2017 health system reform survey

Monday, May 01, 2017 12:08 PM

Members prefer to preserve the individual mandate and Medicaid expansion

by Benjamin Kupersmit, President, Kupersmit Research

Kupersmit Research is pleased to present the results of the 2017 CMS Member Survey on federal health system reform. Our survey was written in January (before the AHCA was formally proposed) to gauge CMS members’ attitudes toward potential reforms being considered by the new administration and Congressional leadership at that time.

CMS has surveyed members since 2008 on health system reform; most recently, we focused on system reform in the context of Amendment 69 in 2016.

• In 2008, a plurality of CMS members (41 percent) favored a system that would preserve commercial insurance but expand government regulation of payers (similar to the ACA), versus 33 percent who favored a single payer system and 13 percent who preferred deregulation of commercial payers and a reduced role for government.
• In 2016, 40 percent said their optimal health system would continue to build on the ACA, while 33 percent favored repeal of the ACA and 15 percent favored moving toward a national single payer system.

Priorities: Preserve the individual mandate and the Medicaid expansion

• CMS physicians are skeptical about eliminating the “requirement that individuals carry health insurance,” with 65 percent saying this would make things “worse” versus today’s health care system and 18 percent saying things would get “better.”
• The idea of moving to “continuous coverage” provisions to encourage individuals to maintain insurance is seen negatively as well, with 58 percent saying this would make things “worse” and 25 percent saying “better,” and 51 percent say that “higher deductible, lower premium” plans would make things worse (27 percent “better”).
• CMS members are most positive about the idea of “allowing insurance to be purchased across state lines,” with 62 percent saying this would be an improvement over the current system (versus 10 percent who say it would make things “worse”).
• A majority of CMS physicians (61 percent) support keeping “everyone on Medicaid who was added in the ACA.”
• One in five (21 percent) support rolling back the expansion: 9 percent support rolling back the entire Medicaid expansion and 12 percent support allowing those who were eligible pre-ACA to remain, while removing those added via the eligibility expansion from the rolls.
• By a 50 percent to 31 percent margin, CMS physicians believe that the Colorado Medical Society should continue to work toward a health care system that “achieves coverage and access to health care for all Coloradans,” with 7 percent unsure and 12 percent taking neither side on the question.

CMS physicians have significant concerns about reforms to the current health care system that would reduce coverage and increase costs for patients. We see strong opposition to eliminating the individual mandate, allowing continuous coverage provisions, encouraging higher deductible plans, eliminating the Medicaid expansion and other steps that they believe would make the current system worse for Coloradans.

At the same time, CMS physicians are open and willing to engage in reforms at the federal level, such as allowing insurance to be sold across state lines, if such ideas demonstrably move toward a system of affordable health insurance coverage for all Coloradans. As we saw in the Amendment 69 debate, there is a strong sense that state-based solutions alone are not sufficient to achieve this vision for Colorado (or other states across the nation).

CMS physicians have spent significant time and effort focusing on health system reform for nearly a decade. They are willing to engage in a constructive process to address challenges in the system, and look forward to continuing conversations with interested parties and offering support to those who want to create a more patient-centric system in the days and months ahead.

Methodology
This survey was administered online by the Colorado Medical Society. The survey was in the field from March 1-21, 2017. A total of 661 Colorado Medical Society members responded to the survey, for a margin of error of +3.8 percent at the 95 percent confidence level.