The disclosur during the AMA's annual policy-making House of Delegates meeting on Sunday comes as member doctors consider withdrawing support of a key tenet of the health overhaul law that requires Americans to purchase an insurance plan. The AMA is also debating scores of other issues, including whether to support state taxes on sugar-sweetened drinks, Medicare payment polices and public health issues.
The Chicago-based national doctors group disclosed this morning in testimony about a continued deterioration of its membership, that it has "just under" 216,000 member doctors, which is down about 5 percent from the 228,000 members at the end of 2009. The bulk of the 12,000 members who left the AMA last year pay the full $420 annual dues, AMA delegates said this morning. The group said about one-third of its members are younger doctors, residents and medical students who pay less than $50 compared to the $420 paid by full dues-paying members the AMA is losing.
The AMA's support of the health care legislation, which was passed by Congress and then signed into law in March 2010 by President Barack Obama, was seen as critical at the time the controversial legislation was being debated.
On Sunday, dozens of physicians in a line that stretched outside a conference room at the Hyatt Regency Chicago engaged in a heated debate for more than two hours over whether the AMA will change its stance in favor of the "individual mandate." A formal vote on the mandate issue will could come as early as Tuesday. The meeting runs through Wednesday.
The AMA's stance on the individual mandate is "getting less popular with our members who are dropping," said Dr. Peter Lavine, an AMA delegate from Washington D.C. "We should be silent on mandates."
Though several AMA members say the membership decline is somewhat related to health reform, it's also thanks to economics and cost pressures on doctor practices. AMA members also say doctors are choosing to join other medical and specialty societies. And while that hurts AMA dues, almost all state and national medical societies are part of the AMA and have representation in the House of Delegates.
Still, the health law is one of the most contentious before the AMA in years.
A resolution introduced by three national surgery groups, including the American Society of General Surgeons and six largely Southern state delegations of physicians, says the federal mandate "regulating the individual purchase of health insurance will likely undermine the innovations and improvements in health care financing that can evolve in a free market."
The AMA should "regard the purchase of health insurance to be a matter of individual responsibility to be encouraged by the use of tax incentives and other noncompulsory measures," those opposed to the mandate said in their resolution.
"This individual mandate will not take us places we want to go," Dr. Richard Warner, a delegate from Kansas who is opposed to the AMA's support of the individual mandate.
The delegates' debate comes following the filing of federal lawsuits by several attorneys general challenging the individual mandate. Legal challenges in general are contending that the mandate requiring Americans buy health coverage is unconstitutional and exceeds Congress' power to regulate commerce. Legal analysts expect the challenge to be settled by the U.S. Supreme Court.
But the groups who endorsed the resolution represent less than 10 percent of the 512 doctor delegates who will vote among the AMA's House of Delegates.
The opponents will face about 20 groups within the House of Delegates that remain in favor of an individual mandate.
Supporters of the individual mandate have argued a "guarantee-issue model" of insurance would provide insurers with a larger risk pool to pay claims, which helps them turn a profit and provide benefits and services to more people.
AMA president Dr. Cecil Wilson said the AMA's support of an individual mandate is not new policy and is needed for "everybody to have skin in the game."
It's one of the few key areas of the health law where doctors agree with the health insurance industry, which has long supported an individual mandate to purchase medical insurance.
An individual mandate was among the early principles promoted by America's Health Insurance Plans, the Washington-based lobby for such health insurance giants as UnitedHealth Group, Aetna Inc. and Chicago-based Health Care Service Corp., the parent of Blue Cross and Blue Shield of Illinois and three other Blues plans.
Without an individual mandate, the AMA, insurers and employer groups have said, people will wait to buy health insurance until they are sick, and that would lead to a spike in premiums for everybody.
"If you have coverage, you have better care," said Dr. Roland Goertz, president of the American Academy of Family Physicians, which supports the mandate with several groups that includes at least eight state delegations.