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Dec. 9 — More than 5,000 doctors who are unhappy with President-elect Donald Trump’s choice of Rep. Tom Price (R-Ga.) as secretary of HHS are disavowing the American Medical Association’s support of the former orthopedic surgeon.
The endorsement “reneged on a fundamental pledge that we as physicians have taken—to protect and advance care for our patients,” a letter from the Clinician Action Network signed by more than 5,000 doctors whose practices range from psychiatry to pediatrics, said. The letter criticizes Price’s views on Medicaid, the Children’s Health Insurance Program and Medicare. It was sent Dec. 9 to the AMA and to congressional representatives who either have worked as health-care providers or sit on the confirmation committees for the Department of Health and Human Services nomination, one of the authors told Bloomberg BNA.
The AMA joined many industry groups who had welcomed one of their own and backed Trump’s decision to nominate Price last week. But backlash is building. A letter from Senate Democrats Dec. 7 vowed to protect Medicare and Medicaid, and scores of health-care providers tweeted using #NotMyAMA in the wake of the nomination.
Health and social justice organizations including Families USA, Doctors for America and the Center on Budget and Policy Priorities also announced on the same day the letter was sent that they were banding together to create a “Protect Our Care” Coalition. The group is opposing Affordable Care Act repeal, which has long been a top priority for Price.
“Millions could face higher premiums and out-of-pocket costs, and the availability of adequate, affordable coverage for people with pre-existing conditions like cancer, diabetes, and heart disease could be jeopardized,” the coalition said in its release. “Women could also be denied coverage and charged higher premiums just because of their gender.
“These people deserve an answer from Congress—not a bait and switch.”
The conversation, which shows discord even among the health-care industry, further underscores the debates leading into next year’s administration and the tough battle on health care ahead.
“It’s clear for a sector that already has a lot of uncertainty to it, there’s going to be even more,” Mayer Brown Senior Adviser Warren Payne said in a Dec. 1 call about the legislative landscape. “The health-care sector is going to be in for a heck of a rollercoaster ride in the next few months.”
Toby Moffett, also a senior adviser for Mayer Brown on the call, added that leading with health care, as the Trump administration is expected to do, will be “messy, very partisan and may not work.” Moffett and Payne are in Mayer Brown’s Washington office.
Price has supported fundamental changes to entitlement programs, such as block-granting Medicaid, more health-savings accounts, budget cuts for CHIP and privatizing Medicare.
The letter and the response to it “really capture a widespread sentiment and fear that a lot of clinicians have following the election about what a threat these policies are to our patients,” Dr. Manik Chhabra, Robert Wood Johnson Foundation Clinical Scholar in the Perelman School of Medicine at the University of Pennsylvania, and an author of the letter, told Bloomberg BNA.
Many of the doctors have not been politically involved or engaged in activism in the past, he said. But now they want to make known their concerns, which are based on experiences in clinics and hospital rooms spanning every state except North Dakota.
The AMA, the largest group of its kind with a membership numbering around a quarter of a million people, stood by its endorsement. It lauded Price’s background in the medical field (the first doctor nominated to the post since 1989), “understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations,” according to a Dec. 1 statement from AMA Board Chair Patrice Harris.
Harris added that supporting the nomination did not equate to supporting every policy he has proposed, noting that a bottom line for any proposed health-care reform would be to ensure no one loses health insurance coverage. The AMA will “actively engage Dr. Price, other leaders in the incoming Trump administration and Congress in discussions on the health system’s future direction,” she wrote.
The AMA, which pushed for Obamacare, would not officially comment further on the Dec. 9 letter.
Its comments on Price’s nomination came in sync with endorsements from other major health-care industry groups: the Association of American Medical Colleges, the American Academy of Family Physicians and America’s Health Insurance Plans, among others.
Dr. Jane Zhu, a national clinician scholar in the same University of Pennsylvania medical school as Chhabra, said the Clinician Action Network’s grassroots organizing was not about Trump’s election victory and being “sore losers.” Nor was the call-out against the “loud, but minority voice” intended to attack the medical association, Zhu, who co-wrote the letter, added.
But instead, the authors told Bloomberg BNA the goal was to stand up for their patients, many of whom had benefited from ACA provisions such as expanded Medicaid, substance-abuse treatment benefits and birth control coverage. Though they “don’t think we’re naive” and believe Price will be confirmed to head the top health-care agency, they hope the conversation will reassure patients that not all doctors are on board. The letter also aims to encourage other health-care providers to get involved.
“Now is the time to really speak up to make sure we don’t go back on any of the progress we’ve made in the past few years,” Zhu said.
“It’s impossible now to take care of patients without paying attention to the political and social context in which that’s done,” she said.
The Clinician Action Network was formed out of conversations in the weeks following Trump’s election and has grown from 60 or 70 members to a few thousand e-mail members, the organizers said. The nonpartisan entity, which does not receive outside funding, said it verified the names of doctor signatures on the letter by taking random samples of unfamiliar names and checking them against national provider identification numbers. They deleted some fake names they found, but the number stands around 5,000.
“I don’t think there are a lot of interdisciplinary groups whose sole purpose is speaking out on behalf of patients and patient care,” Chhabra said. “In that way, because we’re not affiliated with a party or other organizations or parties at this point, hopefully that gives us a distinct voice as we start to advocate for the policies we’re recommending.”
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