Why Did The AMA Support Tom Price?

Posted on | January 13, 2017 | Comments Off on Why Did The AMA Support Tom Price?

Mike Magee

Not a few health professionals have been asking themselves, “Why did the AMA support Tom Price for head of HHS”? Their concerns took voice in this week’s New England Journal of Medicine in a piece titled “Care for the Vulnerable vs. Cash for the Powerful – Trump’s Pick for HHS”. In the article, written by the current and former Assistant Secretaries for Planning and Evaluation at HHS, Price’s record and value system are contrasted unfavorably with two former physician directors – Otis Bowen and Louis Sullivan. The authors concerns include:

1. “Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.”

2. “Price has sponsored legislation that supports making armor-piercing bullets more accessible and opposing regulations on cigars, and he has voted against regulating tobacco as a drug.”

3. “ …he was one of only 47 representatives to vote against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health care in private insurance plans.”

4. “He also voted against funding for combating AIDS, malaria, and tuberculosis; against expansion of the State Children’s Health Insurance Program; and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments.”

5. “Price favors converting Medicare to a premium-support system and changing the structure of Medicaid to a block grant — policy options that shift financial risk from the federal government to vulnerable populations.”

6. “He also opposed reauthorization of the Violence Against Women Act and has voted against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people”

7. “He opposes stem-cell research and voted against expanding the National Institutes of Health budget and against the recently enacted 21st Century Cures Act”

8. “Price has also been a vociferous opponent of the Affordable Care Act (ACA)”

9. “The Price plan would eliminate the guaranteed-issue and community-rating requirements in the ACA and create anemic substitutes for these commitments to access to comprehensive coverage for Americans with preexisting conditions.”

10. “Whereas Price’s actions to date have not reflected the tradition of the physician as advocate for the poor and vulnerable, they do harken back to an earlier tradition in American medicine: the physician advocate as protector of the guild.”

In that final quote, the one referencing the “guild”, the authors point an arrow directly at the AMA’s heart. Why did they rush to support Price? Why not push “Neutral” over “Buy”? A substantial part of the answer may be found in the chart below tracking the percentage of active physicians who belong to the AMA. (full disclosure: I am one of them, and have been for nearly 50 years, as was my father before me.)

Source: Mother Jones

As the chart notes, in my father’s day 75% of active physicians were AMA members. These were the heydays when the organization teamed up with a younger Ronald Reagan to unsuccessfully fight Medicare. In the new Millennium, the AMA faced slow and steady continued declines in membership of 1 to 2%, from 2000 to 2007. In that period, they went from roughly 1/4 of the nation’s active physicians as dues paying members to 1/5. The downward slide was briefly halted in 2007 by offering 8,577 free memberships to residents in training.

The descent resumed with a 2% loss in 2008, 3% in 2009, and a record breaking 5.3% in 2010, bottoming at 17% of active physicians. What happened? Most track the cliff back to March 19, 2010, when AMA President Jim Rohack announced AMA support for Obamacare. To say that conservative members, especially those from southern states, were displeased is something of an understatement.

The losses were announced at the 2011 House of Delegates meeting, but no specific state breakdowns were provided. But MedPage, without citing sources at the time, wrote, “Membership declines were most acute in Southern states – the same region in which state medical societies have been championing opposition to the Affordable Care Act.”

According to MedPage’s report, in some of those states, AMA delegates like nephrologist Daniel Edney appeared to dislike the President’s signature legislative achievement so much, he not only wouldn’t call it “Obamacare”, he wouldn’t even use the acronym ACA, preferring the more bureaucratic original initialing PPACA for the Patient Protection and Affordable Care Act. “It’s PPACA and we all know it. PPACA is what is driving all our doctors crazy”, he said then with extreme confidence. In his home state of Mississippi, he claimed that 3/4 of their roughly 2400 AMA members had resigned over the issue. Same thing in Alabama, where resignations were so steep that only “good will” saved them from losing one of their proportional seats in the AMA’s House of Delegates.

So why did the AMA step way out front to support Georgia’s ultra-conservative orthopedist Tom Price? It certainly wasn’t because he aligned with the AMA list of the top 5 state legislative priorities for 2017 which includes strengthening and expanding Medicaid, funding solutions to the opioid epidemic, and improving public health funding for vaccinations, firearm safety, and reproductive health.

Far more likely is that the organization has a “southern strategy” of its own. It’s likely we’ll never know for sure. But one thing is for certain, it’s more about numbers than money. Through the years of declining membership dues, AMA profitability has continued to rise from publications, CME and business offerings like their Masterfile Database used to empower PhRMA physician specific prescription profiling. They had over $500 million in reserves in 2012. Money funds lobbying. But total numbers of doctors represented ground the legitimacy of AMA’s government relations program.

Many younger physicians have fled the AMA state and national organization, and proudly proclaim that they have instead chosen speciality options like the AAFP, ACOG, ASIM or APA. What they seem to be unaware of is that, through the AMA Federation or ACCME or ACGME, they and their institutions continue to be represented by the AMA whether they like it or not. We’ll discuss that more next week.