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AMA Endorses House Health Overhaul Bill

By Jane Norman, CQ HealthBeat Associate Editor

July 16, 2009 -- The American Medical Association (AMA) on Thursday endorsed House Democrats' health overhaul bill, casting aside earlier qualms over a public plan option and giving an important boost to the legislation (HR 3200) as three House committees worked on marking it up.

Michael D. Maves, executive vice president of the AMA, said in a letter to House Energy and Commerce Committee Chairman Henry A. Waxman that the board of the influential doctors' organization supports the legislation because it "includes a broad range of provisions that are key to effective, comprehensive health system reform."

The outcome was exactly what had been sought by President Obama when he spoke to the AMA at its annual convention in Chicago in mid-June, when he told physicians that his plan—which the House bill broadly resembles—will reduce costs for individuals, expand coverage choices and curb rising health care costs. The House bill includes a government-sponsored plan that would be offered through a new health insurance exchange.

In a statement sent out by the AMA, J. James Rohack, AMA president, said AMA physicians urged passage by the full House.

"The status quo is unacceptable," Rohack said. "This is an important step, but one of many steps in the process. The AMA is actively engaged with Congress and the administration to achieve health reform that best meets the needs of patients and physicians. We are committed to passing health reform this year consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients."

Republicans in the House quickly criticized the AMA for endorsing the House bill. The AMA's support "trades short-sighted promises for meaningful long-term changes," wrote Rep. Charles W. Boustany Jr., R-La., a former physician, in a letter he intends to send to doctors. "Under the new health care system proposed as part of HR 3200, federal bureaucrats will have greater control over treatment options and reimbursement rates." Republican Rep. Michael Burgess of Texas, a physician and member of the AMA, said in a statement: "Today the American Medical Association lost a historic opportunity to take the high ground and lead the charge in changing our nation's health care system. By endorsing the tri-committee bill, they affirm all of its parameters, as we are only beginning the dialogue. Important principles, such as liability reform, Medicare payment reform and antitrust issues could have been discussed. However, by their preemptive surrender, they lose incredible momentum, and just as we begin the mark-up process in my committee, House Energy and Commerce."

Boustany said that state medical associations are "standing up to the AMA" and 17 of them have written to the association expressing opposition to a public plan. He urged that doctors who oppose a public plan contact their state medical associations to let them know that "you oppose a government takeover of health care and comparative effectiveness research denials based solely on cost."

The Medical Association of Georgia issued an alert Thursday to its members asking them to contact lawmakers and oppose the bill, saying leaders there believe it could bring an end to private practice in the United States.

Prior to now the AMA had said it remained open to the idea of a government-run health insurance plan, as long as doctors are not required to participate and the plan pays doctors more than Medicare does. After The New York Times reported that the AMA had told lawmakers of its opposition to any public plan, former association president Nancy H. Nielsen in June issued a statement saying doctors would accept a public plan that competes on a "level playing field" with private insurers.

At a minimum, she said, the government should not require doctors to participate as a condition of retaining their Medicare billing privileges, and the plan must pay higher rates than Medicare does.

"The AMA is willing to consider other variations of a public plan that are currently under discussion in Congress," she said at the time.

Under the public plan option in the House Democrats' bill, the secretary of HHS establishes geographically-adjusted provider payment rates for the public option. For the first three years, those rates are based on Medicare rates with a 5 percent add-on for doctors who also participate in the Medicare program.

After the first three years, the secretary is granted greater flexibility in setting rates, but the general rule is that overall spending would remain consistent with the initial levels, a committee bill analysis says. Medicare providers are presumed to be taking part in the public option unless they opt out, and there are no penalties for opting out.

The AMA's Maves praised the bill for promising to extend coverage to all Americans through health insurance market reforms, providing consumers with a choice of plans through a health insurance exchange, eliminating denials of insurance coverage for pre-existing conditions, revamping of the Sustainable Growth Rate (SGR) formula for physicians in the Medicare program, additional funding for primary care without slashing specialty care, making the Medicaid program stronger, including an individual mandate for coverage as well as subsidies for low-income people, and "significant" payment and delivery system reforms such as the accountable care organization and medical home concepts.

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