The American Medical Association has given up on passage this year of a controversial measure to expand physicians' ability to contract privately with Medicare beneficiaries.
As the number of working days dwindles in an election-shortened congressional session, the organization of 293,500 physicians has decided to spend its time pushing patient-protection legislation sponsored by congressional Democrats and tobacco-control legislation being debated in the Senate.
Even the chief sponsor of the private contracting measure, Sen. Jon Kyl (R-Ariz.), has conceded defeat for this year.
Last year's balanced-budget legislation allows physicians and other providers to sign contracts to deliver Medicare-covered services to beneficiaries under terms independent of the Medicare program. To qualify, however, providers are prohibited from billing Medicare for any other patients for two years.
Kyl's measure, which is sponsored in the House by Ways and Means Committee Chairman Bill Archer (R-Texas), would eliminate the two-year exclusion.
Only about 300 providers have chosen to contract privately with Medicare beneficiaries and forgo Medicare payments, according to HCFA. Of those, nearly half, 140, were psychiatrists.
While saying that passing the Kyl measure remains a legislative priority, J. Edward Hill, M.D., an AMA board member and a family physician from Tupelo, Miss., recently disclosed the AMA's probable emphasis for the rest of Congress' 1998 term.
"Our priority is the Patients' Bill of Rights," Hill said.
His comments followed a forum on the Kyl measure held last month by the conservative Heritage Foundation.
In that forum, however, Kyl did not give the AMA much reason to continue pushing hard for his measure.
"We don't have the votes to get it out of the Senate Finance Committee," Kyl said. "We're not likely to get the legislation passed."
"We accept Sen. Kyl's assessment, and perhaps this will be revisited another day," said AMA spokesman James Stacey.
A group that isn't accepting Kyl's assessment, however, is the 640,000-member United Seniors Association, one of the chief interest groups pushing the private contracting measure.
"Kyl is really committed to this bill, and he has every intention of pushing for this bill with or without the AMA," said Meg Kilgannon, a spokeswoman for the seniors group.
Capitol Hill aides, meanwhile, said Kilgannon's group, not the AMA, has been the leading voice for the private contracting bill.
"I didn't hear a peep out of the AMA," said a House Republican aide who asked not to be identified.
House Republicans told the AMA its mission was "to get us Democrats" to sponsor the legislation, said another House GOP aide who requested anonymity. But the aide said only a few conservative House Democrats, known as the "Blue Dogs," were on the list of 192 sponsors of the legislation.
As a stand-alone bill, the Kyl measure has some formidable odds against it. Although the Senate attached a nonbinding measure that supports private contracting to its budget blueprint for federal fiscal 1999, the amendment won with only 51 votes.
That tally is well short of the 60 necessary to stop extended Senate debate aimed at killing legislation.
Chances are slim that advocates could attach a private contracting measure to related legislation, because Congress isn't showing much enthusiasm for passing a new budget package or a Medicare-related bill before adjournment this fall, one year after it passed the balanced-budget law.
One candidate for carrying a private-contracting amendment is patient-protection legislation, a possibility that would be awkward for the AMA, said some healthcare sources.
If private-contracting advocates choose that strategy, the AMA could be forced to lobby against the amendment. The AMA could see it as a "poison pill" that would sink a patient-protection bill because Democrats would be far less likely to support a measure with the private-contracting language, while Republicans would oppose any health plan regulation.