AMA, AARP in Lobbying Link-Up

Here's an interesting development. The American Association of Retired Persons and the American Medical Association have joined hands to support a House bill to expand the states' Children's Health Insurance Plan (S-CHIP). The strange bedfellows coalition was reported this morning by Robert Pear in the New York Times.

The article is clear on what the AMA gets out of the deal. The House bill, which covers more kids and even some uninsured adults who were not covered in legislation that cleared a Senate committee last week, also increases physician payments. Under current law, Medicare payments to doctors are scheduled to decline slightly next year.

But what's in it for the AARP? To its credit, the AARP has been willing to wield its lobbying clout on behalf of seniors' grandkids, not just seniors themselves. Enlisting the AMA in the cause is a real feather in its cap.

Moreover, the bill would raise some additional funds by cutting Medicare's excess payments to insurance companies that sell group plans (HMOs) to seniors. They're known as Medicare Advantage plans. The 2003 law that created the prescription drug benefit encouraged these plans by offering higher-than-average payments for every senior who enrolled. The goal of the architects of this approach is to undermine Medicare. They accomplish that by siphoning off its healthier beneficiaries into private insurance plans that are subsidized for taking on these lesser risks (for a good overview of the subject, see Saul Friedman's column in Saturday's Newsday). The insurance industry's pathetic defense of these scams is that it is offering greater benefits to these healthier seniors. Again, it's a coup for the AARP, which actually helps market some of these Medicare Advantage plans, to get the AMA on board in cutting Medicare advantage payments to insurance companies while defending the public program.

But don't look for the kumbaya moment to last long. Two weeks ago, William Novelli, chief executive officer of AARP, outlined his priorities for health insurance reform at a Center for American Progress briefing. One of Novelli's preferred approaches for "getting Medicare right" would increase the use of physician assistants and nurse practitioners to hold down health care costs. Such a move is adamantly opposed by organized medicine. Indeed, the AMA has made that provision its prime reason for opposing Gov. Ed Rendell's health insurance reform plan in Pennsylvania.

Meanwhile, President Bush is threatening to veto any expansion of S-CHIP, whether the Senate or House versions. For this extremist president, undermining any and all public programs far outweighs the needs of children.