House of Medicine's Medicare win aids doctors and patients

It was a long and winding road, but on July 15, a broad majority of Congress finally heard the voices of millions of patients and physicians and voted -- repeatedly and decisively -- to prevent a Medicare meltdown.

The voices of organized medicine -- and our patients -- were crucial in this victory.

The American Medical Association, state medical societies, specialty societies and other interested groups, such as the AARP and military families, joined forces and spoke as one.

More than 750,000 patients and physicians contacted their lawmakers through the AMA grassroots network alone since this process began last spring.

The danger was real, and imminent. The 10.6% cut in pay to physicians who treat Medicare patients would have devastated seniors and people with disabilities who depend on the program, as well as the military families who rely on TRICARE. And physicians can't continue to see Medicare patients if payments don't keep up with rising medical costs.

This legislation stops Medicare cuts for the next 18 months and gives physicians a modest increase next year to help meet the rising cost of health care for seniors.

The AMA thanks the members of the U.S. House of Representatives and the Senate who voted so overwhelmingly, in a bipartisan way, to stop the Medicare cuts.

Some needed more persuasion than others, and for that, we can thank the House of Medicine. Our combined efforts generated front-page coverage in the nation's newspapers and lead stories on TV news.

For my part, I did interviews seemingly nonstop and recorded video messages seen on the AMA Web site and YouTube. CNN, National Public Radio and even the New England Journal of Medicine covered the story extensively.

The Denver Post asked why "would so many [senators] fight to defend health insurance company profits even in the face of an assault by the American Medical Association?" And The New York Times said "the AMA used a vigorous advertising campaign ... cowing them into retreat."

In addition to the earned media coverage, an AMA advertising blitz hammered the message home to voters and key lawmakers.

Launched on July 1, the AMA ads in support of the Medicare legislation focused on Pennsylvania, Mississippi, New Hampshire, Tennessee, Texas and Wyoming. Patients and physicians in those states were especially vocal in contacting their senators to urge them to vote "aye."

The July 15 vote was the culmination of a process that began even before the ink was dry on an emergency measure passed by Congress in December 2007 postponing a 10% payment cut for six months.

The AMA was on the case when leaders in the Senate began negotiating new Medicare payment legislation in March. That month, Sen. Debbie Stabenow (D, Mich.) introduced S 2785, a bill that provided 18 months of positive updates and extended other expiring physician payment provisions. That became the medical community's negotiating baseline.

The campaign for S 2785 was a major focus of the National Advocacy House Call on Capitol Hill in April.

In June, Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, which has jurisdiction over Medicare, introduced S 3101, legislation to avert cuts for 18 months and provide a 1.1% increase in 2009. Sen. Charles Grassley (R, Iowa), the panel's ranking member, also proposed stopping the cuts and providing a 1.1% increase.

On June 12, Baucus' bill came up for a vote but was unable to garner enough support to end Senate debate and bring it to an up-or-down vote.

A week later, U.S. Reps. Charles Rangel (D, N.Y.) and John Dingell (D, Mich.) introduced HR 6331, a modified version of S 3101 that also averted cuts for 18 months and provided a 1.1% payment increase in 2009.

The House passed it with an overwhelming bipartisan vote of 355-59.

On June 26, a vote in the Senate to end debate and bring HR 6331 to a vote failed by a single vote. On your behalf, I was at the Capitol, just off the Senate floor, with representatives of AARP and the disabled community, jointly asking the Senate to pass this bill.

In a procedural move, Senate Majority Leader Harry Reid (D, Nev.) switched from yes to no to allow reconsideration of the bill when Congress returned the week of July 7.

After the AMA's advertising blitz, the Senate finally passed the bill on July 9, 69-30 in a dramatic vote that included the return to the Senate floor of Sen. Ted Kennedy (D, Mass.) to vote for the Medicare legislation.

The next week, President Bush vetoed the legislation, but the momentum of organized medicine was by then too great. The House voted to override the veto, 383-41, and the Senate voted by 70-26. It marked only the third time Congress successfully overturned a veto during this presidential administration.

In this fight, the House of Medicine's positions were based on the best interest of our members and their patients. And we believe that patients and physicians should not be used as pawns in power struggles between branches of government or political parties.

The AMA has and will continue to be a bipartisan organization that reaches out to both parties to improve health care for all Americans.

There was much to be proud of in this all-out effort to stop the Medicare cuts on behalf of America's patients and physicians, but we know the battle has just begun.

As welcome as it was, the Medicare legislation passed in July doesn't fix the broken Medicare payment system. As a result, physicians will face a 21% payment cut in 2010.

Essentially, it will be the sum of all payment reductions that would have been implemented in recent years without short-term legislative "fixes."

But listening to the debate in Congress gave reason for hope -- the sense of a growing urgency to develop a true solution to the dysfunctional Medicare payment formula.

The AMA is committed to using this 18-month reprieve to work with the Federation to develop long-term Medicare payment reform proposals. The tremendous grassroots support evident in this year's advocacy efforts makes our position stronger as we seek a permanent solution.

This support makes it that much easier for physicians to focus on our real work: Taking care of patients.