WASHINGTON - The American Medical Association maintained its support of a federal health overhaul requirement that Americans obtain insurance coverage or face a tax penalty.

The group voted Monday near its headquarters in Chicago to reject an effort by physicians from Republican-dominated states to withdraw backing for the rule. The American Medical Association endorsed the health overhaul enacted by President Barack Obama last year that includes a mandate that most Americans enroll in a health insurance plan.

The schism within the biggest U.S. trade group representing doctors reflects a national debate over the so-called individual mandate in the Affordable Care Act. Florida and Virginia are leading 27 states suing the U.S. to have the rule declared unconstitutional as it sparked opposition among Obama’s Republican rivals for the White House, said Jack Lewin, CEO of the American College of Cardiology.

“The debates on health-reform-related matters like the individual mandate and support in general for the AMA’s position on the Affordable Care Act were probably the most contentious areas at the meeting,” Lewin said prior to the vote. “Within the physician community there’s a split, an ideological split, that’s fairly parallel to the public.”

Two-thirds of the 491 physicians voting at the meeting backed the current position on the mandate, a margin the association’s president, Cecil Wilson, described as “overwhelming.”

The mandate is a means to ensure broader coverage that prevents people from forgoing insurance until they become sick, Wilson said. An American Medical Association committee recommended that members vote to maintain the organization’s position after a debate Sunday.

The health overhaul “cannot be fully successful in covering the uninsured without individual responsibility for health insurance,” Wilson said during a conference call with reporters Monday.

Upset Members

The American Medical Association’s endorsement of the health overhaul, legislation that received no Republican votes in Congress, rankled a portion of the physicians and medical societies that make up the organization, Lewin said.

“There’s definitely a sense that the AMA Board of Trustees somewhat stuck their neck out to do something that probably wouldn’t have gotten the endorsement” in a vote, he said. “On the other hand, that’s what leadership is all about.”

The American Medical Association reports it had 215,864 members last year, a decline of 5 percent from 2009, and that the decline is consistent with smaller membership rolls in U.S. professional societies overall. The health overhaul debate didn’t have a “significant effect in regard to our membership,” Wilson said.

The outcome of the vote won’t influence the courts considering the states’ lawsuits or the ability of Republicans to repeal the individual mandate or the health overhaul in Congress, said Bob Doherty, the senior vice president of governmental affairs and public policy for the Philadelphia-based American College of Physicians.

Medical societies from Arkansas, the District of Columbia, Florida, Georgia, Kansas and Oklahoma, the American Academy of Facial Plastic and Reconstructive Surgery and organizations representing brain surgeons and general surgeons sponsored the resolution to scrap the American Medical Association’s backing of the insurance mandate.

“This should not be federally determined,” said Jonathan Sykes, the president of the Alexandria, Va.-based plastic surgeons’ group. Decisions on whether to adopt an individual mandate to obtain health insurance should be left to states, Sykes, who practices in Sacramento, Calif., said before the vote. Massachusetts enacted such a mandate in 2006.

A resolution affirming the American Medical Association’s existing policy in favor of the mandate came from the American College of Cardiology, the American College of Physicians and groups representing family physicians, obstetrician-gynecologists and pediatricians along with the state medical societies from California, Connecticut, Maine, Massachusetts, Nebraska, New Hampshire, Rhode Island and Vermont. The New Mexico physicians’ group submitted its own resolution in support of the insurance requirement.

The American Medical Association first endorsed a mandate that individuals obtain health insurance in 2006.