The bill threatens to eliminate state-enacted health care mandates.

State insurance-equality laws and mandates for health services, including chiropractic, are the “backbone” of rights the chiropractic profession has fought for, and won, to provide the care our patients need and deserve. Other than licensure status, probably no other issue is as paramount to the profession as the assurance that chiropractic care is covered under state-regulated insurance plans.

Unfortunately, the mandates we’ve fought for are in jeopardy. The American Chiropractic Association (ACA), in cooperation with state chiropractic associations and a diverse coalition of provider groups, has launched a massive grassroots assault to defeat a bill in the US Senate—S 1955—that threatens to eliminate state-enacted health care mandates and leave older and chronically ill patients with less care and higher costs.

Introduced by Sen Mike Enzi (R-Wyo), the bill, also known as the “Health Insurance Marketplace Modernization and Affordability Act,” would enable small businesses and associations to band together to purchase health care for their employees, theoretically lowering costs by increasing their buying power. The plans, however, would not be subject to any state insurance-equality or any willing provider laws—including any laws that mandate special services or therapies such as certain diabetes treatments, mental health services ... and chiropractic.

As a result of state mandates being eliminated, carriers would be able to market less-complete and, thus, less-expensive plans, but these plans will leave patients with huge coverage gaps that they won’t think about until they need the services. Of course, carriers may opt to include chiropractic services in their plans, but there’s no requirement for it, and we don’t know how they will respond. Furthermore, self-funded plans, already free from mandates, may eliminate benefits they already include, because the “gold standard” of state-mandated coverage will be diluted.

Proponents of the bill say that state mandates increase the cost of health care for employers. However, the ACA and groups such as the American Cancer Society, the National Mental Health Association, the National Multiple Sclerosis Society, and others, fear that only young and healthy employees will benefit from the “bare-bones” benefits that employers will choose to offer. Older, sicker people will be forced to purchase more expensive coverage to access the additional care they need.

Bill Changed to Neutralize Insurance Concerns
Bills similar to S 1955 have been passed in the US House of Representatives on several occasions, but the bills have always met opposition in the Senate, primarily due to tough lobbying against them by the insurance industry—particularly Blue Cross Blue Shield (BCBS). However, in March, Sen Enzi made changes to the bill to appease BCBS, significantly improving its chances of passing the Senate.

The ACA’s team believes the best strategy is to prevent the bill from ever being introduced on the Senate floor for a vote. To do that, chiropractors across the country have been asked to contact their senators in Congress and express their deep dissatisfaction with the bill—emphasizing its detrimental effects to state rights and consumer protections. The number of complaints received must be to the level where senators would prefer never having to vote on the issue at all rather than pick sides—and possibly lose the support of constituents.

Coalition Also Opposes Bill
The ACA is an active participant in a diverse coalition opposed to the association health plan concept. As part of this coalition—which includes the American Cancer Society, the American Diabetes Association, the American Optometric Association, and the American Psychiatric Association—approximately 100 organizations are working to defeat S 1955. As a coalition leader, the ACA is implementing an extensive media-relations campaign, preparing op-ed pieces and letters to the editor that can be sent to national publications and by our members to newspapers and radio and television stations within their communities.

How DCs Can Help
As you read this column, the issue could already be settled. Senate Majority Leader Bill Frist (R-Tenn) dubbed the first week of May “Health Week” and plans to address health-related legislation, including S 1955, during that time.

Depending on when you receive your copy of Chiropractic Products, there still might be time for DCs and their patients to stop this legislation from passing. Take the following action:

• Contact the offices of the two US senators that represent your state and voice your strong opposition to the enactment of S 1955. Urge them to oppose S 1955 to the point of filibuster, if necessary, to defeat the bill. Senators can be reached by calling (202) 224-3121 or via www.senate.gov. It is suggested that you not only place telephone calls to the offices of your senators, but that you fax them as well. Surface mail sent to Washington, DC, may be delayed due to security screening. As a result, phone calls, e-mails, and faxes work best.

• If the bill were to make it to the Senate floor for debate, urge your Democratic senators to filibuster the bill. Republicans and Democrats should be urged to vote against S 1955.

• Enlist your patients in a grassroots battle to defeat S 1955. Successful mobilization of your patients against this bill is the single most important step you could take to defeat this legislation. Let them make phone calls to the Senate from your office and provide whatever level of assistance you can.

• The ACA has put together an S 1955 Survival Kit to aid doctors and patients in their advocacy efforts. To access the kit, go to www.acatoday.org/s1955.

• Cooperate and work with your state chiropractic association. Some associations may be organizing visits to local Senate offices in your area or in other parts of the state. These visits may involve doctors and/or patients, so contact your state association to see if your help is needed with special events organized to oppose S 1955.

For more information on how you can join the fight to defeat S 1955, visit the ACA’s Web site at www.acatoday.org/s1955. You can also contact the ACA Government Relations Department at (703) 276-8800 or via e-mail at stop1955@acatoday.org. CP

John Falardeau serves as the ACA’s vice president of government relations. He served previously as the director of federal and state government affairs for the Rubber Manufacturers Association. In addition, he spent 10 years as a senior assistant to two members of the US House of Representatives. He can be reached at jfalardeau@acatoday.org.