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December 1, 2016

2,100 doctors fire back at AMA for endorsing Trump's HHS pick

Daily Briefing

This story has been updated

There's been an "outpouring of anger" among some doctors in response to the decision by the American Medical Association (AMA) to endorse President-elect Donald Trump's HHS secretary nominee, Rep. Tom Price (R-Ga.), Rebecca Robbins reports for STAT News.

AMA and other several other physician groups have cheered the selection of Price, a House lawmaker and former orthopedic surgeon.

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AMA in a statement called on the Senate to "promptly consider and confirm" his nomination, which the group said it "strongly supports." The association added, "His service as a physician, state legislator, and member of the U.S. Congress provides a depth of experience to lead HHS." AMA also cited Price's work on policies "to advance patient choice" and "reduce excessive regulatory burdens."


However, many Democratic doctors pushed back, saying the AMA's endorsement of Price is a "betrayal of patients and physicians," Robbins writes.

As of Thursday morning, an open letter titled "The AMA Does Not Speak for Us"—which was written by the Clinician Action Network, an advocacy group—listed more than 2,100 physician signatories. The group said it will send the open letter to AMA and other doctor groups in the coming days.

The letter reads, "The AMA represents approximately a quarter of physicians in the [United States]—a loud, but minority voice. It certainly does not speak for us." The group argues that "Price's proposed policies threaten to harm our most vulnerable patients and limit their access to health care" and says that "by supporting Dr. Price’s candidacy ... the AMA has not aligned itself with the well-being of patients."

Specifically, the letter takes issue with Price's stances on Medicaid, Medicare, and certain value-based care programs. In particular, Price:

  • Supports turning Medicaid into a block grant program, requiring "able-bodied" beneficiaries to meet work requirements to receive benefits, and allowing individuals to opt out of Medicaid, Medicare, or Veterans Affairs coverage and instead use tax credits to purchase private plans;

  • Supports switching Medicare from a "defined benefit" to a "defined contribution" plan, under which the government would give beneficiaries financial assistance to help them buy private coverage; and

  • Opposes new mandatory payment reforms implemented or proposed by the Center for Medicare and Medicaid Innovation, which Price has argued could harm health care quality and exceed CMS' authority.

In an interview with STAT News, former HHS Secretary Kathleen Sebelius said she "wasn't surprised to see some pushback" from physician's about AMA's endorsement. She noted that AMA has been involved in outreach related to the Affordable Care Act and has supported Medicaid expansion, and that "clearly, this nominee does not share those views."

AMA in 2009 praised Sebelius' nomination for HHS secretary, stating that in her previous "roles as insurance commissioner and governor, she ... demonstrated the leadership skills required to direct HHS and implement health system reform."

Meanwhile, the National Physicians Alliance, an association of about 10,000 physicians, said it was "dismayed that other large physician organizations have endorsed Dr. Price without consideration of the harm his policies would inflict on our collective patients," including the repeal of the Affordable Care Act's coverage expansions.

Response from AMA, other groups

Patrice Harris, chair of AMA's board of trustees, told STAT News, "We understand that our diverse membership will never agree on every position the AMA takes."

She noted that AMA has sometimes disagreed with Price on "important policy issues," but argued that Price has "consistently recognized the many challenges facing patients and physicians, and he has been willing to listen" to AMA's concerns.

She said that AMA's endorsement is a result of its "relationship with Dr. Price going back decades."

Harris on Wednesday also said that AMA "remains committed to improving health insurance coverage," adding, "A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured."

Several other doctors groups also have praised Price, including the Association of American Medical Colleges (AAMC), which said he "is a strong choice for HHS secretary," and the American Hospital Association, which said he is "impressively qualified."

One senior official at an unnamed physician organization asked Politico's "Pulse" the rhetorical question, "What should we have done? Fight Price and wait for Trump to nominate Ben Carson?" Carson, a retired neurosurgeon who sought the Republican presidential nomination, was reportedly on Trump's shortlist for HHS secretary.

AAMC EVP Atul Grover told "Pulse" that "like [with] any administration, we expect there will be policies on which we will disagree and we will fight to change them. While Congress and the administration are changing and we will actively engage with them, our priorities haven't changed" (Robbins, STAT News, 12/1; Diamond, "Pulse," Politico, 12/1; Clinician Action Network open letter, 12/1; Cooper, Talking Points Memo, 3/2/09).

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