Ken Terry

June 14, 2017

CHICAGO — The American Medical Association's (AMA) House of Delegates voted here Tuesday to have the association study the feasibility of a "public option" insurance plan to improve access to care. But the resolution specified that the study be done in the context of a "pluralistic health care delivery system."

The public option would create a government health plan that would compete with private health plans in the marketplace. The AMA opposed this idea when it emerged as an issue in the 2009 debate over the legislation that became the Affordable Care Act. The association viewed the public option as a step toward a single-payer, government-run healthcare system, which it has long resisted.

In the House of Delegates, some delegates said they were concerned that the public option resolution would be misinterpreted as a reversal of that position. Daniel "Stormy" Johnson, MD, a former AMA president, said, "The debate over the public option is the same as the debate over single payer and conveys the wrong message."

But a Wisconsin delegate countered that the public option and single payer aren't the same, and that an option is not a mandate. "Providing a public option to strengthen access to care is worth studying," he said.

Thomas Sullivan, MD, from the Massachusetts delegation, also spoke in favor of the resolution. He quoted former AMA President Nancy Nielsen as saying that a public option might be acceptable if it were part of a menu of plans similar to those of the Federal Employees Health Benefits Program.

The resolution passed by a margin of 61% to 39% without the language about a pluralistic system. That additional language, which passed on a voice vote, was proposed by a delegate who said it would make it easier to sell the decision to his members. The amendment passed on a voice vote.

A 2009 survey published in the New England Journal of Medicine showed that 63% of physicians supported a public option as part of a public-private insurance system for people not on Medicare or Medicaid. Almost the same percentage of AMA members also supported this kind of public option.

Among primary care doctors, 65% supported a mixed public-private insurance system, 24% endorsed a private-only system, and 11%, a public option only. Among medical subspecialists, 65%, 25%, and 10% supported these respective alternatives; the percentages for surgeons were 59%, 33%, and 7%, respectively.

The public option resolution was part of a recommendation that the AMA "study mechanisms to improve affordability and competition in the individual insurance marketplace." The resolution pointed to the inadequacy of the current "advanceable refundable tax credit policy" for helping low-income people buy insurance.

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