After decades of swatting back federal efforts to change how care is provided and paid for in the United States, the American Medical Association found enough to its liking to support the administration's long, difficult campaign to enact health reform legislation.
But the goodwill the AMA earned in Washington could come undone by its support of a Republican Senate candidate running on a "repeal and replace" platform targeting the new law.
The AMA and its state counterpart, the Pennsylvania Medical Society, this week contributed $5,000 to former GOP Rep. Pat Toomey, whose promise to scrap the health law has been a key plank of his campaign for the Senate.
The contribution, coupled with a highly public endorsement from the Pennsylvania physician group, came as the White House, House Speaker Pelosi and their allies plan to tout the key consumer protections in the new law that take effect Sept. 23, exactly six months since its enactment.
It also has raised eyebrows among some of the advocates for health reform who stood with the AMA during a protracted legislative process.
"From the standpoint of health reform, this is a very strange thing, and I think it's really counterproductive to where the association has tried to move America's healthcare system," said Ron Pollack, executive director and vice president of Families USA. "To put support behind someone who is really working to destroy the key reforms that are going to help patients, physicians and other stakeholders, is a bit astounding."
While the AMA itself does not endorse candidates, financial contributions through its political arm, AMPAC, are nevertheless telling and frequently reflect the political tenor found at the grassroots level.
Over the years, the AMA's powerful PAC has skewed conservative--sometimes overwhelmingly. But in recent campaign cycles, the association's contributions have moved more to the left, showing favor toward Democrats, who for now hold the majority on both sides of the dome.
To be sure, it is not uncommon for interest groups to share the wealth among Democrats and Republicans during an election cycle, especially ones that serve a diverse membership. But the campaign contribution to Toomey, whose public comments seemingly run counter to the visible role the AMA took in its qualified support of the health bill, stands out in part because debate over the law is still so fresh.
In July, Toomey and his election opponent, Rep. Joe Sestak, D-Pa., met separately with AMPAC members for about an hour apiece. In addition, each candidate answered a questionnaire to further gauge their stance on specific policy matters.
According to several sources, Toomey won out because of his support for medical liability reform. The AMA and other medical groups have for years lobbied for stronger protections against medical malpractice lawsuits even though Democrats -- long allied with the trial bar -- have been wary of the effort.
The national association has recently taken heat from some of its members for failing to secure tort reform measures in the broader health overhaul package.
AMA President Cecil Wilson said that his group would continue to support the Affordable Care Act. He said the contribution reflects Toomey's commitment to changing the laws on injury litigation and also to fixing the formula Medicare uses to determine physician reimbursement rates.
"This would be an easy job if everyone had a 100 percent record on issues we support," Wilson said Thursday. "I think the important thing to emphasize is that it's not as simple as one issue or the other. It's a matter of where candidates stand in general."
Another factor is one of simple politics: While the mantra of "repeal and replace" may play well on the campaign stump, few in Washington actually believe it is politically achievable. The difference between campaign speeches and the actual legislative process could give some groups enough cover to make financial contributions that on the surface send politically mixed signals.
While in the House, health provider groups generally viewed Toomey as an ally. As a lawmaker in 2001, he co-sponsored legislation that gave hospitals and physicians more recourse in fighting back against claims of fraudulent or misdirected billings.
As one healthcare lobbyist put it, "He talks the language of docs."
For his part, Sestak, his Democratic rival who voted for the reform bill, has gained the endorsement of the American Nurses Association. In a written statement, he railed against his opponent's record on health care.
"We respect the PAC's decision," Sestak's office said in a written statement. "Congressman Toomey has fought for the insurance companies. He wants to deny coverage to children in need of care by opposing [the Children's Health Insurance Program], has worked against increasing access to preventative care and prescription drugs for seniors; and has cast the deciding vote in favor of creating the Medicare donut hole."
This article appears in the September 18, 2010, edition of NJ Daily.