The Affordable Care Act (ACA) is approaching four years old, and it remains largely unpopular. Currently, 53 percent of Americans disapprove of the law and 41 percent approve – numbers that are essentially the same as last September's. A new national survey by the Pew Research Center, which polled 3,335 adults, found opponents of the law generally want elected officials to make the law work, rather than wanting it to fail.

A majority of ACA opponents, representing 30 percent of respondents overall, want politicians to do what is possible to make the law work efficiently, while 19 percent of respondents would like politicians to work toward making the law fail.

Opinion about the ACA is also still split along party lines, with 72 percent of Democrats approving of it compared to 37 percent of independents and only 8 percent of Republicans. Among the 81 percent of non-Tea Party Republicans who oppose the law, only 25 percent want elected officials to work to make it fail.

Differences in opinion also vary among racial and ethnic lines. More whites disapprove than approve of the law by nearly two-to-one, while the vast majority of black people approve. Hispanic people are equally divided on the issue. Sex and age differences also play a role in predicting whether an individual will disapprove of the law, with more young people and women in favor of it than not.

Forty-seven percent of respondents said they felt it was the federal government's responsibility to provide health coverage to all Americans, while only 41 percent approved of the ACA.

Physician practices and the ACA
The way physician practices have experienced the ACA so far is also mixed. However, just like the American public in general, physician practices must contend with the reality of the law regardless of their feelings on it.

Some impacts practices have already reported or can expect include higher demand for services as the newly insured seek health care, varying reimbursement and coverage from exchange-based payers and a trend toward pay-for-performance reimbursement. In this new health care climate, physician practices need the assistance of revenue cycle management companies. They can handle medical billing and coding better than physician practices' in-house departments can, and can bring higher rates of reimbursement even in the face of the changes the ACA has brought to health care.