Did Health Reform Death Panel The AMA?

If there are any death panels in health care reform, then they may have very well killed the American Medical Association, which suffered another loss in the Senate this afternoon after Majority Leader Harry Reid (D-NV) failed to secure enough votes to patch the 21% pay cut coming to physicians participating in the Medicare program.

In 2009, the AMA lent its support to the health law after receiving assurances that Congress would scrap the existing SGR formula to avoid future cuts, but now, as Democrats continue to look for 60 votes, Republicans are letting it be known that there is a price to pay for bucking the grand old party:

— SEN. TOM COBURN (R-OK): “I don’t blame the AMA for being upset, but they kind of walked into this themselves by embracing, and then not embracing, and then embracing” the reform bill, he said. “It didn’t have an SGR fix and it didn’t have liability fix. The two goals that every doctor that’s associated with AMA wants — they want payment reform and they want liability reform — they got none of it.”

— SEN. JOHN CORNYN (R-TX): “For some inexplicable reason, I think the AMA has kind of burned all its bridges. It just makes absolutely no sense to me.”

— SEN. JOHN THUNE (R-SD): “That’s why a lot of Republicans right now are looking at this issue and saying: ‘Yeah, we want to help you. We want to fix this. We thought it should have been fixed a long time ago.’ But [they] are not particularly sympathetic to their sense of urgency about getting a 10-year fix in place given the fact that it should have been done in the health care debate.”

The AMA’s trouble counting Republican votes began as early as last year, when Senate Majority Leader Harry Reid (D-NV) attempted to pass a $245 billion 10-year doc fix. The legislation wasn’t offset and failed to garner a single Republican vote, despite AMA assurances to the contrary. “We were told by the American Medical Association and others, that we would get help by the Republicans to take care of senior citizens so they could have doctors to take care of them,” Reid lamented. The vote represented a defeat for the group, which had spent some $2 million dollars lobbying for the SGR in the weeks before the vote.

Doctors — the organization’s supposed bread and butter — are also turning their backs on the organization. While it theoretically represents all physicians, the AMA’s current paying membership comprises somewhere between 15 to 18% of doctors, declining almost 3.4% in 2009 to 228,000 — itself about a 2% decline from the 241,000 reported for 2007. (The 2007 figure is notable in that it marked the first time in seven years that membership increased, about a 1% jump. But that boost was achieved by giving away 8,577 free memberships for first-year residents who had been student members the previous year.)” Consequently, the dues accounted for just 16% of AMA revenue. The rest of its funds come from things like billing codes, CMS payment negotiations, and other non-membership-related operations.

Now, the group is on record as supporting an unpopular health care law and remains powerless in preventing the pending reimbursement cuts. Its hemorrhaging membership problem and its political decline will create an opportunity for other physicians’ group to fill the leadership void. Whether they’ll be more successful in completely reforming SGR and guiding the country’s transition through health reform however, is a different question altogether.