Slightly less than 50% of the respondents said that they support tax penalties for individuals who do not have insurance.

Some improvements to the ACA that PCPs support include the creation of a public-insurance option (66.5%), providing tax credits for Medicaid-eligible individuals towards purchase of private insurance (58.6%), and using health savings accounts (68.7%).

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PCPs are least in favor of changes that would increase cost to consumers, with only 29.4% in support of high-deductible health plans.

The researchers said that many PCPs misunderstand the relationship between insuring both healthy and sick Americans and providing sustainable and affordable health care, including for people with pre-existing conditions.

“Policies that do not address adverse selection would lead to increased and unsustainable health insurance costs,” the researchers argue.

There is a need to educate Americans as to why these two ACA provisions are inseparable, they write.

The authors finally warn that nearly 30 million people are at risk of losing coverage if the ACA is repealed and the marketplace disrupted. They also make a strong point that PCPs need to be included in the decision-making process.

“As policymakers consider changes to the ACA, they might consider the views of PCPs, given their unique role in the US health-care system,” they write.


Pollack CE, Armstrong K and Grande D. “A View from the Front Line—Physicians’ Perspectives on ACA Repeal.” The New England Journal of Medicine. 2017. 376(6): e8. doi: 10.1056/NEJMp1700144

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