AMA Upholds Stance on Individual Responsibility for Health Coverage

Absent Single Payer, Only Mandate Can Achieve Access, Health Goals, Says AAFP

June 27, 2011 04:40 pm Cindy Borgmeyer Chicago –

If there was any question about whether the house of medicine gave due consideration to its support of the Patient Protection and Affordable Care Act, those concerns were set aside during the 2011 annual meeting of the AMA House of Delegates, here June 18-22. After nearly four hours of often impassioned discourse by dozens of meeting participants, including the Academy's delegation to the AMA house, the delegates strongly reaffirmed the AMA's support for the personal responsibility concept that underlies the act's requirement that all individuals acquire health care coverage, a position shared by the AAFP.

At the meeting, the AAFP, along with its primary care and other colleague groups, joined forces to uphold the AMA's 2009 stance in favor of health care reform, submitting a resolution that, among other requests, called for the AMA to "continue to support policies that include personal responsibility to participate in private insurance risk-pooling arrangements, including financial disincentives (penalties) on persons who choose to forgo coverage until they are sick."

During a June 19 reference committee hearing, testimony in support of that resolution and related measures, including a comprehensive report submitted by the AMA Council on Medical Service, focused largely on making it clear that, absent such an individual responsibility requirement, the only other viable choice for achieving the goal of health care for all would be a single-payer system.

AAFP member William Kobler, M.D., an Illinois State Medical Society delegate and chair of the Council on Medical Service, led off reference committee testimony on the combined group of measures by offering insight into the rationale behind recommendations contained in the council's report. All of those recommendations, he noted, reaffirm existing AMA policies, especially its policy supporting "individual responsibility to obtain a minimum level of catastrophic and preventive coverage."

Should the AMA fail to uphold its policy on individual responsibility, Kobler testified, the organization could be seen as supporting those without insurance who get a "free ride" on the backs of insured individuals, other taxpayers and even physicians, who already are mandated to provide uncompensated care, such as that required under the Emergency Medical Treatment and Active Labor Act.

Finally, Kobler reminded physicians at the hearing, "What we are debating at this meeting is AMA policy, not the ACA (Affordable Care Act)."

In his testimony, AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, made the case that evidence has shown that expanding health coverage translates into better access to care, which, in turn, allows people to make better health decisions and improves the overall health of the public.

"As physicians, we should want better health care for our patients," he asserted.

Yul Ejnes, M.D., chair of the American College of Physicians, or ACP, Board of Regents, testified that the individual responsibility requirement advocated by the AMA is fundamental to ensuring the survival of private health insurance. Requiring individuals to obtain health coverage before they require care broadens the health insurance risk pool to include healthy individuals, which, in turn, lowers health insurance premiums for all insured individuals.

That, he said, is in keeping with the AMA's long-standing support for free-market competition among health insurers and the expanded product choices such competition brings.

"Without a personal responsibility requirement," Ejnes warned, "the most plausible and likely alternative is government-run health care."

AAFP President-elect Glen Stream, M.D., of Spokane, Wash., supported that view, saying, "We believe the research has been done, and there's no other way, short of a single-payer system, to achieve this coverage."

Still, although most opponents of the reaffirmation measures agreed with the AMA's overall goals of supporting increased health care coverage and access to care, many couldn't get past the mechanism current reform uses to attain those goals.

"This is not a debate about personal responsibility or insurance reform, it is about a mandate," said W. Jeff Terry, M.D., a delegate from the Medical Association of the State of Alabama.

"We need AMA policy to be silent on the mandate and still encourage personal responsibility."

But Steven Kanig, M.D., a delegate from the New Mexico Medical Society, offered a different perspective. "Some people are acting like this 'mandate' is a dirty word," he testified. "I don't think asking people to make health care a priority in their lives -- to budget for it and plan for it -- I don't think that (makes it) a dirty word."

Many of those who opposed reaffirming the AMA's stance on individual responsibility contended that it would increase overall health care costs, with one challenger going so far as to claim, "The individual mandate will actually destroy medicine in this country."

Another staunch opponent of the personal responsibility requirement, Leah McCormack, M.D., a delegate from the Medical Society of the State of New York, pronounced to her colleagues -- in both the reference committee hearing and the next day on the floor of the AMA house -- "Some things are more important than health care; some things are more important than life itself. Freedom is one of those things."

The majority of delegates, however, were not to be swayed from the course they had chosen in 2009. In a 326-165 vote, they adopted the recommendations outlined in the Council on Medical Service report, as well as two amendments offered by the reference committee that reaffirm additional AMA policy on health care coverage for all Americans, insurance market reforms that expand choice, and the freedom of states to develop and test their own models for covering the uninsured.