CHICAGO -- As the constitutionality of the individual mandate is debated in the nation's courts, the issue has emerged as a lightning rod in the American Medical Association's annual House of Delegates meeting here.
Physicians spent Sunday passionately debating the AMA's current policy -- adopted years before the Affordable Care Act (ACA) was passed -- which favors requiring all U.S. residents to buy some form of health insurance.
"This debate has threatened to suck the oxygen out of this entire meeting," said Daniel Johnson, MD, president of the AMA in the 1996-1997 term.
The AMA has had a policy supporting insurance mandates in some form for more than a decade, and in 2006, the House of Delegates adopted a resolution that supports requiring individuals and families earning more than 500% of the federal poverty level to obtain, at a minimum, catastrophic health insurance coverage and coverage that pays for preventive healthcare.
That policy endorses using the tax structure to get people to comply.
Under the ACA, nearly every U.S. citizen is required to have health insurance starting in 2014 or else pay a penalty.
The AMA's "individual responsibility" hasn't been a point of contention at previous meetings. But that was before the national debate over healthcare reform divided the nation, and divided AMA members.
The organization lost 12,000 members in the past year, and many point to the group's support of the ACA as the sole reason.
The House of Delegates will vote this week on a resolution in favor of the individual mandate, and one against it.
The first resolution will express the AMA's support of the individual mandate and codify the organization's current position. It has the backing of more than a dozen physician groups including the American College of Physicians, the American Academy of Family Physicians, and the American College of Cardiology.
The other resolution would rescind the AMA's old policy and replace it with one that encourages the purchase of health insurance by "tax incentives and other non-compulsory measures," but does not require it. That resolution is backed by the delegations from Arkansas, Florida, Georgia, Kansas, Oklahoma, and the District of Columbia, and by the American Academy of Facial Plastic and Reconstructive Surgery, the American Association of Neurological Surgeons, and the American Society of General Surgeons.
During Sunday's meeting of the Medical Services Committee where the issue was being discussed, lines of physicians eager to voice their opinions for or against the individual mandate snaked around the room and out the door.
Those in favor of the mandate and the AMA's current stance argued that without the requirement to have health insurance, many people would not purchase it.
In the courts, supporters of the mandate argue that it's the linchpin of the ACA and the law would fall apart without it.
"This is not a political issue," said Steve Kanig, MD, a nephrologist and delegate for New Mexico. "This is a moral issue."
But the individual mandate is a fiercely political topic, and doctors at both microphones were heated over the issue.
"From our perspective, the individual mandate will actually destroy healthcare in our country" said Scot Glasberg, a delegate for the American Society of Plastic Surgeons.
Peter Lavine, an orthopedic surgeon in Washington, D.C., and a member of the District of Columbia delegation, said the AMA should not take a stance on a mandate.
"AMA supporting mandates is a bad idea," he said. "It's extremely divisive for this House. It serves us no benefit to have a statement that says we're in favor of mandates. We should be silent about it until the courts decide it's a legal entity. There is no benefit to us having a policy."
The U.S. Supreme Court will likely be the final arbiter of the constitutionally of the individual mandate.
But Kanig said the credibility of the AMA would be called into question if the House of Delegates voted to rescind its policy, which, he said, aims "to do the best job possible of addressing the crisis of people who are unable to get adequate care in this country."
Speakers who oppose the mandate pointed to longer wait times to see a primary care physician in Massachusetts since that state enacted a universal healthcare law enforced by an individual mandate in 2006.
But doctors in Massachusetts, such as Lynda Young, a pediatrician and a member of the New England delegation, praised the plan, admitting that the state has problems like every other state, but pointed out that 98% of residents now have health insurance.
The committee will make a recommendation to the full House of Delegates, which will vote on the resolutions on Monday or Tuesday.