AMA Reaffirms Support of Health Insurance Mandate

June 21, 2011 (Chicago, Illinois) — The American Medical Association (AMA) voted to continue its support of the individual health insurance mandate last night at its annual meeting of its House of Delegates, which includes physicians representing all state and medical specialty societies.

AMA president Cecil B. Wilson, MD, spoke at a press briefing after the contentious vote: "We celebrate the democracy of our house and we celebrate that our house came to this conclusion."

Dr. Wilson noted that the AMA has a strong policy in support of covering the uninsured. He added that this vote renews the AMA's commitment to achieve this through individual responsibility for health insurance, and with avenues of assistance for those who need it. The policy advocates a requirement that those earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and preventive coverage.

The AMA believes that the individual mandate is the best option available today to improve access and ensure coverage for the uninsured. The AMA also notes that there is a difference between the positions of the AMA policy that supports individual responsibility and the individual requirement provisions of the Affordable Care Act.

Prior to the vote, the AMA reviewed and evaluated alternatives to the individual mandate and described its findings in a Report of the Council on Medical Services, entitled Covering the Uninsured and Individual Responsibility. The report reviewed AMA policy and advocacy efforts on the subject and summarized the history of requiring individual responsibility. The report was hotly debated in the reference committee meeting on Sunday, and the reference committee made 3 recommendations to the House of Delegates:

• The AMA reaffirms that it is committed to health system reforms that include health insurance coverage for all Americans, and to insurance market reforms that expand choice of affordable coverage, which are consistent with AMA policies concerning pluralism, freedom of choice, freedom of practice, and universal access for patients.


• The AMA reaffirms its policy of advocating that state governments be given the freedom to develop and test different models for covering the uninsured.


• That the report be filed and adopted in lieu of resolutions 102, 109, and 114.

The first 2 recommendations passed easily through the House of Delegates. The last recommendation initiated a 40-minute debate on the House floor related to the nature of the 3 resolutions that were being rejected.

Resolution 102 asked that the AMA continue to support policies that include personal responsibility to participate in private insurance risk-pooling arrangements, such as financial disincentives (penalties) on people who choose to forgo coverage until they are sick.

Resolution 109 asked that the AMA support the use of tax incentives and other noncompulsory measures to encourage the purchase of health insurance, rather than a federal mandate, and rescind the AMA's Individual Responsibility to Obtain Health Insurance Policy.

Resolution 114 asked that the AMA reaffirm policies that provide for an individual insurance mandate, combined with sufficiently financed advanceable and refundable tax credits, as a fundamental part of market-based comprehensive health system reform.

The reference committee heard extensive testimony on all of these resolutions during Sunday's well-attended committee meeting. The debate continued on the floor of the House of Delegates on Monday. Supporters of the individual mandate noted that, in addition to improving healthcare access for the uninsured, the individual mandate would create a private-market approach to expanding coverage and choice, and thereby would promote the growth of the private health insurance market.

Speakers who wanted to modify the AMA's policy on the individual mandate expressed concerns that the AMA's Covering the Uninsured and Individual Responsibility report conflicts with AMA policy that supports freedom of choice, pluralism, free-market economic principles, and preserving the physician–patient relationship. Some physicians also expressed concern that the individual mandate equates with support for increased government intervention and interference in healthcare. Another concern that was raised was the fear that an individual mandate would lead to an increase in the number of individuals who depend on a government subsidy for their health insurance coverage.

The discussion included references to the Affordable Care Act and the Massachusetts health reform effort, both as reasons to support and to reject the individual mandate.

The debate concluded with the testimony of Leah S. McCormack, MD, the delegate from New York, who stated: "I would still give care to patients whether they had insurance or not. . . . There are some things that are more important than healthcare [insurance]. . . . That is the liberty to make my own decisions and not have the government tell me what to buy."

Throughout the debate, many of the physician speakers reflected Dr. McCormack's acute sensitivity to the health consequences of being uninsured and the effect of an individual mandate on personal liberty. In the end, the vote seemed to come down to how to balance these 2 needs.

AMA physicians voted 326 to 165 (66.4% to 33.6%) to reaffirm the AMA's position on the individual mandate. It also voted to reaffirm support for the AMA policy supporting health insurance tax credits and health insurance market regulation, health savings accounts, and direct subsidies for coverage of high-risk patients.

American Medical Association (AMA) 2011 Annual Meeting. Press briefing, June 20, 2011.