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Obamacare: Repeal or Replace?

Recent survey finds support for keeping parts of it intact, even among those who want it repealed.

If the Affordable Care Act was repealed the first day the new president takes office, then 30 million people would lose their insurance and a huge burden would be placed on those with prior existing health conditions.

A recent survey’s findings come as leaders in the Republican-controlled Congress make plans to repeal the law, also known as Obamacare, when President-elect Donald Trump takes office. It was promised that it would be on of the first things he does as president.

The survey found virtually no support for keeping the law as is. But nearly 4 in 5 physicians who answered the survey want at least some aspects of it preserved, whether as part of the current law or in a new one.

The survey was conducted in late November and includes responses from 687 physicians and 835 consumers of a medical online newsletter.  Of those:

  • Nearly half (49%) of the consumers and 43% of physicians believe the law should be kept, but improvements should be made.
  • 31% of consumers and 36% of physicians believe the law should be repealed, but some aspects of it should be used in a replacement law.
  • 19% of consumers and 18% of physicians believe the law should be repealed and replaced with a new one.
  • Only 2% of the consumers and 3% of physicians believe Obamacare should be kept as is.

The finding is consistent with other recent polls that have found less enthusiasm for a total repeal of the law. A Kaiser Health Tracking Poll released on December 1 found that 1 in 4 Americans wanted a full repeal. It also noted that the number of Republicans who want the law repealed had dropped from 69% to 52%. A HealthDay/Harris poll found that 28% of Americans supported a full repeal.

“In the past, when people might have been asked if they were for or against the ACA, it was almost a free pass; with President Obama in the White House, there was no way it was going away. Now, where there’s a very real threat it will be repealed, people are saying, ‘Hey, wait a minute. What are we losing in the process?’ ”

The survey also found broad support for specific aspects of Obamacare that physicians and consumers say should be required of all healthcare plans. They include the following:

  • Coverage of mental health services: 95% of consumers, 91% of physicians
  • Coverage of preventive services, such as mammograms and colonoscopies, with no copayment: 92% of consumers, 78% of physicians
  • Women’s health coverage, such as birth control and maternity benefits: 87% of consumers, 80% of physicians
  • Coverage for young adults up to age 26 under a parent’s plan: 82% of consumers, 88% of physicians
  • No lifetime maximum benefits on health insurance coverage: 82% of consumers, 82% of physicians
  • The majority of respondents had a high level of support for women’s health coverage
  • 77% of both consumers and doctors felt that the federal government should provide an option allowing people to purchase government-administered health coverage, also known as a “public option.”

Even among the consumers who say they support a full repeal of the ACA, an overwhelming majority still support some of its provisions:

  • 89% believe all healthcare plans should provide coverage of mental health services.
  • 85% believe all healthcare plans should cover preventive services with no copayment.
  • 77% believe healthcare plans should have no lifetime maximum benefits on coverage.
  • 76% believe all healthcare plans should provide women’s health coverage.

In addition, 66% of those supporting a repeal say they believe it’s important to have affordable healthcare coverage for everyone, and 63% support a “public option.”

According to the survey, if the ACA is fully repealed, physicians and consumers paint a different picture of what they believe will happen.

Among doctors:

  • 47% believe their patients’ costs will increase.
  • 57% believe their patients’ benefits will decrease.

Among consumers:

  • 45% say they believe their costs will stay the same.
  • 58% believe their benefits will remain the same.

Asked about their biggest healthcare priority for the next president and Congress, physicians and consumers were split.

Physicians listed their priorities as follows:

  • Cuts in healthcare premiums (41%)
  • Universal healthcare coverage (31%)
  • Lower drug prices (21%)

Consumers, however, had a different top priority:

  • Universal healthcare coverage (34%)
  • Cuts in healthcare premiums (34%)
  • Lower drug prices (24%)

Practice Pearls:

  • The majority of those covered under ACA want the cost to come down and keep some of the benefits.
  • Prior existing conditions is one of the major items that should be kept.
  • Mental health services, coverage of preventive services at no cost, and lower drug prices round out the most important elements that people want to continue with.

Center on Health Insurance Reforms, Health Policy Institute, Georgetown University; Kaiser Family Foundation; HealthDay/Harris poll.