The California Medical Association (CMA) and the American Medical Association have each come out with differing takes on health reform legislation.

Though both organizations voiced similar support and disapproval, respectively, of certain provisions of health reform bills in Congress, both organizations have made comments on different items which they support or oppose, and their conclusion with respect to an overall “aye” or “nay” are quite different.

The following information is a digest of information provided in a CMA letter to Senators Dianne Feinstein (D- Ca.), and an AMA letter to Senator Harry Reid (D-Nev.).

Provisions that both the AMA and CMA support include:

1. Expanded access:

 The AMA stated that “health insurance reforms to provide more choice and access to affordable coverage for individual and small businesses (e.g. pre-existing condition limitations, non-discrimination based on health status, annual and lifetime limits), and advanceable, refundable tax credits, inversely related to income to low-income individuals to purchase health insurance are positive aspects of health care reform.  The CMA similarly voices the opinion that expanded health care coverage for 94% of the uninsured and assistance for low-income families to afford coverage are good.

 2. More competition and reforms in health insurance:

 Both the AMA and the CMA support creation of health insurance exchanges to stimulate competition and offer more affordable choices of doctors and plans. CMA also specifically supports Insurance industry reforms that protect patients and a requirement that insurers dedicate 80% of revenues to direct patient care.

 3. Expansion of Medicaid:

 Both CMA and AMA support the additional federal funding and expansion of Medicaid provided for in the proposed legislation.

4. Prevention and Wellness

Both CMA and AMA support the emphasis on prevention and wellness programs.

5. Other items

CMA also approves the following provisions: “investments to improve access to primary care physicians; resources for surgeons practicing in rural areas and incentives for physicians who collaborate and coordinate quality care”

The AMA also approves the creation of an independent comparative effectiveness research entity to enhance patient-physician decisions on treatment options “provisions to streamline, standardize and lower the cost to process health insurance claims.” 

CMA and AMA are similarly opposed to certain provisions:

 1. Failure to include a long term fix of the sustainable growth rate (SGR)

A one-year temporary patch to the Medicare physician payment formula instead of a permanent repeal of the sustainable growth rate is delineated.

 2. Medical Advisory Board

 Both CMA and AMA oppose the establishment of an Independent Medicare Advisory Board. CMA specifically states that this board would not be “accountable to physicians and patients and removes Congress’ responsibility for the program.  Rather than mandating reforms, the Board is required make arbitrary provider cuts that could reduce treatment options for patients.”

3. Cost and Value Modifiers

The AMA opposes “the development and application of a cost/quality index modifier to redistribute Medicare payments among providers based on outcomes, quality and risk adjustment measures that are not scientifically valid, verifiable and accurate.” CMA opposes the Value Modifier, “which could harm communities with large numbers of poor, minority patients already suffering from health care disparities.” Additionally, CMA notes that “individual physician reporting programs (PQRI, Value Modifier, Feedback) …have been fraught with problems in California’s demonstration projects.”

4. Reduction in fees to specialists

Both CMA and AMA opposed the budget neutrality provisions which would reduce payments to specialist physicians to partially offset bonus payments for primary care.

Additionally, CMA has voiced disapproval or concern about the following:

 ·      Fails to establish a stable Medicare program in the future.

·      Fails to address serious shortfalls in Medicaid funding yet adds nearly 2 million Californians to the Medi-Cal program.  It will completely overwhelm the invisible safety net of solo and small group private physicians.

·      Institutes quality reporting but does not assure the accuracy of the information which misleads patients and hinders physicians’ ability to improve.  

·      In three years, would remove Medicare resources for office rents and nursing wages costs beyond a physician’s control - from California’s higher practice cost areas. 

·      As recommended by GAO, MedPAC, Urban Institute and Acumen for CMS, it fails to update California’s Medicare locality borders that would vastly improve access to doctors in California’s newly urbanized communities.

·      Fails to provide anti-trust relief for physicians to negotiate on a level-playing field with the powerful insurance industry to improve patient care.

·      Many programs have the potential to interfere with existing physician-patient relationships and the provision of care.

AMA expressed opposition to the following provisions: