Physician Community’s Reaction to Health Reform Verdict is Mixed

July 17, 2012 - When the Supreme Court handed down its verdict upholding the Patient Protection and Affordable Care Act in late June, the reactions began immediately. Fast and furious, opinions were issued: positive reactions, negative reactions, measured reactions.

Even in the healthcare community, the reaction was all over the map. Some healthcare organizations criticized the court for not throwing out the law, while others applauded the verdict. Some expressed their overall support for the law but noted their concerns about certain provisions or the costs associated with implementation of the law.

The divided opinions are also evident within the physician community. For example, an article published in the Journal of the American Medical Association in April stated, “Surveys of practicing physicians present a mixed picture of support for the ACA.” The article, entitled “New Physicians, the Affordable Care Act, and the Changing Practice of Medicine,” noted that “younger physicians are more supportive of the law.”

And more recently, an online poll conducted in July by the American College of Physician Executives found that opinion among physician leaders is mixed. The poll asked members if they agreed with the verdict, and 61 percent of the respondents said they did; of the remaining, approximately 33 percent were opposed and 5.5 percent were “unsure.”

“Doctors are not immune from having diverse opinions,” observed Cedric Bright, M.D., president of the National Medical Association.

Even within organizations that officially supported the law, there’s not necessarily blanket support or agreement from all the members.

The American Academy of Family Physicians took a position in support of the law, for instance, largely because the academy has supported the concept of healthcare coverage for everyone for more than two decades. And yet, not every member may have agreed. Glen Stream, MD, the academy’s president, noted that his association has “the whole spectrum of opinion in our membership.” That was true before the health reform law came along, and it’s still true now.

“We have heard from a relatively small number of people who are very upset with our support of the Affordable Care Act,” he said. “It’s been relatively few.”

Here are examples of opinions of the Court’s decision from two different physicians’ organizations:

Opposed to ACA

The Association of American Physicians and Surgeons (AAPS) has expressed its extreme disappointment with the Court’s decision. According to AAPS Executive Director Jane Orient, M.D., it’s a very simple fact: the law is unconstitutional. “There is nothing in the U.S. Constitution empowering the federal government to dictate the terms of private contracts, or to interfere in medical care,” she said.

In Favor of ACA

The National Medical Association took a strong position in support of the Affordable Care Act. According to Bright, the law affects many of the patients that the association’s members serve--including many uninsured people and people with Medicaid and Medicare. And he’s hopeful that the law will help people like them receive more preventive care services in the future. “We really believe that can be a cost savings, moving forward,” he said.

G. Richard Olds, M.D., founding dean of the School of Medicine at University of California, Riverside, noted that at least some of the recent reactions from the medical community were likely political in nature. He agreed with Bright’s observation that doctors, like everyone else, come in different political flavors. 

Also, Olds added, some doctors--including primary care providers who may receive increased reimbursements--may stand to gain from the law, while others may feel they’re in a position to lose, financially speaking. That could color their reactions, he said.

Stream said he acknowledged that there are legitimate differences of opinion in the best way to transform and reform the nation’s healthcare system--a need that has existed for a very long time, well before the Affordable Care Act was conceived. And he doesn’t shy away from reasoned debate over that topic.

“But it’s unfortunate that it’s become politicized,” said Stream, adding that he wishes for a decline in partisanship and to return to a time when more parties were interested in compromise.

What now?

Many opponents of the law have sworn to see it repealed. In fact, the U.S. House of Representatives has voted or attempted to vote to repeal the law more than 30 times.

But how likely is the prospect of repeal?

In an article published online in July for Health Affairs, authors Joel Ario and Lawrence Jacobs point out, “a deep partisan divide over the law coexists alongside explicit or tacit support by stakeholders in healthcare delivery and financing.”

They go on to say that some stakeholders have decided that “influence on critical implementation decisions is more efficacious than joining the rabble at a town-hall meeting or squandering resources on a national advertising campaign when the key decision makers are few in number and squirrelled away in government agencies.” And because of the collaborations that are occurring, they speculate that those working to have the law repealed will find the task “more daunting than expected.”

But that doesn’t mean that some opponents are backing down. Orient said the AAPS is proceeding with the lawsuit that it filed in March 2010. The association will continue to urge states to refuse to establish exchanges “or take the Medicaid expansion bait” and continue to demand repeal, she said.

Olds said that throwing out the law without a serious alternative plan would be extremely problematic. Something must be done, he said, as the United States is last among industrialized nations when it comes to health outcomes, despite the amount of money it spends on health care.

“We have to do something to provide higher-quality, lower-cost healthcare in our country,” he said. “And I think that most people would agree that that needs to be done. But it becomes about, how do we get there?”