President Obama may have signed the healthcare reform bill into law, but the Florida Medical Association is not letting up in its opposition, and neither are many Orlando-area physicians.

 

Erin VanSickle, FMA spokeswoman, characterized Republicans who voted against the healthcare reform bill as “pro-medicine.”

“We are looking to support candidates that did oppose the bill,” VanSickle said.

 

Democrats such as Rep. Suzanne Kosmas, a Democrat from Orlando who voted for the bill, will continue defending her vote on healthcare through the fall. In March, former Alaska Gov. Sarah Palin took aim at Kosmas for changing her vote from ‘no’ to ‘yes.’ Kosmas then used Palin’s attack for her own fundraising.

In a statement before her vote, Kosmas said she changed her position because the bill reduces the deficit. “Last November, I voted against healthcare reform because I did not believe the bill before the House was fiscally responsible,” she said. “The bill before us now represents the single largest deficit reduction in over a decade, saving nearly $140 billion in the first 10 years and over $1.2 trillion in the decade to follow.”

 

“This legislation,” Kosmas continued, “contains the strongest measures ever enacted to help eliminate waste, fraud and abuse in the system, to rein in skyrocketing health care costs, and to stabilize Medicare while preserving benefits.”

 

Thomas Kelley, MD, president-elect of the Seminole County Medical Society doesn’t see it that way. “All of us are in favor of expanding access to healthcare to all our patients,” said Kelley, a primary care physician. “We can also all agree that the system we have in place now will not be sustainable. But that’s about where my agreement ends.”

 

Kelley wouldn’t go as far as an Orlando-area urologist that posted a note on his door saying anyone who voted for Obama should seek care elsewhere. “Healthcare reform starts now,” the note read.

 

Tort reform and personal responsibility are two things Kelley feels were missing from the legislation. And adding more patients with insurance will further increase the access to care issues and physician reimbursement shortfalls already crippling the state, he said. Kelley’s mother, who’s on Medicare, already can’t find a doctor in Orlando to treat her rheumatoid arthritis.

“People who now have this newly found access to care are going to have trouble finding a physician who can provide it,” Kelley said.

 

Anna Lizama, MD, an OB/GYN and president of the Central Florida Medical Society – which represents mostly African American doctors – said she too agrees the bill should have addressed medical liability reform. Lizama was forced to close her private practice because she could not afford the $130,000 per year premium to provide obstetrics in Florida.

But Lizama was extremely supportive of the bill and even traveled to Washington DC for its passage. Lizama sees hope that Medicaid reimbursement will rise to the level of Medicare as the bill specifies by the time the law fully takes affect in 2014. Most of all, Lizama believes the bill addresses healthcare disparities among minority communities.

“If someone’s making a lot of money, then they might not be so excited about the bill because they don’t see any immediate gain for them,” Lizama said. “The minority communities are the ones suffering the most from being uninsured and not getting the care they need.”

Besides disagreements among local physician groups, the Florida Medical Association remains committed to its vocal opposition unlike the American Medical Association, which supported the legislation.

 “The FMA has not been in support of this bill simply because Florida of all states stands to suffer the worst from this because of our significant population of seniors,” VanSickle said. “These folks are already vulnerable to access to care.”

Expanding coverage with limited reimbursements, she said, will exacerbate access issues and compromise patient safety. The group also strongly objects to the individual mandate.

“People should be free to provide for their own healthcare and not compelled to participate in any healthcare system,” VanSickle said. “That means the public option or any healthcare system in which participation is mandatory we don’t think is in the best interest of our country or patients.”

 

Another rift that’s unlikely to heal soon exists between the FMA and the Florida Hospital Association, which supported the bill beginning early on and through its passage. Bruce Rueben, FHA president, refuted the state medical association’s assertion that opposing the bill was “pro-medicine.”

“We feel we’re pro-medicine and we support the bill. Supported it for a long time. There were various provisions we opposed but overall we supported the idea of getting people who are uninsured, access to health insurance coverage.”

 

For Rueben, the debate came down to whether it’s better to extend coverage or reduce costs for those who have insurance. He concedes there may be a physician shortage, “but it’s not like there wasn’t one already,” he said. “It’s hard to understand how people who care, who’s mission it is to care for people, would feel that all the conditions have to be perfect in order to extend the opportunity to have health insurance to 32 million more Americans. Why would we wait for that?”