Feb 1, 2023 - Health

Republicans break with another historical ally: doctors

Share of contributions from the American Medical Association to <span style="background: #F6643E; padding: 5px; color: white">GOP</span> or <span style="background: #14A0FF; padding: 5px; color: white">Democratic</span> congressional candidates
Data: OpenSecrets; Chart: Will Chase/Axios

Republicans' historical alliance with the nation's leading physicians' group has deteriorated to the point where several elected doctors are openly critical of the organization and what they refer to as its "woke" policies.

Why it matters: The fractured relationship, similar to the GOP's relationship with the U.S. Chamber of Commerce, points to a substantial change in Washington's power dynamics under a newly empowered GOP House.

Driving the news: Several GOP doctors voiced frustrations with the American Medical Association in interviews with Axios, frequently citing the organization's positions on issues like abortion and gender-affirming care.

  • Some members of the congressional Doctors Caucus said they met with AMA leadership last week.
  • "[W]hen they told us their priorities, they aligned with our priorities. But it's like, it doesn't look like those are your priorities. What looks like your priorities are abortion and transgender issues," said Rep. Brad Wenstrup (R-Ohio), one of the co-chairs of the caucus.
  • "It looks like all you care about are woke issues," Wenstrup said, defining the group's policies on abortion and transgender issues as "woke" because they don't align with the Doctors Caucus' "pro-life" stance and feel like a mandate to practice medicine they don't agree with.
  • Sen. Rand Paul (R-Ky.) told Axios that the AMA "has been very much left-wing or left-of-center for a long time ... If I had time I could probably tell you 20 things the AMA has done in the last five years that I disagree with."
  • Paul said the perception of alignment with "woke" policies extends beyond the AMA to other professional medical groups, like the American College of Obstetricians and Gynecologists — who've been leading voices on reproductive health post-Roe — and the American Academy of Pediatrics, which has been supportive of gender-affirming care.

The big picture: The fractured relationship represents major shifts within both the GOP and the AMA, including an increasing openness by the trade group to a larger role for the federal government in the health care system.

  • The group inveighed against "socialized medicine" for decades, opposing President Harry Truman's national health insurance plan in the 1940s, the creation of Medicare in the 1960s and President Bill Clinton's health care plan in the 1990s.
  • In June 2009, FiveThirtyEight reported that 64 percent of the AMA’s donations to federal candidates in the previous decade had been to Republicans. But although it opposed the inclusion of a public option in Democrats' health care plan under President Obama, the AMA eventually became a crucial supporter of the Affordable Care Act, which passed without any GOP support.
  • Since then, the group opposed Republicans' repeal-replace effort in 2017. By the end of the decade, a vote by the AMA's governing body on ending the organization's opposition to single-payer health care had only narrowly failed, the New Yorker reported last year.

But it's been the group's positions on major social issues that may have caused the most friction with congressional conservatives.

  • "I think the AMA, it's been going on for maybe longer, but this summer when they were up on the Hill testifying about gun violence and to some extent the Dobbs decision, that might have been the end," said Joe Grogan, a USC-Schaeffer senior fellow and former Trump administration official.
  • "For a period of years, their persuasiveness with Republicans has been waning, and what has been quiet and private complaining in advance and after meetings has become open contempt for the AMA," Grogan added.

What they're saying: The organization's ideological shift has at least directionally tracked with its membership, which it says numbers more than 270,000.

  • “More or less over a 20-year period, a profession that was always thought of as rock-ribbed Republicans has changed, and tilted to the Democratic side,” David Rothman, a professor of social medicine at the Columbia University Vagelos College of Physicians and Surgeons, told the WSJ in 2019.

Zoom in: AMA adopted positions last year in response to everything from the overturning of Roe v. Wade to climate change. These are dictated by a House of Delegates, which votes every year on what stances the organization should take on medical issues.

The other side: Jack Resneck, president of the AMA, told Axios in an interview that while he knows some of AMA's policies may be seen as controversial, no doctor is likely to agree with all of the group's stances.

  • "With this group of physicians in Congress we do have alignment," said Resneck, who cited the prior authorization and payment rates as issues with bipartisan support. "But yes, there are going to be a few issues that we don't always agree on as well."
  • And some Republicans acknowledged the need for a working relationship with the group. "We've all got to talk. We got a lot of problems that we have to solve," Rep. Michael Burgess (R-Texas), another co-chair of the Doctors Caucus, told Axios.

What we're watching: The tension could make it more difficult for Republicans and the AMA to work on less controversial and bipartisan issues such as prior authorization, physician reimbursement rates and provider mental health and burnout.

A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off.

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