[medscape]  The American Medical Association (AMA) today announced its qualified support for Democratic healthcare reform legislation scheduled to come before the House this Sunday for a historic vote.

“The pending bill isn’t perfect, but we can’t let the perfect be the enemy of the good,” AMA President J. James Rohack, MD, said at a press conference Friday.

The AMA board of trustees took its position, said Dr. Rohack, because it considered the status quo unacceptable.  “We think doing nothing would only accelerate the total [healthcare] costs to America and increase the total number of uninsured, and we know already that they live sicker and die younger if access to their medical care is the emergency room,” he said.

House Democrats are hoping to approve reform legislation already enacted by the Senate and then amend it with a so-called budget reconciliation bill that incorporates wish-list items from House Democrats and President Barack Obama. The Congressional Budget Office estimates that the Senate bill as amended by the reconciliation bill would extend health coverage to 32 million more Americans over 10 years. The Senate also would need to pass the budget reconciliation bill — which by definition cannot be filibustered in that chamber by Republican opponents — for its provisions to take effect.

Two other medical societies this week announced their support of the reform legislation before the House — the American College of Physicians and the American Academy of Pediatrics.

AMA Finds Fault With Some Provisions of Reform Legislation

The AMA harbors reservations about the reform bill awaiting House approval because of what the legislation does and doesn’t do on several fronts. Foremost among AMA criticisms is the lack of a permanent repeal of Medicare’s sustainable growth rate (SGR) formula, which is set to trigger a 21.2% pay cut for physicians this year.

Other legislative sore points for the AMA include:

• An independent Medicare payment advisory board that, unless otherwise redesigned, could result in misguided reimbursement cuts for physicians, according to the AMA.
• Penalties for physicians who do not participate in Medicare’s Physician Quality Reporting Initiative.
• No provision for caps on noneconomic damages in malpractice litigation, which the AMA considers essential to tort reform.
• Regulations that would effectively ban physician-owned hospitals. “It shouldn’t make a difference who owns the hospital,” Dr. Rohack said Friday.

AMA President Sidesteps Question About Support for Bill Hinging on SGR Repeal

The AMA’s announcement of support for reform legislation came on the same day that the online publication Politico posted a memo allegedly from congressional Democratic leadership stating that Democrats were working with President Obama and the AMA to repeal the SGR formula sometime this spring. Politico removed the memo from its Web site later in the day, stating that Democrats had challenged its authenticity.

At today’s press conference, Dr. Rohack was asked if the alleged plan to repeal the SGR formula this spring factored into the society’s support of the latest version of reform legislation. Dr. Rohack did not directly respond to that question.

“So, as we have assurances in our conversations with Speaker Pelosi, the president, as well as Senate Majority Leader Reid that permanent repeal has to be done to stabilize the Medicare program and stop this problem where temporary patches continue to grow the problem,” said Dr. Rohack, given to sometimes speaking in fragments. “There’s an old Texas saying [that] if you’re going to have to swallow a bullfrog, the longer you look at it, the bigger it becomes. It’s a pretty big bullfrog right now.”

When asked to confirm whether he had received those assurances from Democrats, Dr. Rohack said, “Again, our commitment is to work on that. I don’t have a particular legislation language that talks about what they’re going to do…. Understand that our push for the SGR predates all this discussion on health system reform.”

Press officers for Senate Majority Leader Harry Reid (D-NV), House Speaker Nancy Pelosi (D-CA), and House Majority Leader Steny Hoyer (D-MD), did not respond to requests to either confirm or deny the memo’s authenticity.