AMA Reaffirms its Support for the Individual Mandate

Despite strong opposition from some member doctors, the American Medical Association (AMA) supports a key element of the Patient Protection and Affordable Care Act (ACA) that requires Americans to buy health insurance.  By a 2 — 1 margin, the AMA’s policy-making House of Delegates voted to continue its support of the individual mandate, saying such responsibility for Americans who can afford to buy coverage was the best option to expand benefits to people who are currently uninsured.  The results of the vote were 326 in favor and 165 opposed.  Without an individual mandate, people will not purchase health insurance until they are sick; that would lead to a spike in premiums for all.

“The AMA’s policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured,” said AMA president Dr. Cecil Wilson, a Winter Park, FL. internist.  “Important insurance market reforms, such as an end to denials based on pre-existing conditions, are only possible by having broad participation in the health insurance market.  The AMA reviewed alternatives and concluded that any approach to covering the uninsured that is in line with AMA policy cannot be fully successful in covering the uninsured without individual responsibility for health insurance,” Wilson noted.

After the civil, one-hour individual mandate debate,  Wilson said an “overwhelming” majority of physicians voted to continue the position the association has maintained 2006.  Some delegates raised the issue because the constitutionality of that portion of healthcare reform legislation is being challenged.  “Our concern is that if we are not able to have a requirement that people have an individual responsibility to purchase insurance, we’re not aware of another solution, except something that would say that the government would make a requirement and tax the individuals for that,” Wilson said.  “From our perspective, the concern would be raised that would take us down a path toward a government run system.”

Wilson criticized people who can afford health insurance but refuse to purchase it, “who then arrive in the emergency room having fallen off of their motorcycle – and they did not wear a helmet – and they end up with major life-threatening injuries, the treatment for which very few people could afford.  And the result of that is that all of pay for that, private as well as taxpayers.”  Those are the people who cause those who have health coverage to pay premiums that are “$1,000 a year more than they otherwise would be.”  The reaffirmation vote stipulates that for individuals and families who cannot afford health coverage, there would be government tax subsidies or credits inversely proportional to income.  When asked if the AMA might file an amicus brief to support the Obama administration’s fight to block challenges, Wilson said that is unlikely.

According to Wilson, the delegates’ vote emphasized that “We cannot walk away from the fact that some 32 million more Americans would be able to have insurance and who do not have it now, and that as a result of not having insurance, would live sicker and die sooner.”

Several physicians strongly opposed the mandate,  referring to constitutionality challenges, freedom issues, and the opposition of physicians and numerous medical organizations.  The AMA admits to having lost 12,000 members since 2009, many because of their endorsement of ACA.  “The AMA has turned 180 degrees since the 1950s, when it held that ‘the voluntary way is the American way,'” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS).  “Now it has adopted the ‘progressive’ left-wing stance of calling for compulsory purchase of government-prescribed insurance.”  People will no longer be able to choose how to pay their medical bills.  Many might opt for the most affordable way: self-payment of most bills, with low-cost, high-deductible insurance for the rare catastrophe.  “But that choice would deprive the government’s favored plans of some fat premiums,” Dr. Orient said.

With 250,000 of the nation’s physicians comprising its membership,  the influential AMA has historically been opposed to a bigger government role in healthcare.  Physicians who oppose the ACA attempted to convince colleagues that the AMA should change its position.  Some delegates have blamed the Association’s support of the individual mandate for a loss of membership in the AMA in their states.  “I believe that each state, working with the population it has and the specific problems it has, can craft a solution that works better for that state than perhaps the one next door,” said Michael Greene, M.D., a delegate with the Medical Association of Georgia.  Dr. Greene, a family physician, supported the amendment.

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