ACA Repeal – Good or Bad for Doctors?
As Trump is sworn in as the 45th President of the United States, the Republican-led Congress is making strategic moves to repeal the Affordable Care Act (ACA), a.k.a. “Obamacare.” Despite their promises to immediately replace the ACA with a new plan, no solid details have been given out by Trump or Republicans.
The effects of the ACA on the lives and practice of doctors has been complex, and opinions as to whether the law has been good or bad for doctors are clearly divided along party lines. There is high anxiety surrounding the proposed repeal from patients and doctors alike. Without a clear plan in place, it’s hard to know how a repeal would affect doctors and the future careers of current med school students.
Here are some concerns when considering the repeal:
- Fewer patients in a smaller insurance pool – The ACA has enabled roughly 22 million previously-uninsured Americans to purchase health insurance or obtain it through expanded Medicaid programs. The ACA also has rules in place that end pre-existing condition exclusions for children, allow young adults under the age of 26 to be covered under their parents’ insurance and prohibit arbitrary withdrawals of insurance coverage. If repealed with no immediate replacement, millions of people could be dropped from their plans and left unable to purchase new plans. Fewer people with insurance equals fewer patients seeking regular treatment from physicians.
- The end of new government incentives for primary care physicians – A central goal of the ACA was to prioritize the “recruitment, training and retention of primary care professionals”. To meet this goal, the ACA authorized several financial incentives for physicians in primary care and related services and those willing to work in underserved areas. If repealed, the lack of incentives could further exacerbate the decline in primary care physicians, particularly in underserved areas.
- Reduction of red tape for doctors – Limiting regulation and the burden it places on small business (including doctors’ offices) has been a major platform of Trump’s campaign. Additional paperwork and non-clinical duties take doctors away from time with their patients. Even before the ACA, independent practices were being bought up by hospital networks and larger corporations. Physicians have widely reported that the additional administrative burdens imposed by regulations such as the ACA, have been a substantial roadblock to creating and running profitable physician-owned doctors’ offices. A replacement for the ACA could conceivably take steps to reduce the red tape and give incentives to independent practice.
- Handing regulation to the states – An idea that is gaining ground is the possibility of handing responsibility over to the states. This could create an environment of experimentation in healthcare by allowing different types of policies to be tested and evaluated simultaneously. This solution could even give doctors themselves a stronger voice in shaping the policies within their own states.
With all the uncertainty around the “repeal and replace” movement, one thing is certain: doctors are on the front lines when it comes to the effects of policy changes on the ground. The evolving legislature will impact the profession for years to come. It’s essential that doctors and almost-doctors communicate with elected officials, professional organizations and the media to help shape the future of healthcare policy.
If you need to study up on the ACA, here is a great primer.
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