“Find It, Fix It, Keep It”: That's the Texas Medical Association's official stance on the Affordable Care Act. TMA's advocacy page says that it wants lawmakers to “find what's missing, keep what works, [and]fix what's broken.” These recommendations include adding new rules to reform the Sustainable Growth Rate formula for Medicare payments, keeping the ACA's rules about pre-existing conditions and recissions, and getting rid of the ACA's mandated Independent Payment Advisory Board that will make recommendations on Medicare spending.
It's a thorough, nuanced set of proposals that takes into account the intricacies of practicing medicine and recommends what TMA thinks is best for Texas physicians. It doesn't call for a total repeal of the ACA, but rather a re-evaluation and modification of the law.
In contrast, TMA endorsee Ted Cruz's position on the Affordable Care Act is summarized on his website in one sentence: “Obamacare must be stopped.” We've seen the lengths he's willing to go to stop the law, forcing the government to shut down in a misguided effort to halt the implementation of the ACA at all costs. He's repeatedly stated that the law needs to be repealed entirely, even penning a USA Today op-ed with the tag line, “We need to repeal all of the Affordable Care Act.”
TMA has not officially taken a stance on Ted Cruz's efforts to repeal and defund the ACA. But it has continued to provide Cruz a platform to advocate his anti-ACA stance. Ted Cruz was a keynote speaker at the 2014 TMA Conference in October, where he defended the government shutdown to a TMA audience. After the TMA conference, Dr. Clifford Moy, speaker of the Texas Medical Association's House of Delegates, told KUT that TMA was grateful for Cruz's appearance at the conference.
None of Ted Cruz's repeated efforts to repeal the Affordable Care Act have been called into question by TMA, though their stated position on the ACA is radically different than Cruz's. And Ted Cruz is just one of many TMA-endorsed federal lawmakers from Texas who have acted against TMA's recommendations on the Affordable Care Act without criticism from TMA.
Find out which other TMA endorsees are contradicting TMA without consequences after the jump.In addition to Ted Cruz, the Republican members of the Texas Congressional delegation all voted to shut down the government rather than implement the Affordable Care Act. Texas Congressional Republicans have also repeatedly voted to repeal the Affordable Care Act, all 40 times versions of the bill came up. 20 of the 24 House Republicans from Texas were endorsed by TMA in 2012, even though they had all voted in favor of total ACA repeal bills in 2011.
In 2011, TMA endorsees Reps. Joe Barton (R-Ennis) and Kenny Marchant (R-Coppell) also co-sponsored HR 408, the Spending Reduction Act of 2011, a bill to slash federal spending. Among other things, HR 408 would have drastically hurt the Health Information Technology for Economic and Clinical Health (HITECH) Act, a 2009 law that promotes health information technology. In its ACA recommendations, TMA explicitly calls on Congress to “protect the HITECH Act from repeal,” stating that “this will improve health care in America in so many ways.”
Though Reps. Barton and Marchant co-sponsored a bill in 2011 that would repeal a law TMA specifically asked be protected, they still received TMA's endorsement in 2012.
By and large, TMA has endorsed more Republicans for Congress than Democrats. Nonetheless, it has also endorsed and supported Democrats who have staunchly defended the Affordable Care Act against repeal. For example, TMA endorsed both Reps. Lloyd Doggett (D-Austin) and Joaquin Castro (D-San Antonio) in 2012. During the government shutdown, Rep. Doggett denounced the Republican “shutdown caucus” while Rep. Castro reminded Americans about the benefits of the Affordable Care Act.
TMA's continued support for legislators who are firmly on opposite sides of the ACA debate is baffling. It makes little sense that one could endorse both Ted Cruz and Joaquin Castro on the same ballot, given that they have fundamentally opposing visions for the future of health and medicine.
TMA has never tried to reconcile the two viewpoints it appears to endorse, inexplicably supporting both those who act in accordance with its policy recommendations and those who contradict them.
TMA's stance on Medicaid expansion also does not appear to line up with what TMA endorsee Governor Rick Perry has propsed. Perry, who has received close to $240,000 from TMA since 2000, has staunchly refused to accept any funding to expand the state's Medicaid program, costing the state $9 billion. Perry instead wants the federal government to give him a block grant to reform Medicaid, primarily by increasing asset testing for Medicaid eligibility thus leaving many poor Texans ineligible for insurance.
In contrast, TMA's recommendations for Medicaid involve reforming Medicaid payment rates for physicians and streamlining its rules, then proceeding with expansion that takes into account Texas's health care needs. It's not a complete endorsement of the ACA's Medicaid expansion, but it's certainly more comprehensive than a blanket refusal to expand Medicaid at all.
TMA has expressed qualified support for Medicaid expansion in some outlets, making no mention of the fact that the person holding back Medicaid expansion is one that TMA put into office.
TMA has also expressed serious concerns with Perry's block grant plan, stating that “it is by no means certain that Texas could negotiate a block grant favorable to a rapidly growing state.” Despite TMA's concerns with the proposed block grants, Rick Perry received TMA's endorsement in 2010 and has received financial contributions as late as 2012.
It seems that TMA wants to disconnect its policy recommendations from the individuals responsible for policymaking.
TMA wants to maintain its “Find, Keep, Fix” stance on the Affordable Care Act while still backing people like Cruz and Perry, who are leading the charge for a unilateral repeal. It's time for TMA to take responsibility for its endorsees. TMA's policy recommendations hold little weight when the organization continues to endorse people who have proven to have an agenda contradictory to TMA's own.