San Antonio Express-News (Sunday)
Texas medical group against national’s view
The Texas Medical Association recently “fervently” objected to national doctor groups’ filing a legal opposition to a lawsuit seeking to end the Affordable Care Act and ultimately unravel the protections for patients with pre-existing conditions.
The call to stop a friends-ofthe-court brief planned by the American Medical Association and four other medical groups came June 12 from the Texas delegation on the floor of the AMA’s national convention in Chicago, those present confirmed.
“The ACA is an extremely unpopular political symbol in our state,” Dr. David Henkes, a San Antonio pathologist and chair of the state delegation to the AMA House of Delegates, said at the convention. “We fervently urge the AMA not to file a brief in this case at this time.”
Brief filed anyway
The Texas Medical Association objected to any legal weighin from national organizations because now is not the time nor the proper method, Steve Levine, vice president of communications for TMA, said Thursday.
“We wanted to make sure that the rest of the House of Medicine understood the ramifications of the AMA getting involved in a case in our backyard,” Levine said of the nation’s largest state doctor group.
But the American Medical Association, along with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, did so anyway, entering its brief on June 14.
At the heart of the tussle is a once-obscure lawsuit filed Feb. 26 in federal court in Fort
Worth by Texas Attorney General Ken Paxton which was joined by 19 other states. The suit declared the law informally known as “Obamacare” now unconstitutional.
When Congress passed its tax bill late last year, the legislation came with a provision to remove the penalty for not having health insurance starting Jan. 1, 2019. The net effect would mean that a pillar of the law requiring most everyone to have insurance would also be removed. The lawsuit contends the ACA had been propped up by Congress’ power to levy taxes. With the tax essentially gone, the law cannot survive and is no longer constitutional, according to the suit
Most controversial in this legal reasoning is that once the law is no longer valid, neither are consumer protections under the law such as protection against insurers charging more or denying outright those with pre-existing or chronic medical conditions. Other provisions of the ACA that could go by the wayside are the ability of children to stay on their parent’s health plans until age 26 and 100 percent coverage for preventive services. Annual and lifetime dollar limits could be reinstated, and insurance companies would be freed from limits on how much profit they could take off premiums.
The lawsuit got a surprise validation earlier this month when the Department of Justice, with the blessing of the White House, announced it would not defend the ACA in court. Most significant is that Justice agreed with the Texas-led suit that insurers should not be forced into coverage requirements.
Days later at the medical convention, Dr. Gerald Harmon, chair of the association’s board of trustees, announced the American Medical Association would lend its considerable heft to opposing the Texas lawsuit, saying that if the suit succeeded, “federal policy would roll back to 2009 without any substitute in place.”
Henkes from San Antonio then quickly stood and objected.
“If AMA files a brief now, there will be considerable political pressure from our state for TMA to file its own amicus brief supporting the plaintiff ’s position,” Henkes said, according to a transcript of his comments provided by the 51,000-member Texas association.
‘Counterproductive’
“This puts us in a position that will be extremely counterproductive to the TMA’s advocacy agenda on behalf of Texas physicians and our patients,” he added. “Should the AMA file a brief in this case I have no doubt it will interfere with our work on key state issues such as liability reform, scope of practice, insurance reform, Medicaid, public health, and graduate medical education.”
Levine said Thursday the TMA’s objection to other medical groups’ legally intervening for pre-existing coverage should absolutely not be construed as Texas doctors being against such protection.
Dr. Douglas Curran, an Athens family physician and TMA president, said in a statement that his organization takes a “more nuanced” stance than the AMA.
“We like and we want to keep those parts of the ACA that are good for our patients, like guaranteed coverage for people with pre-existing conditions,” Curran said in the statement. “Other parts, like the disruption of insurance markets and overwhelming paperwork burdens on physicians, have to go.”
The Texas Medical Association opposed the final version of the health care law when it passed in 2010.