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CHICAGO -- The American Medical Association's policy-making body is sending a stern warning to Congress: "Keep your hands off Medicaid."
During a protracted, and at times emotional debate in the AMA's House of Delegates, there was little doubt that the AMA is digging in to protect Medicaid, offering no easing of its firmly stated opposition to capping payments.
The AMA's latest hard-line position on Medicaid is crafted to obscure any hint of flexibility, or at least that is the way the leaders of the Medicaid protection faction -- the American Academy of Pediatrics, the American College of Physicians, and a coalition of west coast states -- want the message delivered.
At issue was an AMA Council on Medical Service report that did oppose Medicaid caps, but not strongly enough for the AMA house, while at the same time offering a backup strategy for how to cope if Medicaid block grants did come to pass.
The American Health Care Act, which was passed by the House in May, not only includes a rollback of the Medicaid expansion over 2 years, but would also drastically remake the program.
The bill, if passed by the Senate in its current form, converts Medicaid from an open entitlement to a block grant or per- capita cap model, where states receive lump-sum payments from the government, that would rise or fall according to a fixed formula and not according to need.
An AMA reference committee amended the CMS report by adding a resolution making opposition to caps on federal Medicaid funding AMA policy. That resolution was readily adopted.
The first recommendation of the report "that our American Medical Association (AMA) oppose caps on federal Medicaid funding" was readily accepted.
Another part of the CMS report asked Congress and the Department of Health and Human Services to consider the opinions of the AMA and other key parties (i.e. Medicaid directors, mayors, national medical specialty societies) while developing federal legislation and regulations. That, too, was adopted.
But a long list of principles to guide strategy if Congress ignored the AMA's request to back-off block grants was not rejected by the house after several delegates said those recommendations would simply "tip our hand" and be interpreted as a weakening of the AMA's opposition to cutting Medicaid.
From the original to the revised report the language shifted from "safeguards" necessary in case of Medicaid caps to the more benign "principles of federal Medicaid funding."
Aaron Spitz, MD, a urologist delegate from California said those principles are useful and likened them to giving his son "the talk" in middle school.
"I wasn't giving him a game plan. I was trying to give him guidelines of what not to do," he said.
When it comes to Congress, why should AMA's approach be any different, he argued.
"We're not showing our hand. We're showing the country what we stand for and there's nothing wrong with that."
Lisa Egbert, MD, one of the drafters of the CME report agreed.
"This is a set of principles by which we can stand and fight," she said, likening its principles to "marching orders" and challenging the reports critics to identify which ones they could dispute.
One of the report's staunchest critics, Melissa Garretson, MD, a delegate from the American Academy of Pediatrics said the report's defenders missed the point: the very existence of the report signals defeat.
The language of the report, even the revised report -- which notably removes virtually every mention of the word "caps" except to state the AMA's opposition to them -- is rooted in the assumption that the government will shift to a block grant or capitated system, she said.
Other critics argued that indeed, having a public policy manual that shows the association's views of Medicaid block grants had room for compromise.
The delegates wrangled for more than an hour vacillating between simply "not filing" the full report, to tabling the contentious parts of the report, a parliamentary maneuver that "makes it go away", said HOD vice-speaker Bruce Scott, who fought to keep order while the debate dragged on.
Finally, the delegates decided to sleep on it: the House postponed until Tuesday morning a vote on how to handle the report.