The American Medical Association has a long history of calling for increased health insurance coverage and decreased tobacco use. But the physicians group has not come out in support of bipartisan legislation before Congress that aims to accomplish both goals.
The AMA is not alone, however. Despite a commitment to helping 4 million uninsured people get coverage by the end of 1998, the American Hospital Association also hasn't come out in favor of the measure, which could help extend health insurance to 5 million children.
Neither provider group is among more than 150 members of a campaign launched last week in favor of the legislation sponsored by Sens. Orrin Hatch (R-Utah) and Edward Kennedy (D-Mass.).
One of the leading bills now before Congress, the measure would funnel $20 billion over five years in new tobacco-tax revenues to the states to subsidize health insurance for children at the same time as it discourages children from smoking.
Neither the AHA nor the AMA has come out in favor of any other specific children's healthcare bill.
James Bentley, senior vice president for policy development with the AHA, characterized providers' reluctance to endorse any specific bill as a "pragmatic" decision that keeps them from being trapped in a political corner.
"Don't be so purist that you keep things from happening," Bentley said. "You have to make sure you're not in a narrow camp."
AMA spokesman James Stacey, meanwhile, said the group is reviewing the numerous children's healthcare proposals to consider which to support.
As they have done in past healthcare reform controversies, the AHA has chosen to develop principles by which it will judge children's health insurance proposals.
Among those principles, expected to be approved this week, is whether a piece of legislation has bipartisan support, increases net coverage, provides stable financing, emphasizes wellness and encourages coordinated healthcare delivery.
Richard Wade, the AHA's senior vice president for communications, said the tobacco-tax legislation "stacks up well and meets all those criteria."
AHA officials said they had been asked by Republican leaders not to sign on to any children's healthcare bill until the GOP*leadership could develop its own plan.
The AHA is dependent on staying in the GOP leadership's good graces to stop a freeze on Medicare inpatient payment rates and reach a favorable agreement on allowing provider-sponsored managed-care organizations to enroll Medicare beneficiaries.
An executive of one hospital alliance that has endorsed the Hatch-Kennedy bill urged his provider colleagues to support it more vigorously.
"It's bipartisan legislation-that's pretty rare-and deserves the industry's active support," said Ben Aune, president and chief executive officer of InterHealth, a mostly Protestant provider group. "It's a no-brainer. I can't understand why there's any hesitancy to endorse it."
InterHealth last week joined more than 150 advocacy groups in a campaign in favor of the Hatch-Kennedy bill, which raises federal cigarette taxes by 43 cents per pack. The campaign is purchasing radio advertisements in eight states in support of the legislation.
That ad campaign is in response to $155,000 worth of radio advertisements being purchased in Utah and Oregon by Citizens for a Sound Economy, a free-market advocacy group. The ads attack Hatch for sponsoring the legislation and freshman Sen. Gordon Smith (R-Ore.) for signing on as a co-sponsor.