With results such as the establishment of chiropractic in the VA and Medicare demonstration project, the ACA is making an impact in Washington

If you are reading this article in early September, it is likely that the American Chiropractic Association’s (ACA) annual business meeting has just taken place in St Petersburg, Fla. Each year, this meeting provides our House of Delegates with an opportunity to reflect on the past year while charting the future of the association and the profession.

As I look back on the past year, it is without hesitation that I say the chiropractic profession has had another good year politically. While I know there are many doctors of chiropractic who continue to struggle, there are events that have occurred over the past 12 months that give us hope for the future of this profession. Sometimes in this business, little things that occur over time result in significant outcomes. While there is still much to do, we can say that on the political front, the cup is half full and that there is reason for optimism.

Politics in Action
Politically, the chiropractic profession and, in particular, the ACA reached a new level of recognition this year when the major democratic candidates for president issued positive statements about the profession just months before the Iowa Presidential Primary. It started with former Gov Howard Dean meeting with ACA officials and the Iowa Chiropractic Society (ICS) in the ICS offices to address their concerns about his treatment of the profession during his term as governor, and then to urging him to issue a strong statement supporting the profession. Shortly thereafter, the other leading presidential candidates, including John Kerry, issued equally strong statements.

I can hear the argument that politicians will say anything to be reelected. But if you compare the statements that we received 4 years ago from presidential candidates Al Gore and George W. Bush to what we received this year, there is a difference of day and night in the level of understanding and commitment to our issues.

So why the change in attitude? Perhaps it had something to do with our comments to Sen Tom Harkin’s (D-Iowa) staff that we were planning to target Howard Dean in the Iowa Primary that caused Dean to reach out to us. Do you know of a better state than Iowa where this profession could impact the outcome of a close race? Or maybe it was the fact that in the 2002 senatorial election, we purchased more than 1,500 radio spots the last 2 weeks before the election in support of Sen Tim Johnson (D-SD), who won by less than 500 votes. Or, maybe it was the aggressiveness that we showed in other races that year, including the substantial amount raised by the profession on behalf of Sen Harkin? It all builds up. In politics, one thing for sure is the organization with perceived power gets the attention.

Medicare: Chiropractic’s Biggest Victory? Politics does not operate in a vacuum, and perceived power has its effects. Earlier this year, the ACA surprised many political pundits when it succeeded in including a chiropractic demonstration project in the recently passed Medicare drug reform bill despite strong and persistent opposition by Senate Majority Leader Bill Frist, MD, (R-Tenn) and Rep Bill Thomas (R-Calif), chairman of the Ways and Means Committee—two of the most powerful legislators on health issues.

Newspapers, both within and outside the Beltway, that commented on the $450 billion Medicare reform bill usually mentioned the chiropractic benefit. I do not recall a piece of chiropractic legislation that ever received such attention in the media. While some will argue that a demonstration project is not a reason to celebrate, the public and media thought otherwise. And frankly, when the demonstration project is successful and chiropractic is fully reimbursed under Medicare, everyone in the profession will think as the media did—that this was the most significant victory in the profession’s history.

Grassroots activism. On the heels of the passage of the demonstration project, an article appeared in the November 26, 2003 Washington Times that put us on the radar screen. A fellow of the American Political Science Association published an article that listed the ACA as one of the 25 most effective grassroots organizations for health care in the United States. Out of the thousands of groups that lobby Congress on health care issues, the ACA was ranked 19 in the listing—ahead of the US Chamber of Commerce, which was ranked 21, and the APTA, ranked 24.

He explained in interviews with the chiropractic media that the list of the top 25 grassroots lobbying organizations was developed from a roll of more than 1,200 associations he initially compiled that have interest in health care legislation. He used several criteria, including recommendations by a panel and mentions in previous studies and lobbying efforts, to narrow the list to the top 171 associations. This list was further narrowed to the top 25 after in-depth interviews with 77 congressional staff members.

The ACA was the only chiropractic organization included in the list of 171 top associations—that demonstrates ACA’s dedication to political action, lobbying, and grassroots mobilzation in moving this profession forward.

National Chiropractic Legislative Conference. NCLC has been part of the ACA for years. And this year it gave us another boost in credibility, not only by the number of doctors and students who attended, but also by the caliber of representatives from both the executive and legislative branches of government who spoke to the group. This year, we had six US senators and numerous members of Congress. But probably the most significant was the presence of Speaker of the House Dennis Hastert (R-Ill), who is considered the second most powerful person in Washington and second in line to succession. Rep Xavier Becerra (D-Calif) put it all in perspective when he said to our group, “I understand Speaker Hastert will be speaking to your group. You must be big!”

Historic firsts with the Department of Defense. The recent graduation of more than 300 medical interns from the various branches of the armed services at the National Naval Medical Center in Bethesda, Md, included Joanna Hudec, DC, who received a fellowship in integrated medicine. Bill Morgan, DC, presented the recognition in the presence of US Surgeon General Richard Carmona and other military brass, as well as more than 500 guests who attended the commencement.

Since the ACA-sponsored legislation to make chiropractic a permanent benefit for the armed services was signed into law, there have been many positive things to report. There are now more than 42 military bases that provide chiropractic care, and this number will continue to grow despite continued opposition from some branches of the service. The statutory deadline for full implementation in the armed services is next year, and we will continue to press the issue in Congress and in the DoD to be sure this happens.

These types of building blocks to success have been the strategy of ACA for years as a way to overcome the status quo attitude of Congress. Morgan, our doctor at the Capitol, continues to serve as the chiropractor to members of Congress and the Supreme Court. He is one of our greatest assets in conveying to legislators all that is good about this profession. Knowing this, ACA added the Bethesda hospital to the list of demonstration projects that passed through Congress in 1998, knowing that the doctors who treat at this hospital are the ones who treat members of Congress. Once established, the excuses for not having a doctor treat members of Congress vanished.

New VA benefit opens doors for the profession. The legislation signed by the president calling for the establishment of a chiropractic benefit within the Veterans Administration is being implemented with surprising speed. VA Secretary Anthony Principi and his staff worked closely with the Chiropractic Advisory Committee in adopting more than 30 recommendations for the implementation of chiropractic in the VA. Reading through the commentary from the secretary regarding the recommendation, the common theme was that he wanted to do it right and make it successful.

Approval of the recommendations was followed by the announcement of 26 sites throughout the country where the chiropractic benefit would be implemented. The message we are hearing is that the secretary conveyed a clear message to his employees regarding the importance he is placing on this project. It is also worth mentioning that they are using our doctors in educating the bureaucracy regarding the profession. Recently, Cindy Vaughn, DC, made a presentation via the VA satellite system on proper coding, and doctors on the advisory committee have had an opportunity for input in the other educational material being developed.

We have come a long way in 8 months, but we still have a way to go. Clearly, 26 sites are not enough, but they are an important start. The good news is that there was an effort made to select sites where the local medical directors had an interest in providing the benefit as opposed to being forced to provide it. Successful implementation of the benefit in each of the sites will go a long way toward expanding chiropractic services as we break down the culture that exists in the VA.

At the same time, we will have to continue to press the department to expand the sites through Congress and local veterans. The example of the Connecticut Chiropractic Association should not be lost in this matter. They met with the local VA medical director along with Rep Rob Simmons (R-Conn) before the sites were announced. The meeting resulted in the selection of two VA facilities being added to the sites, as well as discussions between Bridgeport Chiropractic College and the local VA. All politics is local, and the more that our doctors reach out locally the quicker the program will spread. The importance of keeping up the pressure cannot be overstated. Secretary Principi will not be there forever.

Garrett F. Cuneo is the executive vice president of the American Chiropractic Association. His previous positions include executive director of the California Chiropractic Association, director of the Secretary’s Advisory Committee Office of the US Department of Health and Human Services, and executive director of the California Board of Chiropractic Examiners. Cuneo can be reached via e-mail: gcuneo@amerchiro.org.