by Sara Parsons
Sara Parsons
Actions speak louder than words. In order to keep up with the politics of chiropractic, the specific legislation that is being presented to the house and senate, and what side of the fence the American Chiropractic Association (ACA) and the International Chiropractors Association (ICA) stand on, the specific bill is listed below with a summary and ACA/ICA viewpoints.
H.R. 3654. The Chiropractic Medicare Coverage Modernization Act of 2019 was introduced to the House on July 9th, 2019. Currently Medicare only covers spinal manipulation to remove subluxation, and does not pay for any other physician services that are within a chiropractor’s scope under their state license [1]. Examples of other physician services are ordering x-rays, clinical labs, and other diagnostic procedures. The Medicare program started allowing coverage for chiropractic care in 1972 by accepting and paying for one service; “the manual manipulation of the spine to correct a subluxation” [1].
The ACA is in support of this bill passing through the house. They believe that as portal-of-entry doctors, chiropractors should be reimbursed for physician services they can legally perform under their state license including the examination, diagnosis, treatment and, when necessary, the referral of patients to the appropriate providers. Because of the current law, patients that have Medicare coverage and need physician services other than a manual manipulation will have to go to another provider to get a diagnosis likely to then be referred out again for necessary lab or diagnostic procedures. The ACA also argues that this system funnels patients into the medical paradigm where providers rely on more invasive standards of care like prescribing drugs, spinal injections and surgery. They state that research shows chiropractic care is less invasive, more economical, and more effective in reducing pain syndromes than the above allopathic interventions. Therefore, the ACA claims passing this bill has the potential of removing barriers to care for the patient, reducing costs to the Medicare system, and acts in the best interest of the Medicare patients [2].
While the ICA wants to expand Medicare coverage to include payment for examinations and x-rays and believe this specific bill will remove select barriers to care, namely that patients will visit their chiropractor more if it is covered by their insurance, the ICA is not endorsing this bill because it does not include changes to the “opt-out” policy. The “opt-out” policy of Medicare allows patients to choose to privately contract with a certain group of health care professionals who are allowed to opt-out of Medicare coverage, and chiropractic is not one of them. Without the ability to opt-out, chiropractors must work under the Medicare umbrella, and will only get reimbursed for what Medicare decides is covered. The ICA states that they won’t back a bill unless it addresses this issue, and issue they view as discriminatory against our profession [3].
H.R. 2883. The ICA is in support of H.R. 2883 introduced to the house May 21, 2019, which aims to amend the same section XVIII of the social security act as H.R. 3654 to include chiropractors in the definition of authorized physicians. This would allow chiropractors to make private contracts with Medicare beneficiaries and opt-out of working with Medicare [3].
The ACA supports H.R. 3654 [2].
H.R.344. The Chiropractic Health Parity for Military Beneficiaries Act. Under the Department of Defense health care system, active duty military members are eligible for chiropractic care through the Chiropractic Health Care Program. Once active members retire or are discharged, their TriCare insurance does not cover chiropractic care. This bill presented to the House on January 8, 2019 would direct the Department of Defense to include chiropractic care under TriCare covered benefits for retired military personnel, national guard and the reserves [1].
The ACA is in support of this bill and points out that musculoskeletal complaints are common among retired military service members, especially when they are at the point of retiring. Soldiers that have been receiving chiropractic care throughout their career are suddenly faced with having to pay for care out of pocket or go without. TriCare does cover prescription drugs, so many retired service members turn to drugs to handle their pain. The ACA claims this bill will help add a drug free option for those who wish to take a less invasive route to avoid opioid pain management [2].
The ICA is also in support of this bill because they say it will make chiropractic care a permanent benefit under TriCare health insurance, will mandate that only chiropractors can perform the chiropractic adjustment, and it will allow direct access to chiropractic care to TriCare beneficiaries [3].
There has been a bill presented to the Senate (S.30) as well [3]. In order for bills to become law, they must first pass through the house and the senate then be signed off by the president. The ACA and the ICA are the two main actors at play on Capitol Hill and work diligently to push through policy changes that will shape chiropractic in the way they see is the best way forward for our profession. To dig into more policies and keep tabs on the future of chiropractic, join an association! You can also find the specific bills and exact language on congress.gov.
[1] Chiropractic Medicare Coverage Modernization Act, H.R. 3654, 116th Congress [Internet]. 2019-2020 [cited 23 Dec 2020]. Available from https://www.congress.gov/116/bills/hr3654/BILLS-116hr3654ih.pdf.
[2] American Chiropractic Association. Advocacy [Internet]. 2020 [cited 23 Dec 2020]. Available from https://cqrcengage.com/aca/action?4.
[3] International Chiropractors Association. Medicare [Internet]. Last updated 12 Sep 2019 [cited 24 Dec 2020]. Available from https://www.chiropractic.org/medicare/.