and perceived social responsibilities.

With this in mind, Riordan and colleagues repeated this survey to evaluate changes in physicians' opinions over a 5-year timeframe (2012 - 2017) since the ACA was implemented.

They sent surveys to 1200 physicians, of whom 445 responded to at least 80% of the questions and thus were included in the analysis. The survey asked physicians about their views of the ACA's overall effect on US healthcare and its reimbursement fairness, as well as about their impressions of specific provisions of the ACA.

Overall, 53% of respondents believed that the ACA "would turn United States health care in the right direction." This agreement was up from 42% of physicians in the 2012 survey.

In addition, relatively fewer physicians in 2017 vs 2012 felt the ACA would make physician reimbursement less fair (34% vs 44%; P < .0001).

Most respondents (60%) also believed the ACA had improved patients' access to healthcare and insurance and access to care for those with preexisting conditions (73%).

However, 43% believed it had reduced the affordability of insurance coverage.

By contrast, physicians felt that several practice conditions had worsened over the same 5-year period — in particular, the amount of time spent on insurance-related administrative issues (67%), time available to spend with patients (59%), ability to recruit or retain clinical staff (42%), and time they spent managing patients' opioid use (34%).

The researchers found that the rise in overall positive attitude toward the ACA occurred across all specialties during the study period.

They also found that, compared with primary care physicians, more surgical and procedural specialists increased their overall support for the ACA over time.

Specifically, approval among surgeons rose from 30% to 47%, and among procedural specialists it climbed from 36% to 53%.

After adjusting for specialty, political party affiliation, practice setting type, perceived social responsibility, age, and sex, only political affiliation was significantly linked to physicians' support for the ACA.

This association with political affiliation was similar to the finding in the 2012 survey, the authors say.

"The changes we observed over the five years of the ACA's implementation appear to reflect real changes in physician opinion during that period," Riordan and colleagues conclude.

"This longitudinal analysis provides evidence of greater support for the ACA among US physicians, notwithstanding many perceived growing practice challenges in the five-year period."

This study was supported by the Mayo Clinic and the National Center for Advancing Translational Sciences. The 2012 survey was supported by the Mayo Clinic and the Greenwall Foundation. The authors have disclosed no relevant financial relationships.

Health Aff. Published online September 3, 2019. Abstract

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