ACA has scored many victories for chiropractic with its lobbying and PAC

Momentum is a good thing in sports, politics, and, of course, lobbying. After enactment by Congress and President Bush of several ACA-backed bills in 2002 and 2003—measures that are now creating historic new opportunities for doctors of chiropractic in Medicare, the military and veterans health systems, and the National Health

Service Corps—the ACA government relations team remained focused on achieving more victories for DCs and their patients in 2004. The result was another banner year for chiropractic impact on Capitol Hill, the White House, and in federal agencies, such as the Department of Health and Human Services, the Department of Veterans Affairs, and even the Pentagon.

This good news comes at a time when opponents of the ACA, including antichiropractic bureaucrats, health care groups, and even some within the profession, continue trying to defeat ACA initiatives, particularly those aimed at expanding chiropractic care in federal health programs. These doubters and naysayers will continue to be active, and the success and momentum built up by the ACA will no doubt cause them to redouble their efforts next year.

It is well-known in the nation’s capital that the key to ACA’s clout continues to be its grassroots network of active and involved DCs across the United States. In every state and in virtually every congressional district, ACA members respond to legislative alerts, regulatory updates, and specific calls to action. Our experienced corps of lobbyists reaches out to allies on Capitol Hill and builds new coalitions with organizations that count chiropractic patients among their membership, including those representing veterans and seniors.

Last year, the ACA was ranked in a survey of congressional aides reported in the Washtington Times as being in the top 20 out of the hundreds of health care advocacy groups trying to be heard in Washington, DC, on Medicare reform and other important issues.

What else made 2004 another banner year? Well, here are few highlights:

• Seven presidential candidates endorsed chiropractic. As recently as the 2000 presidential election, prochiropractic statements by candidates were almost unheard of. However, this changed dramatically in 2004, when it became clear that those running wanted to talk to the ACA and were ready to listen to DCs and patients.

It was for the first time that the ACA—working closely with the Iowa Chiropractic Society and activists like Dow Bates, DC, and Keith Overland, DC—successfully secured detailed chiropractic policy statements from all the major contenders for the White House, including President Bush, Sen John Kerry, Sen John Edwards, Sen Joe Lieberman, Rep Dick Gephardt, Gen Wesley Clark, and even antichiropractic former Vermont Gov Howard Dean, MD.

While it took some prodding and pushing, in the end, the candidates all recognized that victory now requires an understanding of and appreciation for the 25 million Americans who seek care from chiropractors each year.

• Speaker Dennis Hastert and HHS Secretary Tommy Thompson headlined at NCLC. In 2004, ACA’s advocacy efforts got an enormous boost from the National Chiropractic Legislative Conference (NCLC), the profession’s largest public policy conference. More than 500 DCs and students gathered in Washington, DC, to attend the general session with congressional leaders and to visit the US Capitol for meetings in the offices of every senator and member of congress. The goal was to build support for ACA-backed legislation designed to eliminate barriers and expand access to chiropractic care, like HR 4051 (the Filner bill), which would provide America’s veterans with direct access to a DC and HR 3476, which extends the military’s chiropractic care benefit to retirees and their families.

NCLC 2004 was also about delivering a prochiropractic and propatient message to the most powerful leaders in our government. NCLC sessions headlined by House Speaker Hastert, HHS Secretary Thompson, Sen Grassley, the Chairman of the Senate Finance Committee, House Minority Whip Steny Hoyer (D-Md), and nearly two dozen other members of congress demonstrated that DCs are listened to and heeded as never before.

• VA health system offers chiropractic care and moves to hire more than 27 DCs. When the year began, not one DC was employed by the nation’s VA health care system, and only a handful of veterans could access chiropractic care through their local VA hospital. As the year ends, on orders from congress and VA Secretary Tony Principi, DCs are now the first health care providers added to the VA system in more than a quarter of a century, and the VA is hiring and contracting DCs through 28 VA medical centers in 21 states that serve 5 million veterans.

In addition, VA officials in Washington and across the United States are implementing Principi’s comprehensive plan to integrate chiropractic care for neuromusculoskeletal conditions into all missions of the VA health care system, including patient care, education, research, and response to disasters and national emergencies; designate DCs as partners in health care teams; create internship programs between the VA and chiropractic colleges; and fund chiropractic research programs.

Although this is significant progress, the ACA is already working with members of congress and prochiropractic veterans’ groups to expand chiropractic care beyond the first 28 facilities. Some ACA members, like the SACA chapter at Northwestern University of Health Sciences, are not waiting to take action. In early November, Northwestern students generated nearly 400 letters to their senators and congressmen urging that two VA hospitals in Minnesota be added chiropractic program. These letters close with a reminder to their legislators that Northwestern SACA students will be in Washington soon for NCLC 2005 and expect results.

• Congress informs Pentagon that chiropractic panel is on active duty again. In 2002, the ACA told the Department of Defense that it was a bad idea to deactivate its advisory committee overseeing implementation of the chiropractic care benefit for active-duty military personnel. Although chiropractic care is available at 42 military health facilities, the permanent chiropractic care benefit congress approved in 2000 for America’s military is not yet available throughout the Defense Department’s health system and, by law, it must be.

For a time, it seemed that the military’s medical establishment might succeed in preventing further discussions within the Pentagon on expanding the availability of chiropractic care. However, a year-long lobbying campaign by the ACA and the Association of Chiropractic Colleges and along with the efforts of Sen Jim Talent (R-Mon) and Rep John McHugh (R-NY) produced a new directive from congress contained in Section 718 of the Ronald Reagan National Defense Authorization Act of 2004. The directive ordered the Pentagon to reactivate its chiropractic care advisory committee and ensures that it will report directly to the secretary of defense. The panel, which will include at least three DCs, is required to be up and running in 2005.

Of course, having DCs with specific oversight responsibilities once more inside the Pentagon will help the ACA’s efforts to get America’s active-duty military personnel, including those whose service takes them to combat zones in Iraq and Afghanistan, the chiropractic care they need and deserve.

• CMS frequency limits scheme cancelled. In May, CMS officials unveiled a scheme to authorize carriers to impose arbitrary frequency limits on the chiropractic services that Medicare beneficiaries could receive. Recognizing that this plan could take effect on October 1 without any policy review or formal public comment period, ACA immediately voiced strong opposition to this or any similar plan to cap chiropractic care that is deemed medically necessary.

Through a series of meetings with senior CMS officials who defended the plan as necessary to address error rates in chiropractic claims, ACA made a legal and policy case against frequency limits.

CMS did not budge and, by late September, was making final preparations for the implementation. It was then, after hearing once more from the ACA and the Iowa Chiropractic Society, that Sen Grassley decided it was time for further action. He called Secretary Thompson to urge him to overrule CMS on this matter and to immediately withdraw the frequency limits directive the agency had issued.

Secretary Thompson, who had already heard from his old friend Ken Luedtke, DC, former ACA-PAC chairman, on this issue, then stepped in and issued an order to cancel the planned implementation. While not the subject of a great deal of media attention, this successful effort was a particularly important win for DCs and their Medicare patients. Furthermore, it illustrates the chiropractic profession’s need to be active and engaged in the public policy process and to have an understanding of how Washington works.

Of course, 2004 is not over yet. There may well be a victory still to come when Congress returns to Washington in November for a rare lame duck session. One issue likely to be considered at that time involves an ACA-backed provision sponsored by Sen Harkin to expand and extend the chiropractic pilot in the National Health Service Corps student loan repayment program, and ensure that it receives $3 million in funding.

No matter what, ACA will have a full slate of issues to pursue in 2005. There are many battles ahead, some in Medicare and the Employee Retirement Income Security Act (ERISA) and others in the military and VA health systems. There are some that will be unexpected, but essential to win. There will be many opportunities for DCs to get involved and further strengthen ACA’s chiropractic advocacy machine. We will need more help, involvement, and activism to keep the momentum and to make 2005 yet another banner year.

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.