Healthcare leaders prefer seeing changes to the Affordable Care Act rather than a wholesale repeal and replace. The results are from a new HealthLeaders Media survey that explores healthcare in the Trump era.
This is part of a series covering the Shaping of Healthcare's Future in the Trump era.
As the Trump administration officially begins later this week, a new HealthLeaders Media survey shows that healthcare industry leaders support changes to the existing law rather than replacing it. Two-thirds of respondents (66%) say the best option for the healthcare industry regarding the Patient Protection and Affordable Care Act is to make some changes but otherwise retain it.
At the opposite ends of the spectrum, 27% favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the PPACA.
Interestingly, a greater share of health systems (78%) than hospitals (66%) and physician organizations (65%) favor making some changes to the PPACA.
Healthcare Leaders Split on Incoming Trump Administration
On the other hand, a greater share of hospitals (28%) and physician organizations (27%) than health systems (17%) prefer full repeal and replacement. This is perhaps an indication that health systems are less able than other providers to accept full repeal and replacement because of their greater complexity as organizations.
Among the 66% of respondents who say that the best option for the PPACA is to make some changes, the top three changes they advocate are adding a public health insurance option (61%), eliminating the excise tax on high-cost employer health benefit plans ('Cadillac tax') (50%), and eliminating the individual mandate and noncompliance penalty (37%).
The two changes receiving the fewest responses are eliminating Medicaid expansion (10%) and abandoning the focus on value-based care and reimbursement (16%).
Among the 27% of respondents who say that the best option for the PPACA is full repeal and replacement, the top response by a large margin for key elements of a replacement law is full voluntary coverage to ensure individual choice (62%).
Responses forming a distant second tier are full universal coverage to ensure an adequate risk pool (17%), complete elimination of government-sector insurance companies (e.g., Medicare/Medicaid) and benefits managers (14%), and complete elimination of private-sector insurance companies and benefits managers (13%).
Among the 7% of respondents who indicate that the best option for the healthcare industry regarding the PPACA is to keep it as is, coverage for preexisting conditions (95%), coverage for children up to age 26 on parents' insurance (84%), and Medicaid expansion (76%) topped the list of components that are most important to keep.
Responses for the remaining items are also strong, falling in a range between 68%–76%, indicating that this particular group of respondents sees value in nearly all aspects of the PPACA.
Asked to identify the model that offers the best solution for the healthcare industry, the majority of respondents (52%) favor models with less governmental involvement such as consumer-directed healthcare (38%) and employer-sponsored healthcare (14%), approaches that generally represent politically conservative views.
On the other hand, 39% prefer government-based solutions such as government-funded universal single-payer healthcare (25%) and government-mandated universal health insurance (14%), models that are generally aligned with liberal views and include the current Patient Protection and Affordable Care Act.
Perhaps not surprisingly, among respondents who say the Trump administration will have a very positive or positive impact (41%) on the healthcare industry, a greater share say consumer-directed healthcare (64%) and employer-sponsored healthcare (56%) are the best solutions for the industry than government-mandated universal health insurance (1%) and government-funded universal single-payer healthcare (2%).
Conversely, among respondents who say the Trump administration will have a very negative or negative impact (37%) on the healthcare industry, a greater share say government-mandated universal health insurance (70%) and government-funded universal single-payer healthcare (66%) are the best solutions for the industry than consumer-directed healthcare (10%) and employer-sponsored healthcare (20%).
Nearly two-thirds of respondents (65%) say that the Trump administration should reduce regulations, but within reason, as some regulations are needed. This cautious approach runs somewhat contrary to the rhetoric surrounding the issue of overregulation of the healthcare industry.
At the two opposite extremes of the regulation question are respondents who say regulations should be reduced and that most are unnecessary and burdensome (20%), and those who say they should not be reduced and that most regulations are needed (15%).
A greater share of physician organizations (28%) than hospitals (18%) and health systems (13%) say regulations should be reduced and that most are unnecessary and burdensome, and a greater share of health systems (20%) than hospitals (15%) and physician organizations (13%) say they should not be reduced and that most regulations are needed.
When asked to identify just one governmental regulation that respondents would eliminate, responses covered a broad range of governmental regulations. The top three were to eliminate the individual mandate and tax penalty (10%), simplify and reduce provider documentation regulations (9%), and a broad grouping of other health plan–related items, such as eliminating Medicare regulations, eliminating mandates for care that violate religious conscience, eliminating closed networks, eliminating bundled payments, and ending value-based purchasing (8%).
The results of this open-ended question suggest that there is no single regulation that is considered so onerous that it generates a majority response, or even a large plurality.
Jonathan Bees is a research analyst for HealthLeaders.