When Congress passed the Tax Cuts and Jobs Act in December, it also repealed the individual mandate for health insurance in the Affordable Care Act. InCrowd decided to conduct a survey with 201 physicians to understand the impacts and impressions of this change. This survey was a follow-up to our annual predictions survey conducted in November and InCrowd held a webinar in January to discuss the findings.

Here is a recap of key findings from the survey around the repeal in the tax bill:

Question #1: “How will the repeal of the mandate impact your patients, and how will it impact your practice?”

The concerns physicians had for their patients were pretty consistent across the board. They were afraid that:

• Younger and healthier people will leave the insurance pool.
• Cost for individual plans will increase.
• Low-income or needier patients will no longer be able to afford health insurance.

Along those same lines, for the patients who do continue to purchase insurance, there was concern that insurance plans would be less comprehensive and ultimately would not serve patients well if they experienced a major health issue.

Closely tied to this were concerns about how this will impact actual patient health. Many physicians are expecting patients to decrease the frequency of their visits or fall out of compliance with their treatment plans – taking steps back from preventive care overall. Physicians are also expecting higher out-of-pocket costs for medications.

For their professional practice, physicians were concerned financially and from a workflow perspective. One out of four physicians mentioned concerns regarding patient retention and management. They believe that, first off, many of their patients will drop their health insurance coverage and leave the practice. In other cases, patients will keep their coverage, but out-of-pocket costs will go up, which led many physicians to believe that patients will make fewer visits overall.

And if patients are making fewer visits, each visit will be far more demanding. So instead of a patient coming in looking to discuss one particular issue, they could have a litany of issues that need to be addressed in a very short amount of time.

This connects to our respondents’ major financial concerns as well. A third of respondents are concerned about the impact this will eventually have on reimbursement. With the expectation that in many cases reimbursement rates will decrease.

About 8% of physicians are thinking about how all this will impact their ability to pay employees at competitive rates and the prospect of potentially losing some of their most valuable staff members to higher paying jobs.

Question #2: A series of statements that respondents had to agree or disagree with on a five-point scale.

As evident in the chart above, there’s a strong sentiment that there will be cuts to Medicaid and to Medicare in 2018. Speaker of the House Paul Ryan has stated that Republicans plan to review entitlement spending for Medicare, Medicaid, and welfare during the coming year. So this finding is not surprising. Another item where you see nearly 70% of respondents agree or strongly agree is that over the past four years the individual mandate was effective in increasing insurance coverage.

A few other statements asked to about how effective our respondents believe the individual mandate was. Aside from increasing overall insurance coverage, there’s also the issue of cost.

Here are other key takeaways:

• 55% of respondents believed that repealing the mandate will increase the cost of health insurance.
• 69% said the individual mandate has increased insurance coverage over the past four years, compared to 22% who said it has lowered overall costs.
• Nearly a third took a neutral stance on whether this piece of the ACA, individual control mandate was effective in decreasing costs. So this uncertainty may play into how perspectives on the individual mandate have changed over time.
• Approximately 53% report that they favored the individual mandate when it was first enacted.
• 46% still felt favorable about it – a difference of seven percentage points.
• 19% of these physicians believed the repeal of the individual mandate is a good thing for patients.
• 57% said consumers should be required to carry health insurance coverage.
• 20% said the repeal was good for patients.