Physicians Weigh In on ACA Ruling

The Supreme Court's decision to largely uphold the Affordable Care Act in essence preserved the status quo for the health system and took away some uncertainty - but only in the short term. The congressional and presidential elections in November could bring further changes to the law.

For now, though, the nation's physicians are pondering the court's ruling and how it will affect their practices. Concerns remain regarding some aspects of the law, and there is uncertainty on what the justices' Medicaid decision means.

Christian Shalgian, director of the division of advocacy and health policy at the American College of Surgeons, said he was surprised by the ruling, adding that surgeons are more concerned about what the law doesn't do than what it does.

"The biggest issue in my mind [with] the Affordable Care Act is what's not included in the [law]," said Mr. Shalgian. "The Medicare physician payment issue is one that's driving health care costs, and it needs to be fixed."

However, many other physician groups praised the court's opinions, noting that keeping the law in place would increase health care coverage and maintain the ACA's enhanced preventive care benefits.

"We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," said Dr. Jeremy Lazarus, president of the American Medical Association, in a statement. "This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies."

Dr. David L. Bronson, president of the American College of Physicians, noted in a statement that although the group did not take a position on the constitutional issues, "we believe that the individual insurance mandate, combined with the ACA's subsidies to buy qualified coverage through state marketplaces (exchanges), Medicaid expansion to more low-income persons, and consumer protections against insurance practices that deny or limit coverage, are the most effective ways to expand coverage to nearly all Americans."

The American Academy of Family Physicians said that keeping the law in place will also allow the continuation of efforts to boost the breadth and depth of primary care.

"The Supreme Court decision maintains already-launched initiatives that support wider implementation of the patient-centered medical home and that value primary medical care through payment incentives for primary care physicians," said Dr. Glen Stream, AAFP president, in a statement.

Oncologists noted that they were pleased that many provisions that protect cancer patients would continue to stay intact, such as coverage for preventive screenings like colonoscopies and mammograms, the elimination of lifetime caps and preexisting condition exclusions for insurance plans, and the requirement that private insurers cover the cost of participating in clinical trials.

Cardiologists also applauded the fact that provisions ensuring preventive care and coverage of preexisting conditions would stay in place. American College of Cardiology president William Zoghbi said in a statement that the organization "favors provisions in the law that support preventive care, access to care, elimination of waste, and a payment system that encourages quality." However, the transformation is not complete. "Hard work remains ahead before we arrive at a sustainable payment system that emphasizes value and a strong patient-doctor relationship," said Dr. Zoghbi.

Because the law basically remains the same - for now - the 2.3% excise tax on medical devices will still go into effect on Jan. 1, 2013. AdvaMed, an industry lobbying group, said that it will continue to try to overturn that tax, which could end up driving up the cost of devices such as pacemakers.

The largely positive statements from organized medicine did not hide the fact that many individual physicians are still fearful of the law's effect on their practice.

In a survey of 644 primary care physicians that was conducted the day the Supreme Court ruled, 66% of respondents said that they did not believe the law could achieve health care coverage for all Americans. The poll was conducted by MDLinx, a Web-based information provider for doctors. "The survey showed a surprisingly high level of skepticism among primary care physicians," said Stephen Smith, chief marketing officer for MDLinx, in a statement. The poll also found that only 21% said that increased patient volume would have an "extremely positive" impact on their medical practice. Almost half said it would have an "extremely negative" impact. Respondents expressed concerns about the shortage of primary care doctors.