The AMA's $301M Reason to Fight Reform

The American Medical Association (AMA) has fought every major universal healthcare proposal since 1949. It spent $5 million to kill Truman's plan, hired Ronald Reagan to record anti-Medicare propaganda, and still officially opposes single-payer today. The stated reason has always been "patient choice" and "physician autonomy." But the AMA also collects $301.4 million a year from a copyright monopoly on medical billing codes that every doctor, hospital, and insurer in America is legally required to use. Membership dues bring in $34 million. That monopoly depends on a fragmented, multi-payer system. Universal healthcare would consolidate it.

74% of US physicians don't even belong to the AMA. They pay dues to their specialty societies instead. But every one of them is forced to use AMA-copyrighted billing codes to get paid. When a Senate committee started asking in 2025 how much the AMA actually earns from that arrangement, the AMA refused to answer.

Eighty Years of the Same Answer

The Truman campaign was just the start. In 1961, the AMA distributed recordings of Reagan to doctors' wives through Operation Coffee Cup, a coordinated letter-writing campaign designed to look grassroots while targeting Medicare. Medicare passed anyway in 1965. The opposition continued through the Clinton plan in 1993, the ACA (which the AMA initially opposed before supporting in 2009-2010, losing members in the process), and Medicare for All. At a 2019 House of Delegates meeting, a motion to drop the opposition to single-payer failed 53% to 47%.

The stated reasons have stayed remarkably consistent across eight decades: patient choice, physician autonomy. What's grown over those same eight decades is the revenue from a billing monopoly those positions happen to protect.

The $301 Million Monopoly

CPT codes became the AMA's real business through two federal mandates. In 1983, CMS adopted the AMA's Current Procedural Terminology as the mandatory coding system for Medicare billing. Then HIPAA in 1996 designated CPT codes as the national standard for all electronic healthcare transactions. Every hospital, every insurer, every billing software company, every clearinghouse in the country now has to license these codes from the AMA to function.

The revenue trajectory tells you what that mandate is worth. Form 990 data compiled by Paddock Post and ProPublica's Nonprofit Explorer show CPT royalties climbing from $159 million in 2018 to $269 million in 2022 to $301.4 million in 2024. That's a 90% increase in six years. Over the same period, membership dues stayed flat at $34 to $37 million. The AMA's financial survival depends on billing codes that nobody can opt out of.

Those licensing fees multiply across every entity in a fragmented system with thousands of payers. A single-payer system would consolidate that customer base into one. The federal government, as the sole licensee, could negotiate from total leverage, develop a public-domain alternative, or simply mandate open access as a condition of the system.

That financial logic doesn't prove the AMA opposes universal healthcare because of CPT revenue. No AMA document explicitly makes that connection, and a counter-argument exists: a single-payer government could still license CPT codes, possibly at higher volume. The UK's NHS uses billing codes. But the AMA's consistent opposition to every reform that would reduce the number of independent payers lines up with a revenue model that profits from payer fragmentation. Follow the incentives and you end up in the same place every time.

What the Senate Found When It Asked

In October 2025, Senator Bill Cassidy, chair of the Senate HELP Committee, sent the AMA a letter demanding an accounting of CPT revenue. The letter cited total 2024 revenue of $513.2 million from the AMA's own annual report, with $281.4 million categorized as "books and digital content," a line item dominated by CPT licensing.

The AMA responded on October 23. Cassidy's December follow-up called the response "anything but open and transparent." The October letter had asked the AMA to break out exactly how much of its $281.4 million "books and digital content" revenue comes specifically from CPT licensing. The AMA's response didn't answer that question. Instead, Cassidy wrote, the organization offered general descriptions of its revenue categories without the specific CPT figures the committee requested.

The December letter pressed harder. It laid out the fee schedule the AMA charges: $18.50 per user, $1,050 annual royalty per licensee, $13,000 per annual software release. It noted the AMA represents only 26% of US physicians while controlling the billing codes all of them must use. And it set a December 15 deadline, warning the committee would pursue "other options" to compel a response if the AMA failed to answer. As of publication, the outcome of that deadline has not been publicly reported.

Where the $301 Million Goes

The AMA as an institution sits on $1 billion in net fund assets. Former CEO James Madara earned $2.9 million in 2024, with total compensation from 2015 to 2023 reaching $23 million. The AMA spent $24.8 million on federal lobbying in 2024, funding advocacy on scope-of-practice restrictions, Medicare payment rules, and opposition to single-payer legislation.

CPT royalties fund lobbying that preserves the multi-payer system, and the multi-payer system keeps CPT licensees multiplying. Private insurers benefit too, because every insurer is also a CPT licensee. The AMA co-founded the Partnership for America's Health Care Future alongside insurer-backed groups to oppose Medicare for All before dropping out in 2019 when the coalition expanded to target the public option.

Physicians benefit from one piece of this: supply restriction. In 1997, the AMA was part of a consortium of medical organizations, including the AAMC, that lobbied for the Balanced Budget Act provision capping federally funded residency slots at 1996 levels. Residency positions have grown only 1% per year since, while medical school seats grew 52% from 2002 to 2022, creating thousands of graduates who can't complete training. Fewer physicians means higher physician incomes. The AAMC has reversed course and now advocates lifting the cap. The AMA has not.

The Rest of the Record

The AMA does real public health work. It publishes the Code of Medical Ethics. Its Opioid Task Force contributed to a 44.4% reduction in opioid prescribing nationally. It declared gun violence a public health crisis. During COVID-19, it helped secure liability protections for physicians in 29 states.

But those contributions coexist with a record that includes 158 years of racial exclusion (the AMA did not formally apologize until 2008), the AMA-backed Flexner Report of 1910 that closed five of seven Black medical schools (a 2021 JAMA Network Open study estimated those closures cost 27,773 to 35,315 Black physicians through 2019), and aggressive scope-of-practice lobbying that the AMA itself claims has defeated more than 80 bills allowing nurse practitioner independence in 2023 and 2024 alone. Harvard's Petrie-Flom Center found that blocking NP/PA independence was the AMA's single largest advocacy focus in 2020-2021, bigger than COVID, and that the AMA's safety justifications "aren't well supported by data."

And in 1997, the Ninth Circuit found the AMA had committed copyright misuse in its CPT licensing by requiring the federal government not to use any competing coding system. The AMA later renounced the exclusivity clause that triggered the ruling, curing the misuse. But the underlying dynamic it revealed, a private organization leveraging a government mandate to lock out competitors, has never really changed.

The Question the AMA Won't Answer

The AMA's opposition to universal healthcare is both ideological and financial. The ideology is on the record: 80 years of public statements, House of Delegates votes, PR campaigns. The financial motive is in the Form 990s and the fee schedules and the lobbying disclosures. What's missing is the number the AMA won't put on the table: exactly how much of its revenue comes from the CPT monopoly that a consolidated healthcare system would threaten.

A Senate committee asked. The AMA went quiet. The Senate is still waiting.