Tuesday, President Obama signed H.R. 4302 into law. It is the 17^th temporary sustainable growth rate (SGR) formula fix passed by Congress, but the first such fix actually opposed by the American Medical Association (AMA), which had spent millions to try to win a permanent repeal.

Repealing the SGR permanently and forever ending the uncertainty the formula imposed on AMA members' practices was the Association’s number one issue for the past year. According to OpenSecrets.org, in 2013 the AMA was the eight most influential lobbying group in Congress in terms of money spent. It reported spending more than $18 million on 45 lobbyists, including 16 who had previously held government jobs that might give them additional access to elected officials. The Association also handed out nearly a quarter million dollars in direct contributions.

However, its biggest effort may have been in the mobilizing of members and patients. These costs would not have been reported to the government, but would likely have been substantial judging by the results the AMA achieved. According to a commentary by AMA President Ardis Dee Hoven, M.D., the AMA generated more than 1,158,000 emails and phone calls as well as 500 face-to-face visits with elected officials or their staffs as part of the SGR repeal effort. It also held a National Day of Action for SGR Repeal and National Advocacy Conference that brought in 51 additional House member co-sponsors on the original repeal bill before a provision was added to it to also delay the Patient Protection and Affordable Care Act (ACA) individual mandate as a pay-for.

In the end, the permanent repeal effort may have been a victim of its own success. Because it attracted so much bipartisan support, it became a vehicle for advancing politically charged ideas for how to pay for it.  Each side seemed to hope the other might want the SGR repeal badly enough to vote for a funding plan they disagreed with. The idea of Senator Ron Wyden (D-Ore.) to pay for the SGR repeal with the military Overseas Contingency Fund would likely have gotten no further with the Republicans than the Republicans’ idea to delay the ACA’s individual mandate for five years got with the Democrats.

Meanwhile, Dr. Dee Hoven urged AMA members to stay positive despite all the effort that had been spent only to come up with yet another patch.

“While we are disappointed that the fight for SGR repeal must continue, we are in a far better place to advance reform than we were a year ago,” she wrote to members in the AMA Wire. “Rest assured that the AMA will continue to press for the changes we need to ensure our practices are sustainable and our patients have reliable access to the care they need.”