The Patient Protection and Affordable Care Act (PPaACA/ACA also known as Obamacare) has been a hotbed topic since it was signed into law in 2010. Six years later the ACA still manages to divide the American public.

In a Gallup poll taken last April, 50% of respondents said they disapprove of the ACA while 44% said they approve. It turns out these numbers reflect America’s 1 million doctors, who seem to be just as split on this piece of legislation.

Last fall the Physicians Foundation released the results of their survey which questioned 20,000 doctors on their opinion of the ACA. Of the doctors that responded, 46% gave the ACA a D or F grade, while 25% gave it an A or B grade. Two-thirds of the physicians also said they did not accept health insurance plans offered through the ACA’s online insurance exchanges.

What’s Not to Like?

The doctors who had the most criticism of the ACA cited getting paid as the biggest problem of the current structure. Dr. Joseph Valenti, a board member of The Physicians Foundation, shared his biggest concern, which is that reimbursements to hospitals have risen 35% in the past 10 years while increasing only 3% for private practices.

Another revenue killer is the fact that the newly-insured often fail to pay their premiums. It’s estimated that roughly 20% of people who sign up for ACA eventually fail to pay their premiums and lose coverage after 90 days. These patients are not required to pay their doctors for any services received during that 90-day window. On top of this, insurance companies are only required to reimburse physicians for visits made during the first 30 days – anything after that and docs are, I believe the technical term is – SOL.

This is why many doctors have chosen not to accept ACA plans because the onus is put on them to somehow determine which patients have paid their premiums and which haven’t.

The Kaiser Family Foundation Survey

Another survey, this one conducted by the Kaiser Family Foundation, found opinions regarding the ACA are deeply divided along party lines.

For instance, doctors who identify as Democrats were more likely to say (by a three-to-one margin) that the ACA has had a positive (44%) rather than a negative (15%) impact on their overall practice.

Conservative physicians had a very different view by about seven-to-one, with 57% reporting the ACA had a negative impact on their practice and only 8% reporting a positive impact.

Small Practices are Small Businesses

No other small businesses would be okay with not getting paid for a month’s worth of work, so why should doctors have to go along with this current system? Beyond the low or no payments, small practices are also getting squeezed by administrative overhead and the high cost of keeping up with requirements under Obamacare.

Many conservative physicians, like Dr. Jane Orient, an Arizona physician and executive director of the right-leaning Association of American Physicians and Surgeons (AAPS), feel that doctors are under too rigid price controls under the current ACA laws and that this business model is, well, bad for business.

Those opposed to Obamacare are predicting the quality of health care will decline and consumers will end up paying higher premiums and out-of-pocket costs. In addition, because physicians are not able to adjust their rates to keep up with increasing expenses, many fear they will not be able to keep their practices open.

Where Do the Presidential Candidates Stand on the ACA?

It should come as no surprise that the 2016 presidential candidates are split down party lines when it comes to the ACA, with democratic candidates supporting it and Republican candidates each vowing to repeal Obamacare. At each mention of repealing the ACA, the Democrats ask for specifics as to how the GOP hopefuls will repeal the plan without costing millions access to health insurance.

Last summer, after the Supreme Court ruled to uphold Obamacare, Democratic presidential candidate Hillary Clinton hailed the ruling, saying it upholds “what the authors of the Affordable Care Act clearly intended and wrote into law: that health insurance should be affordable and available in every state across the country. “

She added: “Now that the Supreme Court has once again re-affirmed the (Affordable Care Act) as the law of the land, it’s time for the Republican attacks to end.” Clearly, Hilary is for the ACA.

But what about self-proclaimed socialist Bernie Sanders’ views on Obamacare? Does he support it? The short answer is yes, though he would like a single-payer system (known as Medicare for all), which is used in Great Britain and Canada. This system means the government would pay for everybody’s health care coverage and insurance goes away.

And what about on the other side of the aisle? With so many of the GOP hopefuls recently dropping out, let’s take a look at the top 4 remaining candidates.

Sen. Marco Rubio is in favor of repealing the ACA and creating “a consumer-centered plan that puts patients and families back in control.”

Sen. Ted Cruz has vehemently said he would “repeal every word of Obamacare.”

Dr. Ben Carson brings his healthcare experience to the table to say he’d repeal Obamacare and instead have everyone own a Health Empowerment Account, tax-free savings account for future health expenses.

And as for GOP frontrunner, Donald Trump, he is clear on his distaste for the ACA, claiming he would repeal it, but not too clear on what he would offer instead, simply saying, “it would be terrific.”

Will doctors be voting in favor of the ACA or against it in the coming elections? Looking at the numbers provided by the two surveys, we can expect slightly more doctors to vote against the ACA this coming November. If the entire American population was made up of physicians, particularly ones running small practices, we may be looking at a President Trump or Cruz being sworn into office next year. The rest of the population will let their voices be heard on whether or not they are satisfied with the ACA and we will have to wait and see where the chips fall.