CHICAGO – The American Medical Association’s House of Delegates voted on June 20 to support the premise that all Americans should be required to buy health insurance if they can afford to do so.
The so-called individual mandate is an essential element of the Affordable Care Act, but the AMA itself has had a long-standing policy backing the purchase of insurance. On June 20, the House of Delegates voted 326-165* in favor of keeping the policy adopted in 2010 that more formally backed the individual mandate. The vote was a resounding rejection of an effort by a vocal minority to overturn that policy.
A resolution had been offered by the American Academy of Facial Plastic and Reconstructive Surgery, the American Association of Neurological Surgeons, the American Society of General Surgeons, and state delegations from Kansas, Arkansas, the District of Columbia, Florida, Georgia, and Oklahoma. They sought a new policy stating that the AMA believed that health insurance purchase should be an individual’s responsibility, but not a requirement.
Counter-resolutions were offered by delegates led by the American Academy of Family Physicians and the American College of Physicians.
When it came time for a vote, both the AMA Council on Medical Services, which had jurisdiction over the issue, and the AMA Board of Trustees recommended that the House of Delegates reaffirm the AMA’s current policy and not adopt any of the alternative resolutions.
On the floor, Dr. Richard Warner of the Kansas delegation rose to offer a new amendment that would allow the AMA to support states having the option of whether they wanted to institute a mandate. That amendment was struck down by almost 60% of the delegates.
A similar amendment seeking to give states flexibility was offered up by another delegation, but was ruled as being out of order by Speaker Andrew Gurman. The delegates backed his ruling and voted down the amendment.
Passions ran high on both sides of the issue. Delegates who sought to overturn the AMA policy said that it took away choice and would not guarantee that more Americans would get access to health care.
Dr. Melissa Garretson, a pediatrician from Fort Worth, Tex., and a delegate from the American Academy of Pediatrics, said that while many who were against the mandate were angry, she had 700,000 pediatric patients who were uninsured and "angry too."
"The evidence has shown that mandating insurance coverage gives us the highest percentage of insured in this country," Dr. Garretson said, adding that having insurance translated to better health behaviors, higher school attendance, and ultimately, healthier adults.
After the vote, AMA President Dr. Cecil Wilson said that the organization was gratified that the House supported the mandate. The vote shows that "fully two-thirds of the House said today our policy is good," he said.
Some state delegations had complained that the AMA’s stance supporting the Affordable Care Act was leading to defections in members. But Dr. Wilson said he did not believe that was the case.
The AMA membership overall declined by 5%, or about 12,000, from 2009 to 2010, to a total of 215,854 members. An AMA committee looking at membership issues reported that the numbers for 2011 may increase this year.
* Correction, 6/22/2011: An earlier version of this story reported an inaccurate vote count. The error has been corrected.