Earlier today, two key groups--the American Cancer Society and the American Association of Retired Persons--endorsed the House health care reform bill. On a conference call that's just wrapping up now, the American Medical Association (AMA) pledged its support, as well. But it did so with some crucial qualifications.

The AMA made clear that it was endorsing not one but two bills: H.R. 3962, the bill that would expand insurance coverage, reorient the delivery system, etc.; and H.R. 3961, the bill that would eliminate the planned reductions in Medicare physician payments to keep them in line with the Sustainable Growth Rate (SGR).

AMA President James J. Rohack explained the group's position thusly:

H.R. 3962 is not the perfect bill, and we will continue to advocate for changes, but it goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians,” Dr. Rohack said. "This is not the last step but the next step toward health system reform. We will remain actively engaged with patients, physicians, Congress and the administration to ensure that the final bill results in marked improvements to our health system.

The House originally intended to include the SGR fix in the main bill. But the SGR fix is expensive--more than $200 billion over ten years--and pushed the whole package deep into the red. In order to keep reform itself deficit neutral, the House has decided to take up the SGR separately. The Senate is doing the same thing.

The catch is that Congress seems disinclined to pass an SGR fix, even as a separate bill, without new revenue or savings to offset the cost. Given the difficulty of coming up with enough money just to pay for coverage expansions, that won't be easy.

On the conference call, several reporters tried to pin down Rohack on exactly how the AMA intended to act. Is it ok if Congress takes up the SGR fix later on, after the primary issue? If it becomes apparent that Congress won't pass the SGR fix anytime soon, would the AMA withdraw its support? And what would such a withdrawal entail? Rohack wouldn't give a definitive answer.

That said, even qualified support from the AMA is important, particularly given the group's history. The AMA was arguably the most determined and, at times, most effective opponent of health care reform for most of the 20th Century. Their current position is testimony to how much the politics of reform have changed--and how far this legislative effort has gone.

By the way, a representative of the Texas Medical Association--among the most notoriously conservative of the state medical associations--got on the call and asked Rohack why the AMA was putting so much faith in government. Rohack responded, quite rightly, that Medicare had turned out to be a boon for physicians, as well as patients.

Update: Two more calls from conservatives doctors in Texas, attacking Rohack and the AMA. Rohack is handling himself very well.