AMA to look anew at insurance mandate

Dallas -- The American Medical Association decided it is not ready to support a requirement for all Americans to obtain health insurance, but some members believe it is only a matter of time before the Association embraces the concept.

AMA delegates at the Interim Meeting referred for further study a resolution to support federal legislation that would implement such a personal mandate. Under this plan, all Americans would be required at least to have catastrophic and preventive health care coverage. People with incomes between 200% and 400% of the poverty level who are not eligible for Medicaid or the State Children's Health Insurance Program would be able to claim refundable tax credits to help pay for the insurance.

The resolution introduced by the California and Guam delegations is not a new concept. But the level of support among AMA members appears to be greater than it has been during the last decade or so that the Association has been debating the merits of an individual mandate, supporters said. Delegates were vocal about the potential of such a plan despite the decision to refer the directive for further study and possible action at the 2006 Annual Meeting.

Federal action to combat the uninsured problem by passing on more responsibility to those who can purchase insurance is coming down the road, and the AMA is starting to embrace the concept, said Robert Hertzka, MD, immediate past president of the California Medical Assn. and one of the authors of the resolution. He pointed to a survey of 5,400 members before the meeting that found that 82% of respondents backed AMA involvement in pushing such a plan.

"It's more popular than banning smoking in restaurants," he said. "It strikes a chord ... that having an individual mandate for catastrophic and preventive [coverage] actually seems like a pretty reasonable idea."

The high level of member support for basic individual coverage requirements is not surprising given that health savings accounts are now becoming more and more prominent in the health care world, said AMA Trustee J. James Rohack, MD. HSAs, approved as part of the Medicare reform law in 2003, combine personal savings accounts for health care purchases with high-deductible insurance in an effort to inject more consumer responsibility into the system.

"When we talk about an individual mandate or individual coverage, the options that were available in the past are much broader now," he said.

Several physicians said the federal government soon would start following the lead of private payers in focusing more on such consumer-driven models of health care. If the AMA doesn't add individual mandates to its set of policy tools, the Association will be left behind in the effort to fix the uninsured problem, said San Diego internist Rodney Hood, MD, a delegate from National Medical Assn.

Despite impassioned testimony from some physicians on the need to take bold actions in combating the uninsured problem, others warned against moving too fast.

One need look no further than the example of auto insurance to see some of the pitfalls that can accompany individual mandates, said Donald Franklin, MD, a nephrologist and Tennessee delegate.

"We believe the intent [of the resolution] is satisfactory, but requiring a form of health insurance coverage probably sets a bad precedent," he said. "Even though automobile insurance and driver coverage may be mandated in many states, we all know friends, family, acquaintances who have had the instance of an automobile accident where the opposing driver is not covered by insurance."

In addition, even if the government could figure out how to make mandatory health insurance work, physicians who are tired of dealing with the bureaucratic impositions of Medicare and Medicaid might not want such a level of government control, said psychiatrist Richard Warner, MD, a delegate from Kansas. "A federal government that is going to mandate health insurance is also going to regulate that health insurance," he said.

To underscore his point, Dr. Warner read a provision from the 1965 Medicare authorization law stating that the statute did not authorize any federal official to exercise "any supervision or control over the practice of medicine or the manner in which medical services are provided."

The evolution in government control over Medicare that has occurred since then and with which doctors are well acquainted also would accompany an individual mandate, he said.

"Things have a way of moving along over time from limited beginnings," he said.

AMNews staffer Kevin O'Neil contributed to this report.