The ACA recounts victories for chiropractic in the past year and looks ahead for the advances of the profession in 2004.

Doctors of chiropractic were heard louder and clearer than ever before in Washington, DC, in 2003. Looking back, it was a year of national recognition for the American Chiropractic Association’s (ACA) lobbying clout on Capitol Hill. It was a year in which leading presidential candidates courted the chiropractic vote and competed to offer the most chiropractic-friendly policy statement. More importantly though, it was a year in which the ACA and its members from across the nation led the way to significant legislative accomplishments for the chiropractic profession that offer the prospect of further victories to come.

If impressive wins on key issues were not enough of an indicator, a definitive ranking of 19 of the 25 most effective grassroots lobbying organizations for health care that appeared in the Washington Times on November 26th should provide further evidence that the ACA and its members are listened to and heeded by elected leaders in Washington. The ACA is noted as being “highly successful in building connections between [ACA] members and Congress on a wide geographic basis.”

This recognition is particularly significant because the ACA has far fewer members than many larger groups in the ranking, including the American Medical Association (ranked 2), AARP (3), Blue Cross and Blue Shield Association (6), American Nurses Association (15), the US Chamber of Commerce (21) and the American Physical Therapy Association (24).

In recent weeks, ACA members have been out on the presidential campaign trail asking tough questions of the candidates about their position on chiropractic care. Though they may often disagree on other issues, the leading candidates for the Democratic presidential nomination appear to completely agree on the value and benefits of chiropractic care. In close cooperation with the Iowa Chiropractic Society, the ACA has secured chiropractic care policy statements from five candidates—Senator John Kerry (Mass), Senator Joe Lieberman (Conn), Congressman Dick Gephardt (Mo), Senator John Edwards (NC) and former Governor Howard Dean (Vt).

The highlights for ACA’s legislative achievements are:

Congress passes and the president signs Medicare legislation including the ACA-backed program to test expanded Medicare access to DCs. As part of legislation overhauling the 38-year-old Medicare program—passed by the House of Representatives on November 22, the Senate on November 24, and signed by President Bush on December 8—Congress has authorized four, 2-year pilot projects designed to test expanded access to chiropractic services for seniors.

Senator Charles Grassley (R-Iowa), the chief sponsor of the Medicare Chiropractic Demonstration Project, and other prochiropractic members of Congress, succeeded in turning back strong opposition from the organized medicine lobby and other special interest groups. As the deadline for consideration of the bill approached, Senator Grassley contacted a key opponent of the chiropractic provision, Senate Majority Leader Bill Frist, MD, via his electronic pager and sent the message to “back off!”

Also included in the Medicare bill is a provision aimed at ensuring that Medicare beneficiaries will continue to have access to chiropractors and other physicians by replacing a 4.5% physician payment cut due to take effect in January with 1.5% payment increases in 2004 and 2005.

On November 23, the Washington Post quoted ACA Chairman George B. McClelland in describing approval of the Grassley chiropractic demonstration project as “chiropractic’s biggest win ever on Capitol Hill.” For the first time, Medicare beneficiaries will have the freedom to choose a DC to provide a range of the covered services they want and need.

The current Medicare program imposes an arbitrary limit on the covered services that can be offered by America’s 60,000 doctors of chiropractic. Under current law, a DC may only provide Medicare beneficiaries with a single covered service (manual manipulation of the spine to correct a subluxation) despite the fact that they are licensed in all 50 states to provide additional services that are currently covered under Medicare, including x-rays and other diagnostic tests and physiotherapy services.

The demonstration project, as sponsored by Senator Grassley and to be administered by the US Department of Health and Human Services, will assess how greater freedom of choice for consumers and additional competition among care providers will benefit the health of Medicare beneficiaries and provide for more efficient use of Medicare resources. The demonstration will likely have a profound impact in rural and medically underserved areas where beneficiaries will no longer be forced to visit a second or third provider to receive the full range of necessary services.

In addition, the active involvement of thousands of ACA members around the country who participated in a grassroots lobbying effort beginning with ACA’s National Chiropractic Legislative Conference in March 2003, as well as the efforts of individual friends of the chiropractic profession, such as Kent Greenawalt, president and CEO of Foot-Levelers Inc. Also, a number of national and state chiropractic organizations played an important role in this victory, including the Association of Chiropractic Colleges, the Student American Chiropractic Association (SACA), the National Association of Chiropractic Attorneys, the Iowa Chiropractic Society, the Connecticut Chiropractic Association, the Chiropractic Association of Louisiana, the Florida Chiropractic Association, the Utah Chiropractic Physicians Association, the Tennessee Chiropractic Association, and other member organizations of the Congress of Chiropractic State Associations.

On December 6th, President Bush signed into law the Department of Veterans Affairs (VA) Long-Term Care and Personnel Authorities Enhancement Act of 2003 (S 1156), a bill that will help America’s veterans get the chiropractic care they need and deserve. The legislation had received final approval from Congress on November 21.

Section 302 of S 1156 is an ACA-backed provision (also supported by the Association of Chiropractic Colleges (ACC) that amends title 38 of the US Code to provide the VA with direct authority to hire and employ chiropractors to care for veterans in the VA health system. This provision, strongly supported by Congressmen Chris Smith (R-NJ), Rob Simmons (R-Conn), Jerry Moran (R-Kan), Ciro Rodriguez (D-Tex), Bob Filner (D-Calif), Jeb Bradley (R-NH), Rep. Ed Schrock and Senator Arlen Specter (R-Pa), bypasses a lengthy bureaucratic process that could have delayed or even jeopardized the chiropractic benefit Congress approved in 2002 for America’s former military servicemen and women.

The ACA, ACC, and the Pennsylvania Chiropractic Association worked closely with Senator Specter, the Chairman of the Senate Veterans Affairs Committee, on the legislation after securing initial passage by the House of Representatives last July 21. Rep. Simmons, who received the ACA’s Veterans Health Care Leadership Award in 2003, and Rep. Moran, a leading pro-chiropractic Member of Congress, were the prime sponsors of the House bill.

On November 24, President Bush signed into law the National Defense Authorization Act for Fiscal Year 2004 (HR 1588). This legislation authorizes the US Department of Defense’s (DoD) range of military activities, military construction programs and the defense activities of the Department of Energy. Also, the legislation prescribes personnel strength levels for the Armed Forces and establishes policies and priorities for military health programs, including the chiropractic care benefit Congress approved in 2000 for active-duty military service personnel.

HR 1588 contains an ACA-backed provision (Section 711) that orders the Pentagon to move more quickly to make chiropractic care available to our troops. The legislation accelerates implementation of the chiropractic care benefit for America’s active-duty soldiers, sailors, airmen, and marines and sets October 1, 2005 as the new target date for implementation, 1 year earlier than what was originally called for by Congress.

Congressman Ed Schrock (R-Va), a member of the Armed Services Committee, played a leadership role in including this directive and accompanying report language calling for a $6 million increase in funding for chiropractic care programs in the DoD budget. The Armed Services Committee Chairman, Rep. Duncan Hunter (R-Calif), and a key subcommittee chairman, Rep John McHugh (R-NY), strongly supported the chiropractic benefits acceleration and cited it as one of four key improvements in the military health program contained in HR 1588. Although a chiropractic provision was not originally included in the Senate version of the bill, a successful ACA and ACC lobbying effort targeting House-Senate conferees—backed by the grassroots involvement of ACA and SACA members—ensured that the pro-chiropractic language was included in the final bill and signed by the President. Senator Jim Talent (R-Mo) also fought hard for inclusion of Section 711 and the favorable report language.

In addition to the statutory directive to the DoD to move faster to get chiropractic care to our troops, the legislation seeks to correct specific deficiencies in the overall implementation of the chiropractic care benefit for active-duty personnel. Earlier this year, the Senate approved report language seeking to strengthen the role of the department’s Chiropractic Oversight Advisory Committee, increase the accessibility of the chiropractic benefit to cover 45 military health sites around the United States by next September, and safeguard the status of DCs in the military health system.

The ACA accomplished a great deal for the profession over the past year. Each of the victories of 2003 will require determined follow-up with government agencies and, possibly, additional directives from Capitol Hill in 2004. CP

Jon Hymes is the ACA vice president of government relations. He was a senior legislative adviser and campaign strategist for two members of Congress. Hymes can be reached via email: jhymes@amerchiro.org.