It's not that Senate Republicans aren't sympathetic to doctors' desire to get paid for their services; it's just that they aren't willing to bend over backward anymore to help the American Medical Association get the legislative remedy that it wants.
Republicans and the AMA used to be like peas in a pod — such as in the early 2000s when the GOP had control of Congress and repeatedly pushed payout limits for medical malpractice lawsuits.
But then last year, the AMA did the unthinkable in Republican eyes and endorsed the Democrats' massive health care reform bill. So as the Democratic-controlled Senate now debates a bill that would prevent physicians from taking a 21 percent cut in Medicare payments, Republicans are turning the other way — saying that endorsement and other political missteps have scarred the long-standing relationship.
"For some inexplicable reason, I think the AMA has kind of burned all its bridges. It just makes absolutely no sense to me," National Republican Senatorial Committee Chairman John Cornyn said.
The AMA pulled out the stops against the Texas lawmaker in 2008 when he voted against that year's push for the Medicare "doc fix," running ads against him in Texas and having the Texas Medical Association revoke its endorsement of him for a second term.
The AMA also ran ads against other Republicans that year, and when the Senate revoted on the issue after a two-week stretch of bad publicity generated by the AMA, nine Republicans, including Cornyn, switched to support the doc fix.
But that scorched-earth campaign is not why most Republicans feel so little allegiance to the AMA these days.
"I think a lot of it had to do with health care reform," GOP Policy Committee Chairman John Thune said. "The physicians of course jumped on that bandwagon early, notwithstanding our concerns about it and our trying to convey to them why we thought it would be a bad idea for them in the long run, and what strikes me about it is they're now coming back and trying to get things that they should have done in health care."
The South Dakota lawmaker added: "That's why a lot of Republicans right now are looking at this issue and saying: Yeah, we want to help you. We want to fix this. We thought it should have been fixed a long time ago.' But [they] are not particularly sympathetic to their sense of urgency about getting a 10-year fix in place given the fact that it should have been done in the health care debate."
Even the AMA's fellow doctors had little sympathy for its plight.
"One would think that if there were a major health care bill in this country and the largest physician membership group in the country was involved that it should have included paying for doctors and dealing with lawsuit abuse," said Sen. John Barrasso (R-Wyo.), an orthopedic surgeon and member of the AMA.
Indeed, many Republicans believe that without help from the AMA, Democrats might not have been able to get all 60 Democratic Senators to support the overhaul last December.
AMA President J. James Rohack said the AMA doesn't regret supporting health care reform because it does address other problems in the health care system. He also said the problems with the Medicare physician payment system have been festering for years and should have been addressed on their own by both Republicans and Democrats
Most Republicans said they would support another doc fix if it were offset with spending reductions elsewhere, and Thune has offered an amendment to the tax extenders bill to do just that while also reforming medical malpractice lawsuits.
The $140 billion tax extenders package includes an 18-month delay in the doctors' payment reductions, but Democrats on Tuesday were considering scaling that back to 12 months because of a lack of GOP support for the bill and the possible defections of a couple of Democrats.
Members of both parties have cited concerns that the measure is not fully paid for and would add to an already ballooning federal budget deficit. House Democrats originally floated a three-and-a-half-year doc fix, but that was shot down by fiscally conservative Blue Dog Democrats.
Last year, Senate Majority Leader Harry Reid's attempt to pass a $245 billion 10-year doc fix failed to garner even a bare majority, much less the 60 needed to overcome a filibuster. One senior Senate Democratic aide said the AMA promised last year that it could persuade as many as 22 Republicans to vote for the 10-year package. No Republicans voted for it, and 13 Democrats opposed the measure as well because it was not offset.
Democrats said they have been frustrated by the AMA's apparent lack of influence with Republicans.
"The AMA and Republicans had a long-term love affair, and now when the AMA needs them most, Republicans have turned their backs on them," the senior Senate Democratic aide said. "Either the AMA is an ineffectual lobbying organization or Republicans drop their friends like hot potatoes whenever it's politically convenient."
Though Republicans did not mention campaign contributions as a factor, that has also changed recently. For more than two decades, the AMA and its members have consistently given more to Republicans than Democrats. But that trend was bucked during the 2008 election cycle, when the AMA and doctors gave almost $240,000 more to the majority than to the minority, according to the Center for Responsive Politics.
Still, the AMA is trying to gin up support for this latest effort to keep doctors from taking a pay cut. The group escalated its lobbying campaign and has begun running ads in 17 states. AMA officials said the states were chosen not on the basis of party but on the basis of their large elderly and military populations. (TRICARE, the military health insurance plan, ties its physician reimbursement rates to that of Medicare.)
Eleven of those states also happen to be represented by Republicans: Arizona, Florida, Georgia, Iowa, Maine, Nevada, North Carolina, Ohio, Texas, Massachusetts and Tennessee.
At the AMA conference being held this week in Chicago, doctors signed hundreds of white lab coats that they plan to deliver to Senators this week as part of their protest. In addition, the AMA is taking its case to patients. On its website, the medical group has provided doctors with fliers to post in their offices urging patients to call their lawmakers and tell them to fix the payment rates.
Rohack said the lobbying effort is not just targeted at Republicans, adding that "both parties have ownership" of the Medicare payment issue.
"The reality is both parties need to step up and fix the problem," he said.
Rohack said he is aware that any plan needs the support of 60 Senators, which is why his organization is not backing the Thune proposal to pay for the doc fix by adopting medical liability reform.
He said as much as doctors want liability caps, the votes are not there for such reform.
One health care lobbyist said medical groups had held talks with the staff of key GOP Senators, including Thune, Minority Leader Mitch McConnell (Ky.) and Minority Whip Jon Kyl (Ariz.).
"I don't think they want to keep the cuts, but they all seem pretty dug in on fiscal responsibility," the lobbyist said, adding that medical groups hope to win over Republicans from states with a high number of elderly individuals, including Florida, North Carolina and Arizona.
The lobbyist dismissed speculation that the Republicans were punishing doctors groups for supporting the Democratic health care law. The lobbyist pointed out that many GOP lawmakers didn't support increasing Medicare physician payments when the issue came up for a vote in 2008 before the health care reform debate had even begun.