Chiropractic care in Medicare and the new VA chiropractic benefit are two major battles the ACA faces in 2003

As the second session of the 107th Congress comes to an end, the American Chiropractic Association (ACA) is focusing its legislative efforts on two majors issues: expanding chiropractic care in Medicare and implementing the new Department of Veterans Affairs (VA) chiropractic benefit. The ACA suspects that organized medical groups will strongly oppose our efforts.

Seasoned Veterans
The ACA successfully fought for the passage of comprehensive legislation (HR 3447) that will provide veterans access to chiropractic care. The President signed this legislation into law on January 23, 2002, which, for the first time, creates a permanent chiropractic benefit in the VA health care system, sets a broad scope of practice, authorizes the hiring of DCs in the VA, and establishes a chiropractic oversight committee that will participate in the development and implementation of the new benefit. This victory was not easy—the ACA had to overcome resistance from the VA, White House, Senate VA Committee, and medical groups.

Now that the legislation has passed into law, the ACA has focused its attention on the development and implementation of the new chiropractic benefit, which includes short- and long-term efforts. A key component in the recently passed legislation was the creation of a chiropractic advisory committee, modeled after the Department of Defense (DoD) demonstration project. The VA has been very resistant to incorporating chiropractic care in the VA health care system. This is based on a lack of knowledge of chiropractic care and a lingering bias against the profession. Because of this resistance, the ACA and Association of Chiropractic Colleges (ACC) thought it vital that the chiropractic profession have direct input on the development and implementation of any new chiropractic benefit in the VA. Without input, the VA would continue to limit chiropractic care and refuse to hire DCs.

Since the DoD demonstration was such a success, the ACA and ACC recommended the five DCs on the DoD committee to serve on the VA committee as well. The ACA and ACC worked with other chiropractic groups—the International Chiropractic Association (ICA) and the World Chiropractic Association (WCA)—on this issue. Late last summer, all four chiropractic groups agreed to nominate the five DCs that served on the DoD advisory committee plus Carl Cleveland III, DC. Only two of these doctors, Reed Phillips, DC, and Ronald Evans, DC, were appointed. Unfortunately, as soon as the legislation passed into law, the ICA and WCA broke the agreement and nominated their own doctors.

On August 12, 2002, the Secretary of the VA appointed members to a chiropractic advisory committee. The committee is comprised of 2 members, with six DCs and five non-DCs. The chiropractic members are as follows: Phillips, (Chair); Evans (who declined the appointment); Michael McLean, DC; Cynthia Vaughn, DC; Leona Marie Fischer, DC; and Charles DuVall, DC. The other members of the committee include: Warren Jones, MD; Paul Shekelle, MD, PhD; Michael Murphy, DO; Brian Murphy, PT; and Michael O’Rourke, PA.

Unfortunately, it seems that the VA used the dissension in the chiropractic profession as an opportunity to appoint fringe elements to the committee, as well as medical groups. The ACA strongly opposes MDs, DOs, and PTs being involved in developing a chiropractic benefit. When implemented, these providers will be direct economic competitors with doctors of chiropractic in the VA system. The ACA is also concerned that some of the DCs represent the fringe element of the profession. It appears that the VA intentionally included these groups to cause dissent.

The ACA is very concerned with the make-up of the committee. We have already contacted members of Congress about this issue. If this VA committee is unable to develop a proper chiropractic benefit, the ACA will work with Congress to pass statutory language to force the VA to do the right thing.

Our long-term efforts are to ensure that chiropractic care is available at an adequate number of VA sites. To address this issue, the ACA and ACC met with Congressman James T. Walsh’s office (R-NY; VA/HUD Appropriations Subcommittee Chair). During this meeting, the ACA discussed its concerns with the development and implementation of the new chiropractic benefit. Walsh’s staff understood our concerns and indicated they would help. ACA also met with Congressman Chris Smith (R-NJ; chair of the House VA Committee) and Congressman Jerry Moran (R-Kan; chair of the House VA Subcommittee on Health) about this issue. If the VA fails to provide chiropractic care to all veterans, it would need the VA committee to pass additional statutory language. Both members indicated they would assist.

ChiroCare in Medicare
The ACA continues its effort to expand patients’ access to chiropractic care and end the long discrimination against doctors of chiropractic in the Medicare program. To address this issue, Congressman Wes Watkins (R-Okla) introduced Chiropractic Patients’ Freedom of Choice Act HR 902 in the 107th Congress. This legislation provides chiropractors reimbursement for all Medicare services in their state scope of practice. The ACA initiated an intensive grassroots and lobbying campaign in support of this legislation, which has received strong bipartisan support in the House of Representatives. So far, the legislation has 81 cosponsors, almost equally divided between Republicans and Democrats.

The US Congress is currently debating Medicare reform legislation. The centerpiece of this legislation is a prescription drug benefit for senior citizens. Since chiropractic is a safe and effective alternative to prescription drugs, the ACA has been working to include a chiropractic provision (based on HR 902) into this Medicare legislation. In the House, the Ways and Means and Energy and Commerce committees were tasked by Speaker Dennis Hastert (R-Ill) to jointly develop a bill. Key members in this process are Rep Billy Tauzin (R-La), Chairman, Energy and Commerce Full Committee, and Rep Nancy Johnson (R-Conn), Chairman, Ways and Means Health Subcommittee. The ACA has worked closely with these members on a chiropractic provision based on HR 902. Unfortunately, the ACA is up against tremendous resistance from Bill Thomas (R-Calif), Chairman, Ways and Means Full Committee and several medical groups.

Due to this resistance, the ACA and members of the committee could not reach an agreement on the language before the bill moved through committee. As a result, ACA’s provision was not included in the bill approved by the full House. Although the legislation has passed in the House without a chiropractic provision, the ACA will continue to work with key members of the House on this issue. In fact, Representatives Tauzin and Johnson have indicated a willingness to work with the ACA to ensure that a chiropractic Medicare provision passes into law in the near future.

Once the House finished consideration of the Medicare legislation, the ACA then turned its attention to the Senate, which will likely finish work on its own version of this legislation in the near future. In early July, Senator Tom Daschle (D-SD; Senate Majority Leader) tried to bring the Medicare prescription drug bill straight to the floor without committee action. Two versions of the Medicare prescription drug bill were considered as an amendment to a generic drug bill (S812) being debated on the Senate floor.

Because of a past budget agreement, any Medicare amendment needed 60 votes to pass in the Senate. If a prescription drug bill was able to obtain 60 votes, Senate Democrats planned to consider Medicare provider issues, such as the chiropractic provision. Both versions of the Medicare drug bill failed to obtain the necessary votes for passage. As a result, the Senate did not consider any Medicare provider issues.

Senator Daschle attempted again on July 24, 2002, to attach a Medicare prescription drug bill to the generic drug bill being considered on the Senate floor. This version was developed by Senators Bob Graham (D-Fla) and Gordon Smith (R-Ore). As with the previous amendments, it dealt strictly with Medicare prescription drugs. The Senate voted on a motion to override the budget rule (60 votes), which would clear the prescription drug amendment for consideration. This motion failed to pass by a margin of 49 to 50. As a result, the Senate immediately moved to consider the generic drug bill without a Medicare provision. The generic drug bill passed by a margin of 78 to 21.

Since the Senate left for its August recess on July 26, the Medicare issue will likely be addressed in September or October. This delay will help the ACA build more support for its Medicare provision during the August break. When the Senate returns, Senator Daschle may allow the Medicare bill to go through the committee process. This would help our effort, since we have a number of key supporters on the Senate Finance Committee. If Senator Daschle attempts once again to attach the Medicare bill to another bill moving through the Senate, the ACA will need the support of all Senators to include a chiropractic provision as a floor amendment.

Get In on the Action
The chiropractic profession needs to continue to build support for the passage of a Medicare provision based on HR 902. It is imperative that doctors, students, and patients call, fax, or email their Senators and request that they support and work for the passage of a chiropractic provision based on HR 902. To speak with your Senator, call the Capitol Hill switchboard at 202-224-3121. To find your Senator’s email or fax number, go to www.senate.gov/senators/senator_by_state.cfm. If you have already contacted your Senator, please contact him or her again and ask what actions he or she has taken.

Jay Witter IV, is the ACA vice president of government relations. He can be reached at 800-986-4636, ext 214.