Will doctors continue to support health care mandate?


As many of the nation's physicians gather at a convention in Chicago this weekend, one of the most controversial issues on their agenda is continued support of the "individual mandate," a key part of President Obama's health care overhaul.

"It will be intensely debated," said Dr. Lori Heim, a North Carolina family physician who travelled to Chicago for the annual meeting of the American Medical Association (AMA), the nation's largest physicians group.

AMA support for the Affordable Care Act, and specifically the individual mandate, which requires that nearly all Americans purchase health insurance, was seen as important in setting the stage for its passage last year.

"AMA's support was and is more significant with respect to PR than legislative politics," said Heritage Foundation health care expert Edmund Haislmaier.

Of course, the Obama administration is facing dozens of legal challenges to the Affordable Care Act, including one brought by Republican governors and attorneys general from more than two dozen states that's now before the federal appeals court in Atlanta. Those challenges will almost certainly be decided by the Supreme Court, perhaps as soon as next year, according to CBS News legal analyst Andrew Cohen.

In light of the fact that the battle has moved to the courts, it's not clear what real world effect a change in position by the AMA would have, though it would certainly give more fuel to opponents of "Obamacare" going into the 2012 elections. Haislmaier said it would also weaken the White House narrative that the Affordable Care Act is "settled and everybody needs to get on board with implementation."

Members of the AMA on both sides of the issue said the debate within the organization mirrors the larger national discussion about the health care law and the individual mandate.

"In the same way that you're seeing this debate being played out in the political arena, similarly you have people on both sides of the issue in the AMA," said Dr. Robert Sewell, past president of the American Society of General Surgeons, a medical group that opposes the individual mandate.

Heim, board chair of the American Academy of Family Physicians, which supports the mandate, agreed. She said the issue has played out along political party lines among physicians just as it has in society at large.

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"Although I think the individual responsibility will get the support it deserves," she said. "I think it will be intensely debated."

Heim added she believes a majority of AMA members support the individual mandate. "Most physicians want to see a change in health care in the nation," she said.

"If you think about it in terms of individual responsibility," Heim said. "We want patients and the public to be responsible about their health. They also need to be responsible about health insurance."

Official AMA policy is decided by majority vote among its House of Delegates, whose more than 500 representatives will take up the individual mandate during five days of meetings.

"You're not going to find a uniformity of opinion," Sewell said.

The American Society of General Surgeons and two other national surgery groups, along with six largely southern state delegations of physicians, all back the effort to overturn AMA support of the individual mandate, according to a tally by the Chicago Tribune. Together they represent less than 10 percent of the delegates, the paper said.

But despite that apparent paucity of opposition, the president of the AMA, Dr. Cecil Wilson, was unwilling to forecast how the House of Delegates will vote.

"I know that the delegates will give thoughtful consideration to this issue as well as how to continue to expand coverage and cover the uninsured," Wilson said. "I would not make a prediction about what the outcome will be."

Wilson said the AMA doesn't as a practice poll its members. "I don't try to make predictions and neither does the AMA or the AMA board," he said.

But anecdotally Wilson said that he sensed growing support for the individual mandate among AMA members since the Affordable Care Act became law in March of 2010.

"More and more physicians are recognizing that we can't stay where we are, that we're in a situation that's intolerable because of cost and lack of coverage--people uninsured and therefore at risk of being sicker when they get treated and of dying sooner," he said.

The Heritage Foundation's Haislmaier noted that AMA membership has in recent years shifted toward primary care physicians, who tend to support the Affordable Care Act, and away from specialists, who tend to oppose the overhaul.

Sewell, the surgeon, remains staunch in his opposition. "We don't believe that it's the government's purview to determine whether or not people buy or don't buy insurance," he said, predicting a heated debate with individual mandate supporters.

"I respect their opinion I just disagree with the idea that somehow or another we as physicians should be weighing in to tell our patients, 'Oh you have to have insurance because otherwise we won't get paid,'" Sewell said. "There's nothing in the Hippocratic Oath that talks about that as far as I can tell."