The Affordable Care Act 5 years later

  • Slightly more nurse practitioner and physician assistant survey respondents opposed the Affordable Care Act than were supportive or neutral when the legislation first passed in 2010.

  • Overall, the majority opinion of the ACA has gotten worse over time.

  • Most respondents reported no change in the size of their patient base.

  • In general, revenue per patient has been declining.

  • Clinicians are spending more time on nonclinical administrative tasks.

  • About half of nurse practitioner and physician assistant respondents believe health reform efforts have negatively affected their workload.

  • An equal proportion of clinicians believe that the ACA has either negatively influenced their decision-making ability or not influenced it all. Fewer than 10% believe the legislation was a positive influence on this aspect of care.

  • Clinicians seem evenly divided on whether the ACA’s influence on patient care has been positive (35%), negative (38%), or neutral (28%).

  • About half of respondents believe that the ACA has somewhat or very negatively influenced the health care system.

  • More clinicians believe that the ACA had a negative influence (51%) on the financial health of their practice or group than a positive (24%) or neutral (25%) influence.

  • In terms of patient relationships, more clinicians believe that the ACA had no impact (44%) vs. a positive (27%) or negative impact (29%).

  • More clinicians believe that the ACA had a negative influence (62%) on the overall cost of health care than a positive (25%) or neutral (14%) one.

  • Clinicians appear evenly split on whether online health exchanges will work better in 2015 than last year.

  • Nearly 70% of clinicians believe the ACA contributed significantly to increasing health care costs.

  • Nearly 60% of NPs and PAs believe that their patients have fewer choices in selecting a health care provider.

  • More than 90% of patients think the existing law should be modified or repealed.

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Nearly 600 nurse practitioners and physician assistants responded to The Clinical Advisor’s Affordable Care Act survey between December 2014 and February 2015 by answering questions about how their opinion on health reform has changed since it was signed into law in March 2010.


Overall, public opinion of the law seems to have worsened over time among NP and PA survey respondents, with clinicians reporting they’re spending more time on nonclinical administrative tasks, earning less revenue per patient, and believing the ACA is contributing to increasing health care costs.


A large majority of respondents indicated that they believe the law should either be modified or repealed, and most said they think patients have fewer options when it comes to choosing a health care provider since its inception.


A note about respondent demographics: Women and nurse practitioners were overrepresented, making up 76% and 64% of respondents, respectively.


The largest proportion of respondents had been in practice for 11 to 20 years (33%). Similar proportions of respondents had been in practice for fewer than 5 years (16%), 5 to 10 years (17%), 21 to 29 years (16%), and 30 years or more (18%).


Private practice was the most common practice setting (29%), followed by practices owned by hospitals or health systems (28%), and hospitals (11%).


Not every participant answered every question. We have indicated the total number of respondents for each area addressed. Numbers may not add up to 100% due to rounding.


This is the latest installment of Pulse Point, which aims to bring you easy to absorb visual insights on the latest health care trends among your clinician peers. If you have a topic you’d like to see covered, please send it to editor@clinicaladvisor.com.


Compiled by Nicole Blazek.

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