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Many Providers Hated the ACA When It Became Law. Have Their Opinions Changed Five Years Later?

In 2009, President Obama said, “What’s most telling is that some of the people who are most supportive of reform are the very medical professionals who know the health care system best.”

While the health care reform law eventually gained the backing of the American Medical Association, surveys and physician commentary over the past five years provide a striking contrast to Obama’s assertion.

Opposition in the Early Years

The ACA’s passage in 2010 sparked a string of doomsday opinion pieces and commentary from both health care providers and policy experts.

Physicians for Reform President and Founder C. L. Gray in a March 2010 Fox News opinion piece argued that the law would destroy the doctor-provider relationship and punish providers financially “if they spend more money on patient care than their peers.”

A June 2010 Wall Street Journal opinion piece by the American Heritage Foundation also raised concerns about the law’s effect on providers, saying, “Doctors will find themselves subject to more, not less, government regulation and oversight” and “become increasingly dependent on unreliable government reimbursement for medical services.”

Meanwhile, some providers, such as Ezekiel Emanuel — an oncologist, bioethicist and former health policy adviser for the Office of Management and Budget — called on providers to “embrace the opportunities created by the [ACA] that will enable them to provide better care for their patients and lead the U.S. health system in a more positive direction.”

A closer look at provider surveys during that time shows a similar mixture of outrage and optimism.

A 2011 survey by Jackson & Corker revealed that just 13% of AMA members agreed with the association’s position on the ACA, while 70% said they disagreed. Further, the survey showed that nearly 47% of physicians who terminated their AMA membership cited the association’s continued support for the law.

Meanwhile, a 2010 survey conducted by the Medicus Firm showed that nearly 33% of health care providers would want to leave medical practice after the ACA was implemented.

Two years later, a survey by medical liability insurer the Doctors Company found that 43% of providers said they were considering retirement within the next five years. However, a closer look at that figure reveals the majority of providers considering such a change were 61 years old and older — an age group generally considered to be on the verge of retirement.

A separate survey conducted in 2012 by the Physicians Foundation showed more than half of physicians suggested that they were less positive about the future of health care in the U.S. after the passage of the ACA. 

However, one of the top five least satisfying aspects of medical practice cited by providers was not the ACA itself, but rather the uncertainty surrounding the law’s changes.

Robert Wergin, president of the American Academy of Family Physicians, noted that there was — and still is — “anxiety and frustration with the rapid change” the law put forth. He added that the transition and change can be more difficult for older physicians.

Feelings Changed After ACA Implementation

Research shows that while providers’ opinions of the ACA remain low, they have increased as the law has been implemented.

By 2014:

  • About eight million people had enrolled in coverage through the law’s insurance exchanges;
  • Nearly five million U.S. residents had newly enrolled in Medicaid under the law’s expansion;
  • Accountable care organizations continued to expand;
  • CMS released billing data for thousands of Medicare providers; and
  • Quality-based tracking and reimbursement systems were implemented.

In addition, several indirect changes took place during the two-year time period:

  • There was an uptick in the number of hospital and medical group consolidations; and
  • The number of outpatient facilities, such as urgent care centers and retail clinics, increased.

A survey conducted in 2014 by the Medicus Firm showed:

  • 31.4% of providers gave the health reform law an overall grade of “A” or “B,” up from 23.4% in 2013; and
  • 44% of providers gave the law an overall grade of “D” or “F,” down from 50.8% in 2013.

A separate 2014 Physicians Foundation survey revealed similar results, with most providers (46%) giving the ACA an overall grade of “D” or “F,” while 25% gave it an “A” or “B” grade. According to a release, providers’ optimism about the current state of the medical profession also increased slightly from 2012 to 2014.

Overall, the surveys suggest that health care providers who view the law favorably are more likely to be:

  • Female;
  • Primary care providers; and
  • Younger.

Further, the Medicus survey showed that the percentage of providers who gave the law an “A” for improving access to care increased from 11.8% in 2013 to 23.4% in 2014, and those who gave the law the highest mark for efficiency increased from 5.6% in 2013 to 7% in 2014. Meanwhile, the percentage of providers who failed the ACA in those categories declined.

While the surveys from both the Physicians Foundation and Medicus suggest that providers’ opinions of the law have become more positive, when asked directly in the Medicus survey if their opinion of the ACA had changed only 12.6% said they viewed the law more favorably, while 47% said they saw the law less favorably.

Despite the last finding, Medicus Firm President Jim Stone in a release said the survey results demonstrate that physicians “have become slightly more positive about the ACA compared to last year’s survey,” when the law was not fully implemented. He added, “Unfortunately, the grades on the whole are not very positive.”

Wergin also expressed confidence that AAFP members’ opinions of the law have improved over time in part because of efforts to educate providers on the law and help connect them with the tools needed to adapt to the changes. Wergin said, “The ACA in essence has accomplished some of its goals” by reducing the number of uninsured U.S. residents.” But he added, “Change is hard and this certainly is a lot of change all at once.”

Around the Nation

Partisan attacks. House Republicans this week are set to vote on a series of anti-ACA bills, including legislation to repeal the law’s Independent Payment Advisory Board, National Journal reports.

Final test? If Supreme Court votes to uphold federal exchange subsidies then the ACA is here to stay, Vox‘s Sarah Kliff argues.  

Healthy Self. The Obama administration last week kicked off a campaign aimed at helping newly insured U.S. residents better understand and use their health coverage, particularly no-cost preventive services covered by plans under the ACA, The Hill reports.

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