Whether you think the “first 100 days” marker of U.S. presidencies is indeed an important benchmark or just a media contrivance, most presidents try to make long legislative strides in this time. And this administration has been no exception.
Much of the current legislative agenda is riding on the promise to repeal and replace the Affordable Care Act (ACA). The stakes are high for both legislative priorities and the country’s economic future. InCrowd wanted to hear physicians’ perspectives, particularly their opinions on how policies will impact the healthcare system.
From One Unpopular Health Policy to Another
Though only a slight majority of physicians surveyed approve of the ACA, just 28% support of the American Healthcare Act (AHCA) and 43% disapprove of it. Notably, 17% of physicians state they are unsure where they stand on the AHCA, with parts of the bill expected to change as it makes its way through Congress. “The ACA is extremely imperfect,” said a pediatrician in Wisconsin. “However, the AHCA does nothing but exacerbate its flaws.”
Of the major proposals in the AHCA, the only one with slightly higher support (42%) than opposition (39%) is the ability of insurers to set premiums based on health status so long as the state has established a high-risk pool. The majority is opposed to ending all federal funding for Planned Parenthood (65%), ending employer requirements to cover birth control (58%), and generally setting insurance premiums based on health status (58%).
Before passing the House, there was a late amendment to the AHCA allowing states to eliminate so-called Essential Health Benefits, including coverage for prescription drugs, maternity care, mental health and substance abuse treatment, and other services currently required under the ACA. More than two-thirds of physicians polled by InCrowd believe every Essential Health Benefit in the ACA should continue to be mandatory, with 8 of the 10 benefits supported by more than three-quarters of respondents.
Many Voters Express Lack of Confidence in Healthcare Policy
Of the 1,003 US physicians surveyed, opinions primarily followed physicians’ voting preferences with 56% disapproving of the new administration. The 56% rating is also slightly higher than the national approval of 41-54 points, according to a Gallup poll conducted around the same time.
The president received the highest approval ratings on his handling of the economy (41%) and tax policy (40%). His lowest marks were on healthcare policy (21%) and education (20%). Of those who voted for the Administration, education received 50% approval rating and healthcare 54%. In contrast, this group gave significantly higher marks in other areas, with 74% stating they approve of the president’s overall performance so far, and approval ratings of 86% on the economy, 78% on tax policy, and 77% on immigration.
Healthcare Challenges in the Next Four Years
Physicians were asked about a number of healthcare challenges facing the US healthcare system and whether they expected things to improve, get worse, or remain the same. Of these challenges, there were none, which the majority expected to improve over the next four years. There were many which a majority of respondents expect to get worse, including reimbursement rates for physicians (65%), the cost of insurance premiums (63%), number of uninsured patients (59%), and the shortage of healthcare professionals (59%).
Many of the contextual comments mention frustration with Washington gridlock and a lack of confidence in either party. Funding for the National Institutes of Health is top of mind for many physicians, with a number expressing concern over how cost-cutting will impact public health. “You cannot defund research and expect to get results,” says a gastroenterologist in South Carolina. “Another aircraft carrier will not stop an epidemic.”
When it comes to shortage of healthcare professionals, physicians are pessimistic. Some wonder: Why become a physician?
“There is no incentive for intelligent students to go into healthcare with the large debt from tuition and limitations on income,” according to an OB/GYN from Pennsylvania. An emergency room physician from Florida points out that, “The smart kids are going to business school, not med school.”
The fact that there is not a single healthcare category where doctors feel optimistic is reflective of the complexity and uncertainty around the current state of affairs. Furthermore, InCrowd’s survey results reveal an interesting finding around physicians who voted Republican: that they seem to be compartmentalizing the Administration’s performance on healthcare policy, versus other major issues affecting the country.