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Even Republican doctors oppose discrimination against people with preexisting medical conditions

- May 4, 2017
House Speaker Paul D. Ryan (R-Wis.) prepares to vote on the American Health Care Act. (Andrew Harrer/Bloomberg News)

The House of Representatives has just passed a Republican bill to repeal the Affordable Care Act (ACA). This bill allows states to opt out of provisions that would prevent insurance companies from charging higher prices to people with existing medical conditions who do not maintain continuous coverage. Estimates suggest that about 2.2 million enrollees in the individual marketplace have a preexisting condition.*

What do doctors think about this? From December through January, we surveyed 1,000 primary-care physicians across the United States to assess their views toward the ACA as it currently exists and potential changes to the law. After excluding physicians who were ineligible (e.g., because of wrong addresses), 45 percent responded.

Physicians — even if they’re Republican — want protection for patients with preexisting conditions

There is remarkable consensus among physicians — they don’t want insurance companies to discriminate against people with preexisting conditions. Nearly all (95.1 percent) of the physicians who responded thought it was important to the health of the U.S. population to prohibit insurance companies from denying coverage or charging higher prices on the basis of preexisting conditions.

It may not be surprising that all physicians who wanted to keep or expand former president Barack Obama’s health law supported provisions to protect patients. What is perhaps more surprising is that high numbers of physicians who wanted to repeal or scale back the ACA also supported these protections. The same is true of over 90 percent of physicians who supported the Republican Party.

Percent of physicians who say the Affordable Care Act’s prohibition on insurance companies denying coverage or charging higher prices on the basis of preexisting conditions are “somewhat important” or “very important.” The physicians are categorized according to whether they support keeping or expanding the ACA vs. repealing or scaling it back.

We can’t tell you, on the basis of our data, why physicians supported these provisions. Perhaps they were motivated by fundamental issues of fairness. As physicians ourselves, we understand that serious illness can strike anyone, as Jimmy Kimmel movingly pointed out. Physicians may also have firsthand experience of the barriers that many patients used to face in securing and retaining insurance coverage because of their preexisting conditions before the ACA was introduced, leading them to worry about a possible return to the old system. Another possible explanation is fear that proposed alternative solutions won’t work. Evidence suggests that high-risk pools are often underfunded and inadequate to meet the needs of many with preexisting conditions.

Regardless of the underlying reasons, the data tells a clear story: Even physicians who were in favor of scaling back or repealing the ACA say that scrapping protections for people with preexisting conditions is the wrong way to improve health care. The American Medical Association, which came out against the House bill, probably represents the views of the majority of physicians in the United States with respect to preexisting conditions.

David Grande is assistant professor of medicine at the University of Pennsylvania.

Craig Pollack is an associate professor of medicine at the Johns Hopkins University School of Medicine.

*Correction: an earlier version of this incorrectly characterized this provision. We regret the error.