President-elect Donald Trump campaigned on repealing and replacing the Affordable Care Act, so it’s not a huge shock that he picked Rep. Dr. Tom Price (R-GA), a former orthopedic surgeon and fervent ACA opponent, to head up the U.S. Department of Health and Human Services.
More surprising was the American Medical Association’s strong endorsement of Price in a statement from board of trustees chair Dr. Patrice Harris, who urged the Senate to “promptly consider and confirm Dr. Price for this important role.”
Backlash from physicians was swift. Among those who spoke out were Drs. Manik Chhabra, Navin Vij and Jane Zhu of the University of Pennsylvania, who wrote a post on Medium titled, “The AMA Does Not Speak for Us.” The trio challenged the association’s endorsement in their letter and invited fellow physicians to sign on.
As of Thursday, more than 5,000 health care providers have done so.
“The AMA represents approximately a quarter of physicians in the U.S. ― a loud, but minority voice,” the doctors wrote. “It certainly does not speak for us.”
Indeed, the American Medical Association’s inclusive-sounding name doesn’t mean it represents the opinions or will of all or even most doctors. As of 2012, the AMA represented about 26 percent of doctors, according to Modern Healthcare. Although he didn’t provide a more current percentage, spokesman Jack Deutsch told HuffPost the AMA is “the nation’s largest physician organization with a quarter of a million members.”
Chhabra, Vij and Zhu are part of the Clinician Action Network, a nascent alternative organization that has grown in response to Trump’s election. And their letter struck a cord. Before its publication, the initial group of CAN members included 60 health care providers. Network membership has since swelled to several hundred individuals, including physicians, nurse practitioners, physician assistants, pharmacists, social workers and community members.
While conversation about health policy is nothing new for many health care providers, the new group emphasizes activism in a novel way, according to Chhabra.
“They’re not folks who have previously been in roles as public advocates,” he said. “A lot of us became really scared [after the election] that suddenly the progress we’ve been seeing for the quality of care that our patients are receiving was ruined for us.”
Advocating for the most vulnerable patients through policy
The three doctors stressed that CAN is about promoting policies that improve patients’ lives, not becoming an arm of the Democratic or Republican parties.
“When someone becomes sick in this country, whether they’re rich or poor, we want to ensure that we have a system that’s able to take care of them in a particular way,” Chhabra said. “We don’t think that that’s a partisan thing.”
Instead, the group sees its role as a clearinghouse to connect clinicians to organizations that are already doing good work, and to coordinate support for patient-first, evidence-based health policies. They hope members will take a more public role in policy by writing op-eds for the public, policy briefs and background pieces to voice physician concerns.
“We’re going to be very responsive to legislation that is being introduced and voted on in Congress, both at the state level and the national level,” Zhu said. “This is the time for clinicians to take part actively in a process that’s always been dominated by politicians.”
What Price’s HHS tenure might look like
The group will have its work cut out for them.
Should Price be approved, he’ll enter the Trump administration with a detailed 242-page proposal to repeal and replace the Affordable Care Act, much of it targeted at reducing costs for the young and healthy at the expense of programs intended for the sick and poor. Included in Price’s proposal: a full repeal of Medicaid expansion and less help for patients with pre-existing conditions. And, unlike the ACA, Price’s proposed plan doesn’t require employers to cover addiction treatment, birth control, maternity care or prescription drugs.
The doctors pushed back on these policy changes in their letter:
We support patient choice. But Dr. Price’s proposed policies threaten to harm our most vulnerable patients and limit their access to healthcare. We cannot support the dismantling of Medicaid, which has helped 15 million Americans gain health coverage since 2014. We oppose Dr. Price’s proposals to reduce funding for the Children’s Health Insurance Program, a critical mechanism by which poor children access preventative care. We wish to protect essential health benefits like treatment for opioid use disorder, prenatal care, and access to contraception.
When asked about the criticism, the AMA pointed to a follow-up letter Harris posted Dec. 1, stating that Price’s physician background (Price is an AMA member) would provide important perspective within Trump’s cabinet. The organization said it has disagreed with Price on certain policy issues during his tenure in Congress, including his stance on the ACA. But the endorsement stands.
For the newly formed Clinician Action Network, that message was hard to stomach.
“We should judge a physician based on his polices and not give him a free pass just because he’s a doctor,” Zhu said. “Where he wants to take the direction of the health care system is important to the people who are practicing in it and the people who get served by it.”