For the 8th annual Physicians Practice Great American Physician Survey, 826 physicians were asked about issues they believe health reform should address. Respondents made it clear which health policy issues they care most about with 73.11 percent saying they want protections for patients with pre-existing conditions; 65.83 percent wanting regulations for the cost of medications; and 50.99 percent wanting to see increased competition among health insurers.
Physicians Practice reached out to a handful of respondents to learn more about the healthcare reform issues practicing physicians feel strongest about.
Protection for Patients with Pre-existing Conditions
Patients with pre-existing conditions are of the utmost importance to pediatricians like Alison Days, MD, of El-Paso, Texas. She became concerned with healthcare reform after reading that a [woman receiving a] caesarean section or children's asthma could make it hard for patients to obtain health insurance if new health laws were to pass.
In July, the GOP Senate's Better Care Reconciliation Act (BCRA) met a wave of criticism over its potential effects on patients with pre-existing conditions. If passed, the bill would have ended the pre-existing conditions protection that Days believes so strongly in.
"As a pediatrician, trying to record health conditions of young patients, it's difficult to mark [the conditions] down while thinking to yourself, 'one day these could lead to the patient not having health insurance,'" says Days.
Days is perplexed by the current administration’s choice to attempt to do away with one of the most popular parts of the Affordable Care Act (ACA). She says it may be time to bring some additional parties to the table during the reform process.
"I think people need to take health reform more seriously in the government. The people making healthcare decisions should not only be insurance companies and government officials, but also docs that are in private practice and docs that are in academic medicine…[Healthcare reform] affects us all differently," says Days.
Louis Weinstein, an ob-gyn at the Barrier Islands Free Medical Clinic in Johns Island, S.C., says he believes strongly in preserving pre-existing condition protections.
"We're seeing [many] more patients with pre-existing conditions now than we did one or two decades ago, due to the increase in diabetes, hypertension, and obesity," he says.
Weinstein and Days share the same uncertainty when it comes to the future. Both are concerned that the proposed bills aimed at abolishing Obamacare would reportedly decrease the amount of Americans covered by Medicaid, according to the Congressional Budget Committee (CBO). This would ultimately affect those with pre-existing conditions, many of whom are lower-income.
"These people need healthcare. If you have a preexisting condition and it's under control because you have insurance, you should be allowed to continue that health insurance. If you're knocked [off coverage] because of your preexisting condition, your healthcare is liable to get worse and then you end up in the ER and the cost of healthcare goes up again," says Days.
Weinstein also mirrored Days' thoughts on patients with pre-existing conditions going uninsured ultimately costing both the insurance companies and government more money. "It is more expensive to care for patients with pre-existing conditions after a condition has worsened, rather than treating it early on," says Weinstein.
Deborah Winiger, MD is a family practitioner based in Vernon Hills, Ill., who says the pre-existing conditions mandate under the ACA was one of the only reasons she liked the law. "These were people who could not get insurance due to conditions that were beyond their control. They were basically blackballed from ever getting insurance," says Winiger.
Days, Weinstein, and Winiger all say that the ACA is far from perfect and are not opposed to healthcare reform of some sort in the near future, as long as that reform doesn't remove protection for these patients. "A patient with pre-existing conditions needs to be protected somehow, whether it's by the government or through private insurance. As long as they are protected, I can live with it," says Weinstein.
Increasing Competition among Health Insurers
Kate Roberts, MD, is a Virginia-based endocrinologist who has long been frustrated with the lack of competition against Anthem health Insurance in her region. "They come to you and say, 'here's what we're going to pay you,' and that's it. Because they are a major player, they can do that," says Roberts. "They are my biggest payer, and my worst payer."