Citizens Against Lawsuit Abuse of Central Texas

Dallas Morning News
November 6, 2009

WASHINGTON – Led by Temple cardiologist J. James Rohack, the American Medical Association committed in May to support the White House's effort to expand coverage to millions of uninsured and dramatically cut health care costs.

The move was a calculation that the AMA could help pass a sweeping health care overhaul while securing its own prized goals: caps on medical lawsuit awards and the repeal of a formula that annually threatens to cut Medicare payments to doctors.

But the House health legislation that is headed to the floor Saturday addresses neither special issue head-on. The House will vote separately on a bill to change Medicare payments, but that legislation would add to the deficit and land in the Senate , which rejected such legislation last week.

"They've hurt themselves," said U.S. Rep. Michael Burgess, R-Lewisville, an obstetrician who is an AMA member. "They supported [the bill] too soon, and they didn't get the things they needed."

In a conference call with reporters Thursday, Rohack, president of the AMA, defended the group's support and said it would urge its doctors to ask House members to pass the bill, which he said addressed many of the AMA's goals for a health care overhaul.

"This legislation isn't perfect, but this debate is not over," he said. "The work is not done."

Rohack, a cardiologist at Temple-based Scott & White Hospital, said the AMA has lost some members but gained some over its support of the health care legislation. He has gingerly guided the AMA, which includes several politically conservative state delegations and specialty societies, toward supporting the bill.

Even so, Rohack was put on the defensive by two Texas physicians who were on the call and posed tough questions as reporters listened. One, Paul Handel, insisted that Congress wouldn't fix the Medicare payment formula because "the government in 45 years has not fixed the problem."

Another, plastic surgeon Russell W.H. Kridel of Houston, suggested that Rohack was insufficiently supportive of the kind of tort reform approved in Texas in 2003. Rohack said he was open to other ways of limiting lawsuit awards because Texas' law had not succeeded in reducing the state's 6 million uninsured.

"The reality is Texas led the nation in the number of uninsured before 2003 when [lawsuit] caps were passed, and Texas continues to lead the nation in the number of uninsured after caps were passed," Rohack said.

Handel later said he wasn't speaking for the Texas Medical Association, for which he serves as trustee. He previously worked as medical director of Blue Cross Blue Shield of Texas and serves as chief medical officer of Health Care Service Corp., the Texas insurer's parent company.

President Barack Obama and House Speaker Nancy Pelosi played up the legislation's latest endorsements, which include support from AARP. Obama, who had planned to visit Capitol Hill today but after the fatal shootings at Fort Hood, Texas, will now meet with House Democrats on Saturday, said the endorsements were expert opinions that should carry weight with lawmakers.

"The doctors of America know what needs to be fixed about our health care system," Obama said. "They know that health insurance reform would go a long way toward doing that."

The Texas Medical Association says it doesn't oppose the House bill. Nonetheless, the group sent an e-mail to 21,000 of its members Wednesday that pointed out what it views as the bill's failings, including its lack of a permanent change to the Medicare formula, which calls for a 21 percent cut in doctors' Medicare payments at the start of next year.

"Signing on early, without having a solid fix in place, without having meaningful tort reform in place, is a tragic move on the part of the association," Handel said in an interview after the conference call. "It lends support for a bill that really doesn't have to deliver on either of those two actions."

Rohack described the Medicare payment legislation as part of a "package" that includes the larger health care bill. The House is scheduled to consider the Medicare formula bill the week of Nov. 16, House leadership aides said Thursday.

The Senate rejected a version of that legislation last week that would have cost $245 billion over 10 years. Including the measure in larger health care legislation would push the total cost beyond $1 trillion, a threshold that Democratic leaders want to avoid.

Sen. John Cornyn, who has sparred with the AMA in the past, said Thursday that the doctors' lobby continues to focus too narrowly on Medicare payments.

"I continue to be amazed at the narrow focus of the AMA when focusing on the Medicare provider payment fix, which I think is important, but then basically swallowing hook, line and sinker all the other bad stuff in the Pelosi bill," Cornyn said.

Still, some Texas doctors say Rohack and the AMA have tried to please too many other stakeholders during the health care debate.

"They do good things, but they are not defending the trade," said Stanley Feld, a Dallas endocrinologist and former AMA member. "If you're not helping me, then why be involved?"

Staff writer Jason Roberson in Dallas contributed to this report.