The ACA and ACC successfully lobbied to expand chiropractic students’ access to the National Health Service Corps loan reimbursement programs

Until recently, the only federal student loan program available to the chiropractic profession was the Health Education Assistance Loan (HEAL) program, which was riddled with problems and ultimately cancelled. To help ease the large debts of chiropractic students and recent graduates, the American Chiropractic Association (ACA) identified an opportunity with the National Health Service Corps (NHSC).

Because of the tremendous grassroots action of the profession and the support for chiropractic on Capitol Hill, the ACA successfully lobbied to include a chiropractic provision in the NHSC reauthorization legislation (S1533). The main purpose of this program is to ensure an adequate supply of primary health care providers in designated rural and medically underserved areas. The NHSC enlists fully qualified primary health care providers who agree to provide care in designated sites. In return, NHSC assists selected providers in repayment of their outstanding student loans.

Every provider selected to participate in the NHSC must sign a contract agreeing to provide 2 years of full-time service in the designated medically underserved area. Providers in good standing can apply to extend their services past the 2-year period. For the initial contract period, the NHSC loan repayment program will reimburse up to $25,000 per year of service based on the participant’s outstanding student loan balance.

Doctors of chiropractic are a perfect match for this program. In fact, in many small towns across America, the chiropractor is the only doctor in town. Virtually all health care provider groups, including dentists, podiatrists, physical therapists, and nurse practitioners are allowed to serve in the NHSC. But despite the fact that DCs have an advanced degree and are licensed in all 50 states as primary care providers, they have been excluded from this program. To correct this problem, the ACA and the Association of Chiropractic Colleges (ACC) worked for passage of a provision that would include chiropractors.

Senators, Lend Me Your Ears

The ACA and ACC worked on one particular provision for 18 months—a provision that was nearly derailed a number of times. The ACA started the process in the Senate, since the Senate Health, Education, Labor, and Pensions (HELP) Committee was working on reauthorization legislation for the NHSC program. Senator Tom Harkin (D-Iowa) was the champion on this issue. He pledged to work for the passage of a chiropractic provision in the reauthorization legislation, as well as adding specific appropriations funding for the program. Initially, the ACA encountered tremendous resistance, because the HELP Committee was making a concerted effort to limit the number of providers that could participate. In fact, the legislation drafted by the Senate HELP Committee removed podiatrists and optometrists from involvement in the program.

On July 31, 2001, the ACA received information that a chiropractic provision regarding this issue had been included in the chairman’s base bill (chairman’s mark). Then, the ACA received information indicating that Senator Bill Frist (R-Tenn), a medical doctor, planned to offer an amendment that would strike the chiropractic provision as early as the following day (August 1). ACA staff confirmed this report with Senator Frist’s office.

The ACA and ACC immediately swung into action and alerted the Senate offices and our key contacts. The ACA also initiated an intense grassroots campaign, faxing and emailing legislative alert bulletins to thousands of doctors across the country. Calls flooded into the Senate regarding this issue.

Despite Senator Frist’s objections, the HELP committee moved to include DCs in the NHSC program for a 3-year period on August 1. This provision guarantees that chiropractors will receive loan reimbursement under the NHSC program. This action taken by the Senate HELP Committee represented a significant victory.

After the committee approved the legislation, it was cleared for consideration by the full Senate. The full Senate would likely have voted on the legislation in September, but because of the terrorist attacks on September 11, no further action could be taken in 2001. Once all the emergency legislation relating to the terrorist attacks had been cleared, the Senate considered and passed the NHSC legislation in March 2002.

Bring the House Down

It was time to turn attention to the House of Representatives. ACA’s main efforts in the House focused on Congressman Billy Tauzin (R-La), Chairman of the House Energy and Commerce Committee. Since he was the chairman of the committee with jurisdiction, we felt his support would significantly increase our chances of success. At first, Tauzin’s office was resistant. But thanks to the hard work of J. Michael Flynn, DC, Glenn Manceaux, DC, and the Chiropractic Association of Louisiana, Tauzin has become supportive of our issue.

Unfortunately, because the Republican leadership attempted to add a controversial provision to the NHSC legislation, the legislation was put on hold in the House. All indications were, however, that our provision would be included in the final bill to be sent to the president once the issue had been dealt with.

Unfortunately, it was not so simple. A week before Congress planned to adjourn for the year, the ACA received word that members of the House were going to oppose our provision. This was of huge concern, as the NHSC legislation was fragile and we were running out of time. The ACA immediately initiated another massive grassroots and lobbying campaign. After a series of heated conversations with congressional staff, our provision was added to the legislation with 2 minutes to spare, where it was passed in the House on October 17, 2002.

The final provision guarantees the participation of DCs and students in the student loan reimbursement program for a 3-year period. Doctors and students selected for this program will have all or part of their student loans reimbursed in exchange for serving in a designated medically underserved area. The committee report language accompanying the legislation directs the Secretary of Health and Human Services to work with the ACA and ACC on the development and implementation of the new chiropractic provision. Once that takes place, the ACA will know more details about where and how many doctors and students can participate in this program.

After the demonstration period is over, the Secretary of Health and Human Services, working with the ACA and ACC, will submit a report to Congress on the results of the demonstration project. The ACA is confident that, as with the Department of Defense demonstration project, this demonstration project will be extremely successful. Once the results are submitted, Congress will then consider whether to make chiropractic a permanent part of the NHSC. If this happens, chiropractors will have the first federal designation as primary care providers. This will significantly help the ACA obtain primary care status in other federal programs, as well as in private sector insurance plans.

On October 26, 2002, President Bush signed the NHSC legislation into law (PL 107-251).

For more information regarding the NHSC, please visit the Health Resources and Services Administration website: www.hrsa.org. CP

Daryl D. Wills, DC, is president of the ACA and has been practicing for 30 years in Gering, Neb. He is a member of the Foundation for Chiropractic Education and Research, a Fellow of the International College of Chiropractors, and a Fellow of the International Academy of Clinical Acupuncture. Wills received the prestigious Wilk Award in 1997. He can be reached via email at: ddwillsdc@scottsbluff.net.