Physician groups around the country are angry with Republicans who did not support Medicare legislation, and are gearing up to go after them this election cycle.

Medical societies in Texas, Mississippi and New Hampshire — states where GOP senators face difficult reelection challenges this year — are taking a hard look at whether to withhold their support for incumbents who voted against the bill on June 26. One state group has already acted and others could follow, given the American Medical Association’s (AMA) vehemence on the vote.  

The Mississippi group is arranging meetings with both senators. “The outcome of those conversations will have a great deal of bearing on what we might do,” she said.

This goes beyond bad public relations and could cost the candidates campaign dollars.

Four of the top 20 recipients of campaign cash from physicians and other health professionals are Republicans who voted against the Medicare bill, according to data from the Center for Responsive Politics.

Other than three senators with presidential campaigns, Sen. John Cornyn (R-Texas) got the most, $308,033, including $2,500 from the AMA. The Texas Medical Association rescinded its support of Cornyn on June 28 after he voted against the measure.

Senate Minority Leader Mitch McConnell (R-Ky.), who fought aggressively to block the Medicare bill, is next, with $262,700, including $5,000 from the AMA. Sens. Arlen Specter (Pa.) and John Barrasso (Wyo.), a physician, also rank among the top 20.

Although most state medical societies neither make formal endorsements of federal candidates nor have federal political action committees (PACs), they do influence the campaign giving of the AMA.

Medicare may be less politically potent than issues such as energy and housing this year, but the bill is the biggest healthcare vehicle likely to see congressional action before Election Day.

Democratic campaigns already are trying to use Republican opposition to the bill to their advantage, crafting the message that the GOP voted to cut healthcare for seniors and the disabled.

A bill to stop a cut in Medicare payments failed to advance last Thursday by a single vote. Several vulnerable Republicans voted with Democrats to pass it.

The bill had already passed the House by a veto-proof margin, but the Senate’s failure to move it forward, combined with a veto threat from the White House, meant that as of Tuesday, Medicare’s payment rates for physicians went down by 10.6 percent. The Senate will return to the measure shortly after returning from recess next week.

Republicans object to cuts the bill would make to private health insurance plans in the Medicare Advantage program. They also complain that the Democratic leadership tried to force the bill through Congress without adequate debate.

These arguments do not seem to be holding much water with physicians.

 “Outrage” is the word used by physician groups in summing up how they feel about Republican senators who voted last week against the bill.

AMA President Nancy Nielsen used that word after the vote, as did the Texas Medical Association’s PAC in a statement about withdrawing its support of Cornyn.

The New Hampshire Medical Society’s executive vice president, Palmer Jones, used less harsh language than the AMA while sending a similar message: The physician society is not pleased with Sens. John Sununu (R) and Judd Gregg (R).

“We are very confused and concerned about the vote by New Hampshire’s senators,” Jones said.

The New Hampshire group’s PAC directors will meet next month to decide what to recommend to the AMA’s PAC.

Sununu is one of the Democrats’ top targets and faces former Gov. Jeanne Shaheen (D) in the election. He was watched closely prior to last week’s vote because he missed a vote on a similar bill earlier in June and was viewed as the potential deciding vote.

“Shaheen supports making healthcare more available for seniors, and not cutting it to protect insurance companies’ profits,” a campaign spokeswoman said.

The New Hampshire group is especially piqued, Jones said, because Sununu personally assured them the cut would be prevented, as did aides to Gregg. “We all felt comfortable with the fact that they said, ‘We understand your concerns and we will not let a cut occur,’ ” Jones said.

Sununu countered by noting his support for a Republican alternative bill that was not given floor time and criticizing the Democratic leadership for political maneuvering. “Unfortunately, Democrats in Congress won’t even let [the GOP bill] come to a vote. Instead, they staged a partisan procedural vote,” Sununu said in statement, in which he also asserted the bill would limit private health plan options in Medicare Advantage.

The New Hampshire society will stage a joint press conference next Tuesday with the state AARP office and the Medical Group Management Association calling for Sununu and Gregg to support the bill.

Sununu might not be counting the medical society or the AMA anyway. The AMA’s PAC did not contribute to his 2002 campaign, and the state society endorsed Shaheen when she ran for governor in 1996, according to Jones.

The AMA is running television ads this week in New Hampshire, along with Mississippi, Pennsylvania, Tennessee, Texas and Wyoming, that call out by name 10 senators who voted against the bill.

In Mississippi, Wicker faces a more difficult race than Cochran. Wicker’s bid to finish out the term of former Sen. Trent Lott (R), who retired last year, is opposed by former Gov. Ronnie Musgrove (D). The AMA has already given $2,000 to Wicker and $1,000 to Cochran.

The Mississippi society was not persuaded by the senators’ assurances that Congress will act quickly to craft a bipartisan bill. That goal has eluded lawmakers all year, Jones noted. “I don’t see why there’s any reason to believe 10 more days would’ve made a difference,” he said.

Mississippi faces particular hardships because of the Medicare cuts, Jones maintained. The state ties its Medicaid pay rates to Medicare’s fees, for example. In addition, states like Mississippi lost extra set-asides for rural areas, which expired Tuesday because the Medicare bill did not pass.

“These … things happening at the same time could very well cause our healthcare system around here to implode,” Jones said.