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Originally published February 21, 2010 at 6:27 PM | Page modified February 22, 2010 at 9:01 AM

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A change of heart with health-care overhaul

A decade and a half ago, industry groups like the American Medical Association (AMA) opposed the Clinton administration's version of a health-care overhaul, and helped in ultimately defeating that effort.


LOS ANGELES — A decade and a half ago, industry groups like the American Medical Association (AMA) opposed the Clinton administration's version of a health-care overhaul, and helped in ultimately defeating that effort.

Now, however, on the eve of hearing President Obama's latest version of what the nation's health picture should look like, they and numerous other medical associations are worried today's version of health overhaul will die on the vine.

Obama's overhaul blueprint is expected to be posted on the White House's Web site Monday, ahead of Thursday's bipartisan health-care summit.

An overhaul has never been needed more, industry groups say, adding it is essential that at least some measure of change take place.

"Certainly, the AMA knows that if Congress doesn't do anything, the situation is only going to get worse," said Dr. James Rohack, AMA president.

The AMA, American Hospital Association, American Nurses Association, American College of Physicians, American Health Care Association and even America's Health Insurance Plans (AHIP) — the trade group representing health carriers — all agree on one thing: some type of overhaul is necessary. And they're a little more than irked that health overhual appears to be dormant since they've lobbied for the cause.

"We're very frustrated at the lack of action on it in recent weeks after we've expended so much energy," said Rose Gonzalez, director of government affairs at the American Nurses Association. "The decisions that nurses make at the bedside every day, they need to make on Capitol Hill. They need to make them at the White House."

Obama is expected to put forward some of the highlights of the Democratic House and Senate health-care bills, ahead of Thursday's summit. The event is to be televised live on C-SPAN.

Whichever way the process leads, these medical groups generally want the same key issues addressed: Bend the cost curve, cover the uninsured, boost preventive-medicine measures and excise pre-existing condition provisions from insurance policies.

Both House and Senate bills try to achieve that, but to varying degrees and means.

The most glaring difference is that the House bill contains a public-insurance option that largely is thought to be dead in the water because of Senate objections, though no last rites have been given to it just yet. More lawmakers are signing on to revive the public option — some angry with ever-skyrocketing rate hikes — and could seek to pass it through a budget-reconciliation process.

Many of these groups have indicated support for a public option — numerous physicians groups, in fact, repeatedly have called for a single-payer system for all, though many have resigned themselves to the likelihood no further government insurance option will be on the table.


"Never say never. You never know what policymakers are going to do," said Robert Zirkelbach, spokesman for AHIP, the trade group representing health carriers.

Some of these groups have their own agendas, all of which have widely differing chances of being fulfilled.

The nurses group feels relatively comfortable that incentives to recruit more nurses and nurse teachers to the profession will remain pretty much intact, because those provisions are in both the House and Senate versions. All sides seem to agree a projected shortage of 1 million nurses by 2020 is critical, said Michelle Artz, chief associate director of the nurses association's government-affairs office.

"I think we were really pleased at the attention both the House and Senate gave to this issue," she said.

Others aren't so confident. Dealing with a shortage of primary-care physicians is getting some attention in the form of increased Medicare payments to those practitioners, says Robert Doherty, senior vice president of government affairs at the American College of Physicians. But he'd like to see more.

There are several disincentives to becoming a primary-care doctor, and they start making themselves evident to medical students facing $150,000 or more in debt once they leave school.

"The hours are longer, the pay is lower and the paperwork is greater," Doherty said. And the list of patients seeking a suitable primary-care doctor is growing longer.

The current medical market rewards specialists more than general practitioners, he adds. The United States is trending toward one primary-care physician for every five doctors, but in countries considered to have better health offerings, there is one primary physician for every specialist.

At the American Health Care Association, an advocacy group for nursing homes and acute-care facilities, the concern there is over whether Congress is paying enough attention to long-term patients. Susan Feeney, spokeswoman for the group, says they should because nursing homes and other acute-care centers added 50,000 jobs in the last year — more than three jobs for each of the 15,691 facilities in the United States.

Those facilities receive 80 percent of their money from government-backed plans, Feeney says. One key issue is whether Medicaid is underfunding these facilities. The House bill seeks to address that with $6 billion over four years but there's no provision in the Senate bill.

Lawmakers have insisted expanding technology on patient information is a key link to help save costs, but acute-care facilities have been left out of that discussion, Feeney says.

"It has not been in previous iterations of the bill. We are hoping it could be in new versions of the bill," she said. "It's something that does need to be elevated."

In some cases, though, groups are focusing on more macro issues. The American Hospital Association's main concern is assuring coverage is expanded to as many patients as possible so they can take preventive measures, says Matt Fenwick, AHA spokesman. Otherwise, their entry into the health-care system usually comes through the emergency room.

"Unfortunately, it's the most expensive point of access to health care," Fenwick said. Hospitals have struggled to offset for uncompensated care, which totaled $36.4 billion nationwide in 2008. That usually comes on the back of the insured.

Not surprisingly, that sentiment is echoed by the insurers' group. The group agrees reform is needed — particularly in reducing costs — but don't blame insurers for that, says Zirkelbach, the AHIP spokesman.

Underlying costs in hospital care, doctor services and drug prescriptions are primarily at fault, he says.

"The current bills do virtually nothing to bend the cost curve," Zirkelbach said. "Many Americans believe the current legislation will increase the cost of their health care."

The health-carrier trade group aligns with Republicans on several issues but takes no position on whether insurers should be allowed to sell policies across state lines, a talking point for many conservatives. It does, however, support tort reform.

"We completely agree we need to get medical liability under control," he said.

That's one of several issues the AMA is pushing, along with pending Medicare payment cuts to doctors among them. Rohack, the association's president, says there are tort-reform initiatives in the House bill, but they don't go far enough. He wonders whether a more piecemeal approach would be better.

"The AMA knew that regardless of what Congress passed, they wouldn't get (tort reform) right," Rohack said. "America sometimes is critiqued because they like the home runs. But you can win a game if you put a string of singles together."

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